The Effect of Feedback Electronic Medical Records Systems on the Quality of Tuberculosis Treatment Data in Uganda.
Ssenoga, Micheal Fredrick
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Background: Tuberculosis (TB) is a big problem in Uganda today making Uganda one of the world’s top 30 TB/HIV High-Burden Countries (HBCs) and hence accounts for 65,000 of the 7,000,000 total new TB Cases among the High-Burden Countries accounting for approximately 81% of the Total New TB Cases arising each year globally. However, several electronic medical record (EMR) systems have been tested globally in the bid to strengthen and improve the overall performance of the health systems as well as the quality of health care. High quality data is needed to track patients throughout care. EMR systems are one of the methods to improve data quality. An effective use of health care resources in Uganda by both health providers and national managers requires timely access to accurate and quality patient data. A substantial number of cases of tuberculosis are not detected by the current health care systems and surveys of the prevalence of tuberculosis support this belief. In Uganda, there is underreporting of cases and we are not making progress in reducing TB cases. The notification of new cases and all forms of TB including relapses has fluctuated between 50% and 60% showing more or less a stagnation in notification of new cases hence slowing down our progress towards achieving the WHO End TB Strategy targets to reduce TB deaths by 95% and to cut new cases by 90% between 2015 and 2035. We tested the effect of EMR systems to improve data quality for TB. Objective: To assess the effect of feedback EMR systems on the quality of TB treatment data in Uganda. Methodology: Data from the National TTB and Leprosy Program (NTLP) Unit TB registers were abstracted from ten level IV health facilities using a Paper-based HMIS for the period 2009 to 2011 and using an EMR from 2012 to 2014. A before and after cross-sectional retrospective study was conducted and statistical analyses and comparisons made to assess the completeness, accuracy, sequence and timeliness of reporting in TB patient registers; before and after the implementation of the EMR. Results: Generally, the results show that there was a marked improvement in the quality of the TB treatment data managed using the EMR compared to the TB treatment data managed using the Paper-based HMIS for the four data quality parameters; completeness, accuracy, timeliness and sequence assessed with the improvement in data completeness the most significant; χ2 (1, N = 2,608) P <0.001. Conclusions and recommendations: The EMR resulted into a great improvement in the quality of TB treatment data in Uganda though there is need to address a few hindering factors by the MoH if the use of EMR is to be sustainable.