Assessing the impact of a primary care electronic medical record system in three Kenyan rural health centers

Tierney, William M.; Sidle, John E.; Diero, Lameck; Sudoi, Allan; Kiplagat, Jepchirchir; Macharia, Stephen; Shen, Changyu; Yeung, Ada; Were, Martin Chieng; Slaven, James E.; Wools‐Kaloustian, Kara

doi:10.1093/jamia/ocv074

Cited by 27 publications

(31 citation statements)

References 14 publications

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“…A possible reason is the recent introduction of the EMR system at those centers, as most studies indicated that waiting time tends to improve with time. A mixed methodology study exploring patients' perception of EMR implementation indicated an 85% positive perception, which was mainly in the clinical care theme [22].…”

Section: Discussionmentioning

confidence: 99%

Patient satisfaction with the implementation of electronic medical Records in the Western Region, Saudi Arabia, 2018

et al. 2020

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Background: The implementation of the Electronic Medical Record (EMR) system initiated a significant transition in the healthcare system from traditional paper-based medical records to a digital version. Though EMR offers several benefits compared to Paper Medical Records (PMR), patient satisfaction with the EMR has been an area of concern. The objective of this study is to explore patient satisfaction with the EMR compared to the PMR of patients attending five Primary Healthcare Centers in the Western Region of Saudi Arabia. Methods: A cross-sectional survey was conducted with patients who attended five Primary Health Care centers (PHCs) in the Western Region during 2018. A sample of 377 participants was invited to complete a self-developed structured questionnaire with multiple choice and Likert Scale questions. The questionnaire was distributed to participants in the PHC waiting areas. Results: The sample size realized as (n = 377) participants, the majority (65.0%) were female. The overall patient satisfaction was 3.708. Patient satisfaction with the EMR was statistically significant compared to the PMR (3.7241 vs. 3.6919, p < 0.001). Several factors provided evidence of the overall satisfaction with the implementation of the EMR, including an increase in physician attention during the clinical consultation (82.3%), increased explanation of tests and medication (85.8%), increased time spent with the patient during the consultation (80.4%) and increased active listening by the physician (77.3%). Besides, the patients felt confident to ask the physician question related to health during clinical consultation (84.0%). Conclusion: Patient satisfaction during the clinical consultation and overall satisfaction with various PHC services improved with the implementation of EMR.

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Section: Discussionmentioning

confidence: 99%

Patient satisfaction with the implementation of electronic medical Records in the Western Region, Saudi Arabia, 2018

et al. 2020

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“…4 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. 5 Brown Center for Biomedical Informatics, Brown University, Providence, RI, USA.…”

Section: Acknowledgementsmentioning

confidence: 99%

“…Over the last two decades, digital health systems for hospitals and clinics have been rapidly adopted in high-income countries [1][2][3]. This move away from paper-based storage and retrieval of medical information to digital systems opens the opportunity for new ways of delivering care and a better understanding of the processes and outcomes of the health service [4][5][6]. Along the way, these countries have invested large sums and had multiple challenges and failures [3,[7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Digital health Systems in Kenyan Public Hospitals: a mixed-methods survey

Muinga

Magare

Monda

et al. 2020

BMC Med Inform Decis Mak

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Background: As healthcare facilities in Low-and Middle-Income Countries adopt digital health systems to improve hospital administration and patient care, it is important to understand the adoption process and assess the systems' capabilities. This survey aimed to provide decision-makers with information on the digital health systems landscape and to support the rapidly developing digital health community in Kenya and the region by sharing knowledge. Methods: We conducted a survey of County Health Records Information Officers (CHRIOs) to determine the extent to which digital health systems in public hospitals that serve as internship training centres in Kenya are adopted. We conducted site visits and interviewed hospital administrators and end users who were at the facility on the day of the visit. We also interviewed digital health system vendors to understand the adoption process from their perspective. Semi-structured interview guides adapted from the literature were used. We identified emergent themes using a thematic analysis from the data. Results: We obtained information from 39 CHRIOs, 58 hospital managers and system users, and 9 digital health system vendors through semi-structured interviews and completed questionnaires. From the survey, all facilities mentioned purchased a digital health system primarily for administrative purposes. Radiology and laboratory management systems were commonly standalone systems and there were varying levels of interoperability within facilities that had multiple systems. We only saw one in-patient clinical module in use. Users reported on issues such as system usability, inadequate training, infrastructure and system support. Vendors reported the availability of a wide range of modules, but implementation was constrained by funding, prioritisation of services, users' lack of confidence in new technologies and lack of appropriate data sharing policies. Conclusion: Public hospitals in Kenya are increasingly purchasing systems to support administrative functions and this study highlights challenges faced by hospital users and vendors. Significant work is required to ensure interoperability of systems within hospitals and with other government services. Additional studies on clinical usability and the workflow fit of digital health systems are required to ensure efficient system implementation. However, this requires support from key stakeholders including the government, international donors and regional health informatics organisations.

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“…National-level implementations of EHRs in many LMICs primarily aim to support HIV care and treatment, with funding for these systems coming from programs such as the US President's Emergency Plan for AIDS Relief (PEPFAR) (5,6). Several countries, such as Rwanda, Uganda, Mozambique, and Kenya, have gone beyond isolated and pilot implementations of EHRs to large-scale national rollout of systems within government-run public facilities (7). With such large-scale EHRs implementations, these countries are nding themselves in the unenviable position of being unable to easily track the status of each implementation, especially given that most of the EHRs implementations are standalone and are distributed over large geographical areas.…”

Section: Introductionmentioning

confidence: 99%

Development of Standard Indicators to Assess Use of Electronic Health Record Systems Implemented in Low- and Medium-Income Countries

Ngugi

Babić²,

Kariuki³

et al. 2020

Preprint

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BackgroundElectronic Health Record Systems (EHRs) are being rolled out nationally in many low- and middle-income countries (LMICs) yet assessing actual system usage remains a challenge. We employed a nominal group technique (NGT) process to systematically develop high-quality indicators for evaluating actual usage of EHRs in LMICs.Methods An initial set of 14 candidate indicators were developed by the study team adapting the HIV Monitoring, Evaluation, and Reporting indicators format. A multidisciplinary team of 10 experts was convened in a two-day NGT workshop in Kenya to systematically evaluate, rate (using Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) criteria), prioritize, refine, and identify new indicators. NGT steps included introduction to candidate indicators, silent indicator ranking, round-robin indicator rating, and silent generation of new indicators. Results: Candidate indicators were rated highly on SMART criteria (4.05/5). NGT participants settled on 15 final indicators, categorized as system use (4); data quality (3), system interoperability (3), and reporting (5). Data entry statistics, systems uptime, and EHRs variable concordance indicators were rated highest. ConclusionThis study describes a systematic approach to develop and validate quality indicators for determining EHRs use and provides LMICs with a multidimensional tool for assessing success of EHRs implementations.

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Assessing the impact of a primary care electronic medical record system in three Kenyan rural health centers

Abstract: We successfully implemented a primary care EMR in three rural Kenyan health centers. Patient waiting time was dramatically lengthened while the nurses' and the clerks' patient care time decreased. Long-term use of EMRs in such settings will require changes in culture and workflow.

Cited by 27 publications

References 14 publications

Patient satisfaction with the implementation of electronic medical Records in the Western Region, Saudi Arabia, 2018

Patient satisfaction with the implementation of electronic medical Records in the Western Region, Saudi Arabia, 2018

Digital health Systems in Kenyan Public Hospitals: a mixed-methods survey

Development of Standard Indicators to Assess Use of Electronic Health Record Systems Implemented in Low- and Medium-Income Countries

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