Evaluating a scalable model for implementing electronic health records in resource-limited settings

Area of Science:

• Health Informatics
• Global Health
• Health Systems Research

Background:

• Traditional electronic health record (EHR) implementation models face scalability issues in resource-limited settings due to human-resource and cost constraints.
• Existing EHR solutions often fail to address the unique challenges of low-resource environments, hindering widespread adoption.

Purpose of the Study:

• To describe and evaluate a novel EHR implementation model tailored for resource-limited settings.
• To assess the impact of an open-source EHR implementation on provider time allocation and patient care efficiency in Ugandan HIV clinics.

Main Methods:

• A shared responsibility model was developed, involving local sites and a three-pronged external support structure: a national technical expertise center, an implementer's community, and a developer's community.
• An open-source EHR was implemented in three Ugandan HIV clinics using this model.
• A pre-post time-motion study was conducted at one clinic to measure changes in provider time allocation and patient interaction times.

Main Results:

• Primary Care Providers spent 33% less time on direct and indirect patient care (p<0.001) and 40% more time on personal activities (p=0.09) post-EHR implementation.
• Time spent by patients with non-clinician staff decreased by 50% (p=0.004), and time with pharmacy staff reduced by 63% (p<0.001).
• Surveyed providers reported high satisfaction with the EHR system and its support infrastructure.

Conclusions:

• The described shared responsibility model offers a scalable and viable approach for implementing EHRs in resource-limited settings.
• This model effectively addresses human-resource and cost constraints, leading to improved efficiency and provider satisfaction.
• The successful implementation in Ugandan HIV clinics demonstrates the potential for broad application in similar global health contexts.