JMIR Publications

ABSTRACT

Background:

Electronic health records (EHRs) have been implemented in many low resource settings but lack strong evidence for usability, use, user confidence, scalability and sustainability

Objective:

To evaluate staff use and perceptions of an EHR widely used for HIV care in more than 300 health facilities in Rwanda, providing evidence on factors influencing current performance, scalability, and sustainability.

Methods:

Methods:

A randomized, cross-sectional, structured interview survey of health center staff was designed to assess functionality, usage and attitudes towards the EHR and clinical alerts. The study used the associated randomized clinical trial study sample (56/112 sites received an enhanced EHR) pulling 27 sites from each group. Free text comments were analyzed thematically with inductive coding.

Results:

Ninety staff (90% response rate) were interviewed at 54 health centers: 49% were clinical, 51% technical. The EHR top uses were to access client data easily and/or quickly (68%); update patient records (67%); create new patient records (55%); generate various reports (49%); and review previous records (48%). Greater than 90% agreed the EHR made it easier to make informed decisions, was worth using, and has improved patient information quality. For availability, 75% said they could always or almost always count on the EHR being available, whereas 7% said never/almost never. In intervention sites, staff were significantly more likely to update existing records (P=0.043), generate summaries before (P<0.001), or during visits (P=0.014), and to agree “the EHR provides useful alerts, and reminders” (P< 0.014).

Conclusions:

Most users perceived the EHR as well accepted, appropriate and effective for use in low resource settings despite infrastructure limitation in 25% of sites. Implementation of EHR enhancements can improve perceived usefulness and use of key functions. Successful scale up and use of EHRs in small health facilities could improve clinical documentation, care, reporting, and disease surveillance in low- and middle-income countries.