JMIR Publications

ABSTRACT

Background:

Paper-based routine health information systems often require repetitive data entry. In the West Bank, the primary healthcare system for maternal and child health was entirely paper-based with care providers spending considerable amounts of time maintaining multiple files and client registers. As part of the phased national implementation of an electronic health information system, some of the primary healthcare clinics are now using the eRegistry for maternal and newborn care.

Objective:

The aim of the eRegTime study is to investigate whether the use of the eRegistry leads to changes in time-efficiency in health information management by the care providers, compared to the paper-based systems.

Methods:

This is a sub-study in a cluster randomized controlled trial (the eRegQual study) and uses the time-motion observational study design. The primary outcome is the time spent on health information management for antenatal care, informed and defined by workflow mapping in the clinics. We performed sample size estimations to enable the detection of a 25% change in the time-efficiency with a 90% power using an intracluster correlation coefficient of 0.1, and an alpha of 0.05. We will observe care providers for full workdays in 24 randomly selected primary healthcare clinics – 12 using the eRegistry and 12 still using paper. Linear mixed effects models will be used to compare the time spent on health information management per client per care provider.

Results:

The results of this study will contribute to a process evaluation, supplementing the findings of the eRegQual study.

Conclusions:

Electronic health information systems are expected to reduce workload for the care providers, and thus improve efficiency of clinical work. To achieve these benefits, the implementation of such systems requires both integration with existing workflows, and the creation of new workflows. Studies assessing the time-efficiency of electronic health information systems can inform policy decisions for implementations in resource-limited settings. Clinical Trial: ISRCTN, trial registration number: ISRCTN18008445 retrospectively registered. Registered on 6 April 2017, updated on 17 April 2018.