Evaluating a scalable model for implementing electronic health records in resource-limited settings
Open accessAbstract
Current models for implementing electronic health records (EHRs) in resource-limited settings may not be scalable because they fail to address human-resource and cost constraints. This paper describes an implementation model which relies on shared responsibility between local sites and an external three-pronged support infrastructure consisting of: (1) a national technical expertise center, (2) an implementer's community, and (3) a developer's community. This model was used to implement an open-source EHR in three Ugandan HIV-clinics. Pre-post time-motion study at one site revealed that Primary Care Providers spent a third less time in direct and indirect care of patients (p<0.001) and 40% more time on personal activities (p=0.09) after EHRs implementation. Time spent by previously enrolled patients with non-clinician staff fell by half (p=0.004) and with pharmacy by 63% (p<0.001). Surveyed providers were highly satisfied with the EHRs and its support infrastructure. This model offers a viable approach for broadly implementing EHRs in resource-limited settings.
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The most widely employed modality of EHR system implementation in LMICs involves standalone EHR system implementations at individual facilities.
“The most widely employed modality of EHR system implementation in LMICs involves standalone EHR system implementations at individual facilities [13].”
From mUzima Mobile Electronic Health Record (EHR) System: Development and Implementation at Scale (2021) · cites this paper as [13]
Cites
Overhage, J. M., Perkins, S., Tierney, W. M., & McDonald, C. J. (2001) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.2001.0080361 · Cited by 232 · see citing works
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Quantitative measures of health policy implementation determinants and outcomes: a systematic review
Allen, P., Pilar, M., Walsh-Bailey, C., Hooley, C., Mazzucca, S., Lewis, C. C., Mettert, K. D., Dorsey, C. N., Purtle, J., Kepper, M. M., et al. (2020) · Implementation Science · doi:10.1186/s13012-020-01007-w · Cited by 164 · see citing works
Kiberu, V. M., Mars, M., & Scott, R. E. (2017) · African Journal of Primary Health Care & Family Medicine · doi:10.4102/phcfm.v9i1.1277 · Cited by 147 · see citing works
Benefits and challenges of EMR implementations in low resource settings: a state-of-the-art review
Jawhari, B., Ludwick, D., Keenan, L., Zakus, D., & Hayward, R. (2016) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-016-0354-8 · Cited by 106 · see citing works
Bhavnani, S. P., Sola, S., Adams, D., Venkateshvaran, A., Dash, P. K., Sengupta, P. P., Bhavnani, S., Sola, S., Venkateshvaran, A., Adams, D., et al. (2018) · JACC: Cardiovascular Imaging · doi:10.1016/j.jcmg.2017.06.019 · Cited by 81 · see citing works
mUzima Mobile Electronic Health Record (EHR) System: Development and Implementation at Scale
Were, M. C., Savai, S., Mokaya, B., Mbugua, S., Ribeka, N., Cholli, P., & Yeung, A. (2021) · Journal of Medical Internet Research · doi:10.2196/26381 · Cited by 29 · see citing works
“The most widely employed modality of EHR system implementation in LMICs involves standalone EHR system implementations at individual facilities [13].”
MethodSelf-citationManyati, T. K., & Mutsau, M. (2021) · Health and Technology · doi:10.1007/s12553-020-00485-8 · Cited by 24 · see citing works
- Authors
- Were, M. C., Emenyonu, N., Achieng, M., Shen, C., Ssali, J., Masaba, J. P. M., & Tierney, W. M.
- Affiliations
- Regenstrief Institute (US)
- University of California, San Francisco (US)
- World Health Organization - Uganda (UG)
- Masaka Hospital (UG)
- Mbale Hospital (UG)
- Corresponding author
- Were, Martin C
- Venue
- Journal of the American Medical Informatics Association
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-05
- Volume
- 17
- Issue
- 3
- Pages
- 237-244
- ISSN
- 1067-5027 (ISSN-L)
- 1527-974X
- PMC
- PMC2995711
- OpenAlex
- W2130887771
- Cited by
- 64
- References
- 1
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 4 · 2021: 4 · 2020: 5 · 2019: 4 · 2018: 4 · 2017: 6 · 2016: 6 · 2015: 4 · 2014: 3 · 2013: 2 · 2012: 4
- FWCI
- 8.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Medical Informatics Association (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Rockefeller Foundation
- World Health Organization
- National Institutes of Health
- U.S. Public Health Service (U01 A106991)
- U.S. National Library of Medicine (LM07117-11, T15LM007117)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Nursing › Issues, ethics and legal aspects › Nursing Diagnosis and Documentation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Technology and Human Factors in Education and Health
- Keywords
- electronic health records, resource-limited settings, scalability, implementation model, shared responsibility, HIV clinics, Uganda, primary care providers, developer communities, health information technology
- MeSH terms
- Ambulatory Care Information Systems, Community Participation, Consumer Behavior, Cost Control, Developing Countries, Health Plan Implementation, Health Planning Technical Assistance, Humans, Time and Motion Studies, Uganda, HIV Infections, Outcome Assessment, Health Care, Models, Organizational, Electronic Health Records
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