Time Utilization Among Immunization Clinics Using an Electronic Immunization Registry (Part 2): Time and Motion Study...

Area of Science:

• Digital Health
• Public Health
• Health Informatics

Background:

• Digital health interventions can enhance healthcare delivery through digitized data management.
• Electronic immunization registries (EIRs) are being adopted in low- and middle-income countries to improve childhood vaccination tracking.
• Improving vaccination coverage in Africa, where many children remain underimmunized, is critical, necessitating effective digital health tools.

Purpose of the Study:

• To assess the impact of workflow modifications on time efficiency in Kenyan immunization clinics using an electronic immunization registry (EIR).
• To compare time utilization in routine data entry activities between existing dual-data entry and proposed paperless workflows.
• To analyze efficiency changes based on health facility size and healthcare worker (HCW) experience.

Main Methods:

• An interventional pretest-posttest study evaluated three workflow modifications at the point of care for HCWs using an EIR.
• Time taken for individual activities and total patient clinic time were measured and compared between baseline and modified workflows.
• Bivariate analyses and multivariate linear mixed-effects models were used to estimate differences in time utilization.

Main Results:

• Modified workflows using an EIR decreased service delivery time per child from a baseline of 10 minutes.
• The preparation modification reduced time by approximately 3 minutes, while paperless and combined modifications saved nearly 5 minutes per child.
• EIR performance and internet connectivity issues were identified as potential factors influencing delays.

Conclusions:

• Modified workflows, particularly a paperless system, significantly reduce time utilization in immunization clinics employing EIRs.
• Challenges with EIR performance and internet connectivity can hinder the full realization of time savings.
• Digital health interventions require adaptation to specific use cases, and user workflows must evolve with new technologies for successful implementation.