Assessment of efforts towards implementing a sustainable electronic medical record system at public health facilities in Wakiso and Kabarole districts

Abstract

Introduction: Multiple donors such as Centers for Disease Control and Prevention (CDC), United States Agency for International Development, and many others, have supported implementation of electronic medical records systems (EMRs) in Low-and Middle-Income Countries (LMICs). However, ownership, design, and complexity for the sustainability of the EMRs remains a key concern. We assessed the factors vital for sustainable implementation of EMRs in Wakiso and Kabarole districts, Uganda to achieve improved health service delivery. Methods: This was a cross-sectional study that adopted qualitative methods; Key Informant Interviews (KIIs), Observation and Document review for data collection. The study was conducted at 30 health facilities and District Health Offices (DHOs) in the two districts. Others were implementing partners at (METS and Mildmay), and some officials at Ministry of Health (MoH). The study participants included hospital In-charge (personnel in-charge of the health facilities), UgandaEMR implementers, DHOs, Biostatisticians, HMIS focal persons and Assistant commissioner health information division. The KIIs were audio recorded and inductive analysis approach was used to analyze the data collected while descriptive analysis was done for the document review and observations. Results: In total 64 participants responded to the KIIs. About 26(41%) were In-charges, UgandaEMR implementers 16(25%), 10(15.6%) were from the DHO’s office while the rest 12(18.8%) were users and participants from MoH. Factors necessary for implementation of sustainable EMRs were reported, and categorized into technical, organizational, context and project specific factors. Participants identified key guidelines required for rollout of EMRs. It was observed at every HF there was a computer with Windows 7 Operating system, 4GB of RAM, 1.5 GHz and review documents showed that over 90% of the facilities visited had a backlog of data that needed to be entered into the EMR. Conclusion: User requirement specifications are essential to guide implementation of sustainable EMRs. The factors for sustainable implementation of EMRs are broad but mainly financial factors that require support from donors and implementing partners to facilitate training of users and payment for key staff. The established guidelines cover the different factors that are essential to implementation of sustainable EMRs in Uganda.

Key Words: Sustainability; Electronic Medical Records; Implementing partners; UgandaEMR