JMIR Publications

ABSTRACT

Background:

Between 2020 to 2022, the Philippine Primary Care Studies program piloted the implementation of two electronic health records (EHR) systems across three primary care facilities.

Objective:

This study aimed to assess changes in the acceptability of these EHR systems from the perspective of healthcare workers (HCWs) in remote, rural, and urban settings over a three-year period.

Methods:

This implementation study used an explanatory mixed methods approach to evaluate EHR acceptability among HCWs. Surveys were administered to all HCWs using a previously validated instrument based on the Unified Theory of Acceptance and Use of Technology. Acceptability was measured in terms of behavioral intention to use the system. Quantitative data were analyzed with descriptive statistics, while qualitative data underwent content analysis. The integration of both datasets facilitated an explanation of the observed trends.

Results:

A total of 351 survey responses were collected from 2020 to 2022. Initial findings in 2020 indicated a generally positive intention to use the web-based EHR across all three sites. By the second year, some HCWs in the urban site expressed reluctance to continue using the EHR. By 2022, there was a notable decline in acceptability in both the urban and rural sites where a client-server EHR had been implemented to circumvent internet connectivity issues precluding use of the previous system. Doctors and HCWs with less experience in using EHR demonstrated particularly low intention to use the client-server system. Qualitative findings revealed that while the new EHR system enabled use regardless of internet access, users preferred a cross-platform EHR to allow more flexible access to patient data. They also emphasized the need for onboarding and technical support for the new technology. Positive feedback was received regarding core functionalities such as record input, patient information access, and data integration. However, issues were reported concerning the unresponsive interface, attributed to factors such as slow laptop performance, poor internet connectivity, system bugs, and interface complexity of the client-server EHR.

Conclusions:

The disparities in EHR acceptability across urban, rural, and remote sites were influenced by respondent demographics and the type of EHR system used. The acceptability of the EHR system significantly declined in urban and rural sites by 2022, following the transition from a web-based to a client-server EHR. In contrast, the remote site maintained a high intention to use the web-based EHR throughout the study period. Specific user types exhibited lower acceptability, highlighting the need for targeted interventions to improve user experience and subsequent adoption.