Janise Richards

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The adoption and usability of an electronic medical record (EMR) is a critical step towards its implementation and use to enhance quality care. Use and usability of EMRs are rarely documented in low-income countries. Objective: To explore users’ experience and usability of OpenMRS, an EMR used in HIV program in Rwanda for over 13 years. Methods: We used two qualitative methods: key informant interviews; facility and specific task observations of EMR use in health facilities. We interviewed at least one nurse and a one person responsible for data management in 12 health centers. We analyzed data from key-informant interviews and observations using thematic analysis together with an informed grounded theory and, grouped our findings into themes and sub-themes. Results: The OpenMRS EMR was used, together with paper-based registers and patient cards, in HIV program. Participants were generally able to perform tasks in OpenMRS EMR easily, although nurses could complete less tasks than data managers. Participants thought the system was useful, helped them retrieve patient information easily, and were able to create pre-formatted reports. Barriers related to the use of the system included limited trained staff, staff turnover, limited infrastructure, and double data entry requirements. Suggestions for more effective use of the system were work-based trainings, facility supervisions, improved infrastructure and decentralized technical support. Conclusions: Staff from health centers experienced the OpenMRS EMR as a useful system that improves healthcare delivery process and patient care. The use of the EMR could be improved by increasing infrastructure, human resources capacity and technical support.

BACKGROUND The adoption and usability of an electronic medical record (EMR) is a critical step towards its successful implementation and enhancing quality care. Use and usability of EMRs are rarely documented in primary healthcare settings. This study explored users’ experience in the use and usability of OpenMRS, an EMR used in HIV care in Rwanda for over 13 years. OBJECTIVE To determine the user experience of the EHR in long term use, the factors that were facilitators and barriers to use and recommendations for improvements. METHODS We used two qualitative methods: key informant interviews; and facility and specific task observations of EMR use in health facilities. We interviewed at least one nurse and a data manager or data entry clerk in 12 health centers. We analyzed data from key-informant interviews and observations using an informed grounded theory together with thematic analysis, grouping our findings into themes and sub-themes. RESULTS The OpenMRS EMR was used, together with paper-based registers and patient cards, in HIV care. Participants were generally able to perform tasks in OpenMRS EMR easily, although nurses could complete fewer tasks than data managers. Participants thought the system was useful, helped them retrieve patient information easily, and were able to create pre-formatted reports. Barriers to using the system included limited staff trained to use it, staff turnover, limited infrastructure, and double data entry requirements. Suggestions for more effective use of the system were work-based trainings, facility supervisions, improved infrastructure and decentralized technical support. CONCLUSIONS Staff from health centers experienced the OpenMRS EMR as a useful system that improves healthcare delivery process and patient care. The use of the EMR could be improved by increasing infrastructure, human resources capacity and technical support.

Background: Electronic health records (EHRs) have been implemented in many low-resource settings but lack strong evidence for usability, use, user confidence, scalability, and sustainability. Objective: This study aimed to evaluate staff use and perceptions of an EHR widely used for HIV care in >300 health facilities in Rwanda, providing evidence on factors influencing current performance, scalability, and sustainability. Methods: A randomized, cross-sectional, structured interview survey of health center staff was designed to assess functionality, use, and attitudes toward the EHR and clinical alerts. This study used the associated randomized clinical trial study sample (56/112, 50% sites received an enhanced EHR), pulling 27 (50%) sites from each group. Free-text comments were analyzed thematically using inductive coding. Results: Of the 100 participants, 90 (90% response rate) were interviewed at 54 health centers: 44 (49%) participants were clinical and 46 (51%) were technical. The EHR top uses were to access client data easily or quickly (62/90, 69%), update patient records (56/89, 63%), create new patient records (49/88, 56%), generate various reports (38/85, 45%), and review previous records (43/89, 48%). In addition, >90% (81/90) of respondents agreed that the EHR made it easier to make informed decisions, was worth using, and has improved patient information quality. Regarding availability, (66/88) 75% said they could always or almost always count on the EHR being available, whereas (6/88) 7% said never/almost never. In intervention sites, staff were significantly more likely to update existing records (P=.04), generate summaries before (P<.001) or during visits (P=.01), and agree that “the EHR provides useful alerts, and reminders” (P<.01). Conclusions: Most users perceived the EHR as well accepted, appropriate, and effective for use in low-resource settings despite infrastructure limitation in 25% (22/88) of the sites. The implementation of EHR enhancements can improve the perceived usefulness and use of key functions. Successful scale-up and use of EHRs in small health facilities could improve clinical documentation, care, reporting, and disease surveillance in low- and middle-income countries.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Electronic health records (EHRs) have been implemented in many low-resource settings but lack strong evidence for usability, use, user confidence, scalability, and sustainability. Objective: This study aimed to evaluate staff use and perceptions of an EHR widely used for HIV care in >300 health facilities in Rwanda, providing evidence on factors influencing current performance, scalability, and sustainability. Methods: A randomized, cross-sectional, structured interview survey of health center staff was designed to assess functionality, use, and attitudes toward the EHR and clinical alerts. This study used the associated randomized clinical trial study sample (56/112, 50% sites received an enhanced EHR), pulling 27 (50%) sites from each group. Free-text comments were analyzed thematically using inductive coding. Results: Of the 100 participants, 90 (90% response rate) were interviewed at 54 health centers: 44 (49%) participants were clinical and 46 (51%) were technical. The EHR top uses were to access client data easily or quickly (62/90, 69%), update patient records (56/89, 63%), create new patient records (49/88, 56%), generate various reports (38/85, 45%), and review previous records (43/89, 48%). In addition, >90% (81/90) of respondents agreed that the EHR made it easier to make informed decisions, was worth using, and has improved patient information quality. Regarding availability, (66/88) 75% said they could always or almost always count on the EHR being available, whereas (6/88) 7% said never/almost never. In intervention sites, staff were significantly more likely to update existing records (P=.04), generate summaries before (P<.001) or during visits (P=.01), and agree that “the EHR provides useful alerts, and reminders” (P<.01). Conclusions: Most users perceived the EHR as well accepted, appropriate, and effective for use in low-resource settings despite infrastructure limitation in 25% (22/88) of the sites. The implementation of EHR enhancements can improve the perceived usefulness and use of key functions. Successful scale-up and use of EHRs in small health facilities could improve clinical documentation, care, reporting, and disease surveillance in low- and middle-income countries.