Benefits and challenges of EMR implementations in low resource settings: a state-of-the-art review

Jawhari, Badeia; Ludwick, Dave; Keenan, Louanne; Zakus, David; Hayward, Robert

doi:10.1186/s12911-016-0354-8

Cited by 71 publications

(69 citation statements)

References 28 publications

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“…This study focused on three HIV clinics and primarily targeted infrastructural support. Findings of the evaluation contradicted several other reviews and studies that evaluated technical, financial, ethical, political, and leadership factors as critical for the success of EHR implementation …”

Section: Resultsmentioning

confidence: 99%

“…Globally, there is a consensus that EHRs can enable capture, analysis, and use of data for both population and patient‐centered health care delivery . However, there is limited evidence on what strategies ensure integration of national EHRs in the health care systems of LMICs to improve health outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…6 Globally, there is a consensus that EHRs can enable capture, analysis, and use of data for both population and patient-centered health care delivery. 7,8 However, there is limited evidence on what strategies ensure integration of national EHRs in the health care systems of LMICs to improve health outcomes. A quick screening of the abstracts of 226 EHR-related review papers (https://ehrlmic.unc.edu/), especially systematic reviews, from PubMed and Web of Science databases yielded only two relevant review papers from the LMIC perspective.…”

Section: Introductionmentioning

confidence: 99%

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Research evidence on strategies enabling integration of electronic health records in the health care systems of low‐ and middle‐income countries: A literature review

Kumar

Mostafa

2019

Health Planning & Management

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Summary Integration of electronic health records (EHRs) in the national health care systems of low‐ and middle‐income countries (LMICs) is vital for achieving the United Nations Sustainable Development Goal of ensuring healthy lives and promoting well‐being for all people of all ages. National EHR systems are increasing, but mostly in developed countries. Besides, there is limited research evidence on successful strategies for ensuring integration of national EHRs in the health care systems of LMICs. To fill this evidence gap, a comprehensive survey of literature was conducted using scientific electronic databases—PubMed, SCOPUS, Web of Science, and Global Health—and consultations with international experts. The review highlights the lack of evidence on strategies for integrating EHR systems, although there was ample evidence on implementation challenges and relevance of EHRs to vertical disease programs such as HIV. The findings describe the narrow focus of EHR implementation, the prominence of vertical disease programs in EHR adoption, testing of theoretical and conceptual models for EHR implementation and success, and strategies for EHR implementation. The review findings are further amplified through examples of EHR implementation in Sierra Leone, Malawi, and India. Unless evidence‐based strategies are identified and applied, integration of national EHRs in the health care systems of LMICs is difficult.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Research evidence on strategies enabling integration of electronic health records in the health care systems of low‐ and middle‐income countries: A literature review

Kumar

Mostafa

2019

Health Planning & Management

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“…Arguably the most critical challenge to to the success of existing EHR systems is the lack of involvement of local staff in the design and testing of systems to ensure they are designed according to local needs and workflows. Other significant challenges include purchase cost of the EHR software, the lack of local and inexpensive technical support to maintain EHR systems, frequent power and internet outages, lack of computer literacy and that most EHRs are not be sustainable without funding from international partnerships [8,11,12]. Overcoming these challenges will be crucial to ensuring the successful implementation and scaling of any EHRs in low-resource setting.…”

Section: Challenges Of Implementationmentioning

confidence: 99%

“…High initial costs associated with computer purchase and infrastructure setup is a critical barrier [8]. However, this can at least be partially mitigated by the potential cost-saving from reductions in record keeping costs [9] and significantly improved staff efficiency [10].…”

Section: Challenges Of Implementationmentioning

confidence: 99%

Development and Implementation of Stre@mline, a Locally Developed Electronic Health Platform in Uganda (Preprint)

Liang¹,

Wiens²,

Lubega³

et al. 2017

Preprint

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Introduction: Electronic healthcare records(EHR) are especially important in low-resource settings due to their potential to address unique challenges such as the high numbers of requiring long-term treatments who are lost to follow-up, the frequent shortages of essential drugs, poor maintenance and storage of records and inefficient clinical triaging. However, there is a lack of affordable solutions and many challenges in successfully implementing EHRs in low resource settings. Methods: Stre@mline is an EHR platform that has been locally developed by Ugandan clinicians and engineers in Southwestern Uganda. It is tailored to the specific context and the needs of low-resource hospitals. It operates without internet access, incorporates locally relevant standards and key patient safety features, has a medication inventory management component, has local technical support available, and is economically sustainable without funding from international donors. Results: Stre@mline is currently used by over 60 000 patients at 2 hospitals, with plans to expand across Uganda. User surveys from Kisiizi Hospital indicate that the vast majority of Stre@mline users find it is easy to use and helpful in increasing clinical efficiency as well as enhancing patient care. Discussions: The partnership of local clinicians and developers is crucial to the design and adoption of user-centered technologies tailored to the specific needs of low-resource settings. The EHR described here could serve as a model for the development of future appropriate technologies in developing countries.

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A framework for analysing learning health systems: Are we removing the most impactful barriers?

McLachlan

Dube

Johnson

et al. 2019

Learning Health Systems

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IntroductionLearning health systems (LHS) are one of the major computing advances in health care. However, no prior research has systematically analysed barriers and facilitators for LHS. This paper presents an investigation into the barriers, benefits, and facilitating factors for LHS in order to create a basis for their successful implementation and adoption.MethodsFirst, the ITPOSMO‐BBF framework was developed based on the established ITPOSMO (information, technology, processes, objectives, staffing, management, and other factors) framework, extending it for analysing barriers, benefits, and facilitators. Second, the new framework was applied to LHS.ResultsWe found that LHS shares similar barriers and facilitators with electronic health records (EHR); in particular, most facilitator effort in implementing EHR and LHS goes towards barriers categorised as human factors, even though they were seen to carry fewer benefits. Barriers whose resolution would bring significant benefits in safety, quality, and health outcomes remain.LHS envisage constant generation of new clinical knowledge and practice based on the central role of collections of EHR. Once LHS are constructed and operational, they trigger new data streams into the EHR. So LHS and EHR have a symbiotic relationship. The implementation and adoption of EHRs have proved and continues to prove challenging, and there are many lessons for LHS arising from these challenges.ConclusionsSuccessful adoption of LHS should take account of the framework proposed in this paper, especially with respect to its focus on removing barriers that have the most impact.

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Benefits and challenges of EMR implementations in low resource settings: a state-of-the-art review

Cited by 71 publications

References 28 publications

Research evidence on strategies enabling integration of electronic health records in the health care systems of low‐ and middle‐income countries: A literature review

Research evidence on strategies enabling integration of electronic health records in the health care systems of low‐ and middle‐income countries: A literature review

Development and Implementation of Stre@mline, a Locally Developed Electronic Health Platform in Uganda (Preprint)

A framework for analysing learning health systems: Are we removing the most impactful barriers?

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