JMIR Publications

ABSTRACT

Background:

Digital health interventions have been shown to improve data quality and health services in low- and middle-income (LMIC) countries. Yet in LMIC, systematic assessments of time saved with use of digital tools are rare. We ran a set of cluster-randomized controlled trials as part of the implementation of a digital maternal and child health registry (eRegistry) in the West Bank, Palestine.

Objective:

In the eRegTime study, we compare time spent on health information management in clinics that use the eRegistry versus the existing paper-based documentation system.

Methods:

Intervention (eRegistry) and control (paper documentation) arms were defined by a stratified random sub-sample of primary healthcare clinics from the concurrent eRegQual trial. We used time-motion methodology to collect data on antenatal care service provision. Four observers used handheld tablets to record time-use data during one working day per clinic. We estimated relative time spent on health information management for booking and follow-up visits, and client care using mixed-effects linear regression.

Results:

Twenty-two of the 24 included clinics (12 intervention, 10 control) contributed data; no antenatal care visits occurred in the other two clinics during the study period. 123 and 118 consultations of new pregnancy registrations and follow-up antenatal care visits were observed in the intervention and control groups respectively. Average time spent on health information management for follow-up antenatal care visits in eRegistry clinics was 8.10 minutes versus 5.72 minutes in control clinics (adjusted relative time 0.69; 95% CI 0.60 to 0.79; p<0.001), and for booking visits 15.26 minutes versus 18.91 minutes (adjusted relative time 0.96, 95% CI 0.61 to 1.5; p=0.851). Average time spent on documentation, a sub-category of health information management, was 5.50 minutes in eRegistry clinics versus 8.48 minutes in control clinics (adjusted relative time 0.68; 95% CI 0.56 to 0.83; p<0.001). Our data are consistent with eRegistry clinics using less, the same, or more time on client care compared to clinics that use paper (5.01 versus 4.91 minutes; adjusted relative time 0.85; 95% CI 0.64 to 1.13; p=0.270).

Conclusions:

The eRegistry captures digital data at point-of-care during client consultations and generates automated routine reports based on the clinical data entered. Meaningfully less time (plausibly a saving of at least 18%) was spent on health information management in eRegistry clinics compared to those that use paper-based documentation. This is likely explained by the fact that the eRegistry requires less repetitive documentation work compared to paper-based systems. Adoption of eRegistry-like systems in comparable settings may save valuable and scarce healthcare resources. Clinical Trial: ISRCTN registry, ISRCTN18008445. https://doi.org/10.1186/ISRCTN18008445