Assessing the implementation of a mobile App-based electronic health record: A mixed-method study from South India

Area of Science:

• Digital Health
• Health Informatics
• Primary Healthcare

Background:

• The Indian government promotes information, communication, and technology (ICT) for comprehensive primary healthcare.
• Karuna Trust introduced the Comprehensive Public Health Management (CPHM) application, an electronic health record (EHR) system, in 2014-2015.
• The CPHM App was piloted in a primary health center (PHC) in Karnataka, focusing on household surveys and maternal and child health (MCH) services.

Purpose of the Study:

• To compare the consistency of MCH process indicators between paper-based records and the CPHM App (2016-2017).
• To explore implementation enablers, barriers, and user-suggested solutions for the CPHM App.

Main Methods:

• A sequential mixed-method study design was employed.
• Quantitative analysis compared MCH indicators from paper records and the CPHM App.
• Thematic analysis of in-depth interviews with healthcare providers explored implementation factors.

Main Results:

• Three of 12 MCH indicators showed >80% consistency between systems; consistency decreased over two years.
• Paper records were prioritized due to dual entry burden and monitoring requirements.
• CPHM App facilitated aggregate indicator generation, field data retrieval, and activity reminders.
• Barriers included limited technical expertise, lack of field internet connectivity, and travel for data syncing.
• Suggested solutions involved real-time technical support and improved field data connectivity.

Conclusions:

• A transition period of 1-2 years of simultaneous EHR and paper record use is recommended before full EHR adoption.
• Addressing technical and connectivity barriers is crucial for successful EHR implementation in primary healthcare.