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Contextual Barriers to Implementing Open-Source Electronic Health Record Systems for Low- and Lower-Middle-Income

Sarah Bostan1,2,3, Owen A Johnson3, Lena J Jaspersen1

  • 1Leeds University Business School, University of Leeds, Leeds, United Kingdom.

Journal of Medical Internet Research
|August 1, 2024
PubMed
Summary

Open-source electronic health records (EHRs) offer potential for low-income countries, but implementation faces significant socioenvironmental and organizational barriers beyond technical issues. Addressing these challenges is crucial for improving healthcare delivery and data management.

Keywords:
barriersdigital healthelectronic health recordsglobal health careimplementationlow- and lower-middle-income countriesopen sourcereviewscoping

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Area of Science:

  • Global Health Informatics
  • Health Technology Implementation
  • Open-Source Software in Healthcare

Background:

  • Low- and lower-middle-income countries face a disproportionate burden of global epidemics and chronic diseases, coupled with limited healthcare access.
  • Open-source electronic health records (EHRs) present a cost-effective and adaptable solution to transform healthcare technology delivery and improve health data management.
  • Despite their potential, open-source EHR systems have not widely proliferated in these regions, with research often overemphasizing technical implementation barriers.

Purpose of the Study:

  • To conduct an interdisciplinary scoping review of contextual barriers to open-source EHR system adaptation and implementation in low- and lower-middle-income countries.
  • To identify critical areas for future research to facilitate the successful adoption of open-source EHRs in resource-limited settings.

Main Methods:

  • A systematic scoping literature review was conducted across 7 databases in medicine, computing, and social sciences.
  • Study quality was assessed using the Mixed Methods Appraisal Tool and Critical Appraisal Skills Programme checklists.
  • Findings were synthesized qualitatively using a narrative approach, adhering to the PRISMA-ScR guidelines.

Main Results:

  • Thirteen studies revealed key barriers including limited funding, sustainability concerns, organizational and management challenges, infrastructure deficits, and issues with data privacy, protection, and ownership.
  • Socioenvironmental, technological, and organizational perspectives highlighted that data protection, confidentiality, ownership, and ethical considerations are critical but often overshadowed by technical aspects.
  • Existing research predominantly focuses on technical challenges, neglecting crucial socioenvironmental and organizational factors influencing open-source EHR adoption.

Conclusions:

  • Successful implementation of open-source EHRs in low- and lower-middle-income countries is complex and requires a holistic understanding beyond technical issues.
  • Addressing socioenvironmental and organizational barriers is essential for the proliferation of open-source EHRs, necessitating a shift in research focus.
  • Further research is needed to clarify the role of local organizations and to gain a comprehensive understanding of implementers' experiences, particularly concerning ethical and data protection management.