Accepted for/Published in: JMIR Formative Research
Date Submitted: Nov 29, 2023
Date Accepted: May 3, 2024
Warning: This is an author submission that is not peer-reviewed or edited.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.
Health Information System Strengthening in Haiti: Quality Improvement
ABSTRACT
Background:
Journey to 9 Plus (J9) is an integrated Reproductive, Maternal, Neonatal, Child Health (RMNCH) approach to care in rural Haiti. To show the impact of this program it is necessary that data collection be of the highest quality. In the J9 program monthly reports, it was found that chart loss was contributing to incomplete and inconsistent reports. Initial evaluation of the quality of EMR data entry showed only 15% of J9 prenatal visits were being documented electronically at the start of this quality improvement project.
Objective:
This study aimed to improve the electronic documentation of outpatient prenatal care provided from 18% to 85% into the UHM EMR by J9 staff, from January to September of 2021.
Methods:
A continuous quality improvement (CQI) strategy was undertaken as the best approach to improve the EMR data collection at University Hospital Mirebalais (UHM). The team used several QI tools to conduct this project including: (1) a root cause analysis using Ishikawa and Pareto diagrams; (2) baseline evaluation measurements; and (3) Plan-Do-Study-Act (PDSA) improvement cycles to document incremental changes and the results of each change.
Results:
Documentation of prenatal point of care visits in the EMR was complete for 15% of patient contacts at the start of this QI project, in November 2020. This increased to an average of 89% of J9 prenatal visits entered every month by the conclusion of the project in September 2021.
Conclusions:
The experiences that this quality improvement project team encountered can contribute to the transition from paper to electronic documentation within burgeoning health care systems. Essential to success was having strong and dedicated nursing leadership to transition from paper to electronic data and motivated nursing staff to carry out data collection to improve the quality of data and thus the reports on patient outcomes. Engaging the nursing team closely in the design and implementation of the EMR and quality improvement processes ensures long-term success while centering nurses as key change agents in patient care systems.
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