Implementation of Electronic Medical Records in Kenyan Public Hospitals: Challenges and Opportunities
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Date
2015-05
Authors
Wamae, Peter
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
Abstract
An Electronic Medical Record (EMR), a computer system composed of the clinical
data repository, clinical decision support, controlled medical vocabulary, order
entry, and pharmacy module has become a growing subject of debate in the world
today. While EMRs hold great promise, few studies have been conducted on their
implementation and outcome. Despite the fact that Kenya has made tremendous
steps in Information Communication Technology (ICT) as demonstrated by the
growing number of telephone lines, Internet Service Providers (ISPs), the number
of Internet users, broadcasting stations, mobile phones and the growing competition
by mobile service providers, and development of National EMR standards, there
has been no noticeable penetration of ICT in public hospitals. To unearth the issues
surrounding implementation of EMR in Kenyan Public hospitals, this study aimed
at exposing technical and socio-economic challenges during pre-implementation,
implementation, and post-implementation stages in Kenya. It also examined
opportunities for EMR which can be utilized to improve healthcare. Towards this
end, the study employed a descriptive approach to systematically study and
describe the existing medical records management systems, the available electronic
infrastructure, attitudes towards EMR and the expected EMR by-products.
Structured and unstructured inquiry methods were used to collect quantitative and
qualitative data from a sample of 685 (Strategic Managers, Doctors, Nurses and
Health records and Information Officers) drawn from Moi Teaching and Referral
Hospital, Kenyatta National Hospital, Rift Valley, Embu and Nyeri Provincial
General Hospitals, Naivasha District hospital and Thika, Level 5 Hospital, and
Meru Level 5 Hopital. Data was analyzed to determine the respondents’ view on
the procedures that were followed during EMR implementation, the existing EMR
functionalities, user satisfaction with EMR output, and to look for EMR
implementation trends and patterns. The key findings of the research included low
consideration of financial strategies for EMR funding and sustainability, low
utilization of existing national EMR standards, a disconnect between strategic
managers and EMR users especially in the area of user involvement, Low EMR
impact on healthcare services, and low reliability of EMR as evidence, maintenance
of authentic records and lack of other records management functions such as
appraisal, disposal and permanent retention of records among others. Based on the
findings, the study recommends more sensitization on National EMR standards at
both strategic and users level to ensure EMR quality, appropriate involvement of
users and all stakeholders in all stages of implementation to enhance requirements
analysis, ownership of system and utilization. The study also recommends before
and after studies in health facilities implementing EMRs in order to ensure early
corrective measures and control of the implementation process.
Description
A thesis submitted in fulfilment of the requirements for the award of doctor of philosophy (information science) in the school of education Kenyatta University, May 2015