Accepted for/Published in: JMIR Medical Informatics
Date Submitted: Jul 22, 2021
Date Accepted: Jan 31, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
User Perceptions and Use of an Enhanced EHR with and without Clinical Alerts, in 54 Health Centers In Rwanda: Cross sectional survey
ABSTRACT
Background:
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.
Objective:
To evaluate staff use and perceptions of an EHR widely used for HIV care in more than 300 health facilities in Rwanda.
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) as the sample frame pulling 27 sites from each group.
Results:
Ninety staff (90% response rate) were interviewed at 54 health centers, 49% were clinical, 51% technical. The top uses of the EHR were– to get client data easily and/or quickly (68%), updating patient records (67%), creating new patient records (55%), generating various reports (49%), and reviewing previous records (48%). Greater than 90% agreed that the EHR made it easier make informed decisions, was worth using, and has improved patient information. 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 centers has the potential to improve clinical documentation, care, reporting, and disease surveillance in low and middle income countries.
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