JMIR Publications

JMIR Preprints


Currently submitted to: Journal of Medical Internet Research

Date Submitted: Aug 17, 2017
Open Peer Review Period: Aug 17, 2017 - Oct 12, 2017

NOTE: This is an unreviewed Preprint

Case Study: Implementing an Open Source Electronic Health Record (EHR) System in Secondary Care in Kenya

  • Naomi Muinga; 
  • Steve Magare; 
  • Jonathan Monda; 
  • Onesmus Kamau; 
  • Stuart Houston; 
  • Hamish Fraser; 
  • John Powell; 
  • Mike English; 
  • Chris Paton



The Kenyan government, working with international partners and local organisations, has developed an e-Health strategy, specified standards and guidelines for EHR adoption in public hospitals, and implemented two major health IT projects: DHIS2, for collating national healthcare indicators, and HMIS (using KenyaEHR and IQCare), for managing 600 HIV clinics across the country. Following these projects, a modified version of the OpenMRS EHR system was specified and developed to fulfil the clinical and administrative requirements of primary and secondary healthcare facilities operated by devolved counties and to automate the process of collating healthcare indicators and entering them into the DHIS2 system.


To present a case study of the implementation of an open source Electronic Health Record (EHR) system in secondary care facilities in Kenya.


We conducted a landscape review of existing literature concerning e-Health policies and EHR development in Kenya. Following initial discussions with the Ministry of Health, WHO and implementing partners, we conducted a series of visits to implementing sites to conduct semi-structured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation.


This case report describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital IT infrastructure, training users and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of socio-technical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya.


Implementing EHR systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. We hope this case study will provide some lessons and guidance for other challenging implementations of EHR systems as they continue across Africa.