JMIR Publications

ABSTRACT

Background:

Digital health tools such as electronic immunization registries (EIRs) have the potential to improve patient care and alleviate challenges that arise from the use of paper-based clinic records for reporting. To address some of these challenges, the Kenya Ministry of Health (MOH) and the International Training and Education Centre for Health in Kenya (I-TECH-Kenya) implemented an EIR system in all 161 of Siaya county’s immunizing clinics between 2018 – 2019. Successful implementation of digital health tools depends on many factors, one of which is alignment between the technology and the context in which it is used. One important aspect of that implementation context is the perceptions of the healthcare workers (HCWs) using the EIR

Objective:

This study evaluates HCW perceptions of usability and acceptability of multiple clinic workflows using the new EIR

Methods:

We performed a mixed-methods pre-post study using semi-structured interviews of HCWs at 6 facilities in Siaya county, Kenya. We interviewed HCWs at each facility 4 times: at baseline and once after implementation of three different workflow modifications (n=24 interviews). The baseline state was dual data-entry with paper records and the EIR. We then implemented the three workflow modifications for one full day each: fully paperless data entry, preparation of an appointment diary prior to patient visits for the day, and a combination of the two workflows. We compared ratings and themes across interviews after each of the four workflows in order to understand changes in usability and acceptability of the EIR

Results:

HCWs considered the EIR clinic workflows to be usable and acceptable. Of the modified workflows, HCWs perceived the fully paperless workflow the most favorably. In all workflows, HCWs perceived benefits included ease of clinical decision-making using the EIR, reduced mental burden of the data entry when using the EIR, and ease of identification of errors. Perceived barriers of the workflow included contextual challenges such as staffing shortages and lack of network connectivity, EIR platform challenges such as errors saving records and missing fields, and workflow challenges such as the dual-data-entry burden of using paper and digital tools simultaneously

Conclusions:

Fully paperless EIR implementation shows great promise from a workflow acceptability standpoint, contingent upon presence of supporting contextual clinic factors and resolution of system performance and design challenges. Rather than trying to identify a singular best workflow, future efforts should provide adequate flexibility for HCWs to implement the new system in their unique clinic context. Future EIR implementation stands to benefit from continued monitoring of EIR adoption acceptability during implementation both for Siaya’s program and for other efforts around the globe as digital health interventions become more widely used