An offline-first electronic health record for vulnerable populations: A mixed-methods feasibility study

Area of Science:

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

Background:

• Electronic Health Records (EHRs) offer benefits in resource-limited settings but often require internet access and are difficult to deploy.
• Existing EHR systems present challenges in customization and continuous connectivity for physicians in low-resource environments.

Purpose of the Study:

• To evaluate the feasibility of the Hikma Health (HH) offline-first Electronic Health Record (EHR) system.
• To assess the HH EHR's impact on clinical workflows and patient care in two low-resource clinics serving displaced and rural populations in Lebanon and Nicaragua.

Main Methods:

• A mixed-methods study combining quantitative data collection (REDCap, descriptive statistics) and qualitative in-depth interviews.
• Framework analysis was used for interview coding, achieving an inter-rater reliability kappa score of 7.6.
• Feasibility was assessed through user training, system usage duration, and patient interview time metrics.

Main Results:

• Participants demonstrated comfort with the HH EHR after approximately three hours of training and three weeks of use.
• The HH EHR reduced patient interview times by an average of three minutes, attributed to its simple, modular workflows.
• Challenges were noted in syncing functionality when frequent network connectivity was required, impacting multi-clinician workflows.

Conclusions:

• The HH EHR is a feasible and effective solution for offline-first healthcare settings.
• Implementation of the HH EHR enhanced medical documentation, reduced errors, and improved patient outcomes by facilitating medication and disease tracking.
• The system's ease of use and offline capabilities address critical needs in resource-limited clinical environments.