Implementing Electronic Health Records in Primary Care Using the Theory of Change: Nigerian Case Study

Area of Science:

• Digital Health
• Health Informatics
• Health Services Research

Background:

• Electronic Health Record (EHR) systems offer potential solutions to paper-based documentation challenges in healthcare delivery.
• Successful EHR implementation is crucial in low- and middle-income countries (LMICs) to avoid resource waste and improve healthcare efficiencies.
• Evaluating EHR systems in LMICs is vital for stakeholders like policymakers, funders, and providers to understand their impact.

Purpose of the Study:

• To develop a Theory of Change (ToC) for implementing EHR systems specifically for maternal and child health care in LMICs.
• The ToC approach was utilized to define long-term goals and identify necessary inputs and mediating factors for complex health programs.

Main Methods:

• The ToC approach guided the entire EHR implementation lifecycle, including a pilot study at Festac Primary Health Centre in Lagos, Nigeria.
• Adapted success factors were used to evaluate implementation maturity alongside the ToC framework.

Main Results:

• The initial ToC focused on general primary care service delivery improvement, revised to specifically target improved maternal and child health care delivery via EHRs.
• A generic ToC map was proposed for LMIC implementers, considering sustainability, financial, and organizational factors.
• Key success factors included trained professionals, a shift towards digital health, and data integration; financial sustainability depended on funding partners; organizational commitment varied among staff.

Conclusions:

• The Theory of Change (ToC) approach proved valuable for stakeholder engagement, planning, evaluation, and reflection in EHR implementation.
• The developed ToC framework is adaptable for future health IT implementations in primary care settings within LMICs.