Determinants of Utilization of Electronic Medical Records Systems in Clinical Management in Public Healthcare Facilities in Mombasa County, Kenya
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The adoption of information and communication technology (ICT) in the medical field in the form of electronic medical records (EMR) systems had been promoted as a way to reduce cost, increase effectiveness and improve the quality of care. In Kenya, the EMR is being rapidly implemented in both public and private sector healthcare facilities. However, the implementation of the EMR system has been met with partial success, for example, while the patient billing component is being fully utilized, the patient clinical data capture of the system remains underperforming leading to questions about its useability and usefulness in holistic healthcare management functions. Therefore, the study sought to find out the determinants of utilization of electronic medical records systems in clinical management in public healthcare facilities in Mombasa County, Kenya. Specifically, it sought to establish how perceived usefulness of EMR, staff ICT knowledge and staff attitudes influence the use of electronic medical records systems in clinical management in public healthcare facilities in Mombasa County. It also sought to establish the moderating effect of internet connectivity on determinants of utilization of electronic medical records systems in clinical management in public healthcare facilities in Mombasa County. The study was guided by the Technological Acceptance Model. Cross-sectional study design was adopted which targeted healthcare professional drawn from various public healthcare facilities in the County. Stratified random sampling was used to acquire a sample size of 215 respondents. Data was collected using structured questionnaires. Data was analyzed using both descriptive and inferential statistical techniques with the aid of Statistical Package for Social Scientists (SPSS) version 21. The findings of multiple regression analysis revealed that two variables: staff attitudes (β = 0.221, p < 0.05) and staff ICT knowledge knowledge (β = -. 161, p < 0.05) significantly influenced the use of EMR in clinical management in public healthcare facilities in Mombasa County. However, perceived usefulness of EMR (β = 0.121, p > 0.05), and was found not to significantly influence the use of EMR in clinical management in public healthcare facilities in Mombasa County. Further, Internet Connectivity (R-square change before (β = 0.3387; P = 0.011 and after β = 0.2777; P = 0.020) had a significant moderating effect on utilization of electronic medical records systems in clinical management in public healthcare facilities in Mombasa County. The study, therefore, recommends, the EMR system designers to involve the medical staff substantially in the design of the system so as to fully capture their views and working requirements and also help domesticate the system to improve its implementation rate in the area. In addition, the Mombasa County government ought to increase funding in the health sector for acquisition of ICT resources needed to increase EMR use in the hospitals as well as sponsor regular training on EMR to encourage hospital staffs to participate in the program and also improve on their computer skills.There is need for the County health management team to organize seminars or conferences to bring together academicians, clinicians, hospital administrators and other policy makers to convince the medical staff on the advantages of using EMR in clinical management of patients. Finally, the hospitals‘ management together with other stakeholders need to re-engage the communications networks service providers to improve the network performance of the stystem to provide full coverage and access even from remote locations.