Accepted for/Published in: JMIR Human Factors
Date Submitted: Oct 31, 2017
Open Peer Review Period: Oct 31, 2017 - Aug 20, 2018
Date Accepted: Nov 3, 2018
(closed for review but you can still tweet)
The Usability of Electronic Medical Record Systems Implemented in Sub-Saharan Africa: A Systematic Review of the Evidence
ABSTRACT
Background:
Electronic Medical Record systems hold the promise of accurate, real time access to patient healthcare data. This review evaluated the usability of EMR systems implemented in sub-Saharan Africa (SSA) based on a usability evaluation criteria developed by the Healthcare Information and Management Systems Society (HIMSS).
Objective:
To evaluate electronic medical record system implementations in sub-Saharan Africa against a well defined evaluation methodology and assess their usability based on a defined set of metrics. To identify the extent to which usability has been an enabling or hindering factor in the implementation of electronic medical record systems in sub-Saharan Africa. To identify approaches for incorporating usability in new EMR system implementations to facilitate successful system adoption and use.
Methods:
5 key metrics for evaluating EMR system usability were developed based on the methodology proposed by HIMSS. These include efficiency, effectiveness, ease of learning, cognitive load and user satisfaction. A five point rating system was developed for the review. EMR systems in 20 reviewed publications were scored based on this rating system. It awarded 5 points per metric to any EMR system that was identified as excellent, 4 points for good, 3 points for fair, 2 points for poor and 1 point for bad. Additionally the effectiveness of each system carried a maximum weighted score of 30, efficiency 25, ease of learning 20, user satisfaction 15 and cognitive load 10. The percentage scores for each metric were then computed from these weighted scores from which the final overall usability score was derived.
Results:
In contributing to the usability of implemented EMR systems, ease of learning obtained the highest percentage score of 67% of the publications reviewed followed closely by user satisfaction which obtained a percentage score of 66%. Effectiveness and efficiency obtained similar percentage scores of 65%. Cognitive load obtained the lowest percentage score of 59%. The overall usability score for all systems was calculated to be 64%.
Conclusions:
The usability of electronic medical record systems implemented in sub-Saharan Africa has been only fair with ease of learning and user satisfaction being the biggest positive contributors to this rating. Effectiveness and efficiency have been third joint contributors in positively influencing the usability of EMR implemented systems. Cognitive load has impeded EMR system usability in in sub-Saharan Africa and hasn’t been given adequate attention by EMR system designers.
Citation
Per the author's request the PDF is not available.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.