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Multicenter Study
. 2010 May-Jun;17(3):237-44.
doi: 10.1136/jamia.2009.002303.

Evaluating a scalable model for implementing electronic health records in resource-limited settings

Martin C Were  1 , Nneka Emenyonu, Marion Achieng, Changyu Shen, John Ssali, John P M Masaba, William M Tierney
Affiliations
Multicenter Study

Evaluating a scalable model for implementing electronic health records in resource-limited settings

Martin C Were et al. J Am Med Inform Assoc. 2010 May-Jun.

Abstract

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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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
An implementation model for EHRs in resource-limited settings. Support for multiple local implementations is provided by a single external support resource made of a national technical expertise center, the developers' community and the implementers' community.
Figure 2
Figure 2
Implementation sites: 1–Mbarara, 2–Masaka; and 3–Mbale. The national technical expertise center serving all three implementation sites was in Kampala.
Figure 3
Figure 3
User satisfaction with the electronic health records (EHRs) and the support infrastructure in place at the three implementation sites.
See this image and copyright information in PMC

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