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Barriers to using eHealth data for clinical performance feedback in Malawi: A case study.

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Barriers to using electronic health records (EHR) data for healthcare provider feedback in Malawi include staff changes and system issues. Addressing these is key to improving care quality in low-resource settings.

Keywords:
Audit and feedbackClinical guideline implementationData qualityElectronic medical recordsLow-resource settingseHealth

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Area of Science:

  • Health Informatics
  • Health Services Research
  • Global Health

Background:

  • Sub-optimal healthcare provider performance is a major challenge in low-income countries.
  • Electronic health information technology (eHealth), such as electronic medical record (EMR) systems, offers opportunities to improve performance measurement and feedback.
  • An EMR system in Malawi collects data for clinic-level performance feedback, but understanding individual-level barriers is crucial.

Purpose of the Study:

  • To identify and describe barriers to using EMR data for individualized audit and feedback for healthcare providers in Malawi.
  • To inform the design of technology to overcome these identified barriers.

Main Methods:

  • A qualitative study was conducted in eight public hospitals in Malawi utilizing an EMR system.
  • Data collection involved 32 semi-structured interviews with healthcare providers and seven hours of system use observation.

Main Results:

  • Four key barriers were identified: provider rotations, disruptions to care processes, user acceptance of eHealth, and the lifespan of performance indicators.
  • These barriers varied across sites and impacted the quality of EMR data available for individual performance feedback.

Conclusions:

  • Routine eHealth data holds significant potential for improving clinical performance in resource-limited settings through individualized feedback.
  • Technology must be designed to adapt to the dynamic barriers encountered in complex adaptive systems (CAS) within clinical settings.
  • Mitigating these barriers through thoughtful technology design can enhance the effectiveness of eHealth for quality improvement.