Implementing Electronic Health Records in Philippine Primary Care Settings: Mixed-Methods Pilot Study

Area of Science:

• Health Informatics
• Public Health
• Health Services Research

Background:

• The Philippine government piloted two electronic health records (EHR) systems in primary care settings between 2020-2022.
• This initiative aimed to support universal health care implementation across urban, rural, and remote locations.

Purpose of the Study:

• To evaluate the implementation and user acceptance of two distinct EHR systems in diverse Philippine primary care settings.
• To identify factors influencing EHR adoption and identify best practices for future health information technology rollouts.

Main Methods:

• An explanatory mixed methods design was employed, deploying an Open Medical Records System (OpenMRS)-based EHR and a Microsoft-based EHR.
• Implementation involved training, user feedback, and cofinancing. Behavioral intention to use the system was the primary outcome, measured via yearly surveys.
• Quantitative survey data were analyzed alongside qualitative responses to understand trends in EHR acceptability.

Main Results:

• Initial high acceptance of the OpenMRS-based EHR declined by 2022 after the introduction of the Microsoft-based EHR, particularly among urban healthcare professionals.
• Remote sites retaining the OpenMRS-based system maintained high user acceptance.
• Users preferred cross-platform EHRs for flexible data access, despite the new system's privacy features. Task-shifting in rural sites showed less impact on EHR use.

Conclusions:

• Disparities in EHR acceptability were linked to contextual, technical, and demographic factors.
• Transitioning EHR systems requires implementation strategies tailored to the specific needs and capacities of diverse primary care settings.
• Findings provide practical insights for adapting EHR systems to enhance primary care delivery in varied environments.