A comparison of electronic records to paper records in Antiretroviral Therapy Clinic in Ethiopia: What is affecting the Quality of the Data?

Abstract

BackgroundAnti-Retroviral Therapy (ART) care is a lifelong treatment, which needs accurate and reliable data collected for long period of time. Poor quality of medical records data remains a challenge and is directly related to the quality of care of patients. To improve this, there is an increasing trend to implement electronic medical record (EMR) in hospitals. However, there is little evidence on the impact of EMR on the quality of health data in low- resource setting hospitals like Ethiopia. This comparative study aims to fill this evidence gap by assessing the completeness and reliability of paper-based and electronic medical records and explore the challenges of ensuring data quality at the Anti-Retroviral Therapy (ART) clinic at the University of Gondar Referral Hospital in Northwest Ethiopia.MethodsAn institution-based comparative cross-sectional study, supplemented with a qualitative approach was conducted from February 1 to March 30, 2017 at the ART clinic of the University of Gondar Hospital. A total of 250 medical records having both electronic and paper-based versions were collected and assessed. A national ART registration form which consists of 40 ART data elements was used as a checklist to assess completeness and reliability dimensions of data quality on medical records of patients on HIV care. Kappa statistics were computed to describe the level of data agreement between paper-based and electronic records across patient characteristics. In-depth interviews were conducted using semi-structured questionnaires with ten key informants to explore the challenges related with the quality of medical records. Responses of the key informant interviews were analyzed using thematic analysis.ResultsThe overall completeness of medical records was 78% with 95% CI (70.8% - 85.1%) in paper-based and 76% with 95%CI (67.8% - 83.2%) EMR. The data reliability measured in Kappa statistics shows strong agreements on the socio-demographic data such as educational status 0.93 (0.891, 0.963), WHO staging 0.86 (0.808, 0.906); general appearance 0.83 (0.755, 0.892) and patient referral record 0.87 (0.795, 0.932). The major challenges hindering good data quality was the current side by side dual data documentation practice (the need to document both on the paper and the EMR for a single record), patient overload and low data documentation practice of health workers.ConclusionThe overall completeness of ART medical records was still slightly better in paper-based records than EMR. The main reason affecting the EMR data quality was the current dual documentation practice both on the paper and electronic for each patient in the hospital and the high load of patients in the clinic. The hospital management need to decide to use either the paper or the electronic system and build the capacity of health workers to improve data quality in the hospital.

<p>The Applicability of the Modified Technology Acceptance Model (TAM) on the Sustainable Adoption of eHealth Systems in Resource-Limited Settings</p>

“…2,3 Health technology applications, like hospital information system (HIS), electronic health record (EHR), mobile health (M-health), decision support system (DSS), electronic medical record system (EMR) and research/data collection systems (RCS) have a big value in different settings of the healthcare by reducing healthcare costs, advancing access for up-to-date information, enable quick access for patient records and improve communication between patient and healthcare providers. [4][5][6][7] Over the past decade, the practical implementation and integration of eHealth systems have been scaled drastically. Many developed nations are utilizing eHealth technologies and make a real difference in improving patient care, and the provision of efficient and effective healthcare services.…”

“…[17][18][19] All the previously deployed systems and the systems that are in progress have been implemented using a trial-and-error approach which is very expensive and unsuccessful. [5][6][7]20 Due to this, the implementation and diffusion of eHealth technology in Ethiopia is still in the embryonic stage. [21][22][23][24] Developing nations like Ethiopia, with limited resources to implement eHealth technology, needs an empirically validated model that supports to identify the main elements of the system implementation and user's behavioral intention to use eHealth technologies that can be used by executives for prior preparation.…”

A qualitative inquiry into implementing an electronic health record system (SmartCare) for prevention of mother-to-child transmission data in Zambia: a retrospective study

“…In Ethiopia, the quality of data was reported to be affected by dual documentation where both paper-based and electronic systems were used 22. In this study, completeness of paper-based records was slightly better than electronic records.…”

The potential of digital health technologies in African context, Ethiopia

“…A study that compared EHR with paper-based records for ART data reported a higher incomplete data with the use of EHR for various reasons including difficulties implementing EHR in high patient load conditions and the frequent need for capturing dual electronic and paper-based data for individual patients. 77…”