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. 2012;7(12):e51631.
doi: 10.1371/journal.pone.0051631. Epub 2012 Dec 17.

Implementation of provider-based electronic medical records and improvement of the quality of data in a large HIV program in Sub-Saharan Africa

Barbara Castelnuovo  1 , Agnes Kiragga, Victor Afayo, Malisa Ncube, Richard Orama, Stephen Magero, Peter Okwi, Yukari C Manabe, Andrew Kambugu
Affiliations

Implementation of provider-based electronic medical records and improvement of the quality of data in a large HIV program in Sub-Saharan Africa

Barbara Castelnuovo et al. PLoS One. 2012.

Abstract

Introduction: Starting in June 2010 the Infectious Diseases Institute (IDI) clinic (a large urban HIV out-patient facility) switched to provider-based Electronic Medical Records (EMR) from paper EMR entered in the database by data-entry clerks. Standardized clinics forms were eliminated but providers still fill free text clinical notes in physical patients' files. The objective of this study was to compare the rate of errors in the database before and after the introduction of the provider-based EMR.

Methods and findings: Data in the database pre and post provider-based EMR was compared with the information in the patients' files and classified as correct, incorrect, and missing. We calculated the proportion of incorrect, missing and total error for key variables (toxicities, opportunistic infections, reasons for treatment change and interruption). Proportions of total errors were compared using chi-square test. A survey of the users of the EMR was also conducted. We compared data from 2,382 visits (from 100 individuals) of a retrospective validation conducted in 2007 with 34,957 visits (from 10,920 individuals) of a prospective validation conducted in April-August 2011. The total proportion of errors decreased from 66.5% in 2007 to 2.1% in 2011 for opportunistic infections, from 51.9% to 3.5% for ART toxicity, from 82.8% to 12.5% for reasons for ART interruption and from 94.1% to 0.9% for reasons for ART switch (all P<0.0001). The survey showed that 83% of the providers agreed that provider-based EMR led to improvement of clinical care, 80% reported improved access to patients' records, and 80% appreciated the automation of providers' tasks.

Conclusions: The introduction of provider-based EMR improved the quality of data collected with a significant reduction in missing and incorrect information. The majority of providers and clients expressed satisfaction with the new system. We recommend the use of provider-based EMR in large HIV programs in Sub-Saharan Africa.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Standardized medical forms.
Forms completed by health care providers and subsequently entered in an electronic database before the implementation of provider-based electronic medical records.
Figure 2
Figure 2. Intake questionnaire (A) and client monitoring flow sheet (B).
Provider-based electronic medical records as they appear in the Integrated Clinic Enterprise Application.
Figure 3
Figure 3. The patient overview.
Summary of patient relevant clinical information as they appear in the Integrated Clinic Enterprise Application.
Figure 4
Figure 4. Survey on acceptability.
Answers to 3 significant questions by providers (A) and clients (B).
Figure 5
Figure 5. Transition from paper forms to provider-based EMR in our program.
See this image and copyright information in PMC

References

    1. Payne TH, tenBroek AE, Fletcher GS, Labuguen MC (2010) Transition from paper to electronic inpatient physician notes. J Am Med Inform Assoc 17: 108–111. - PMC - PubMed
    1. Gearing P, Olney CM, Davis K, Lozano D, Smith LB, et al. (2006) Enhancing patient safety through electronic medical record documentation of vital signs. J Healthc Inf Manag 20: 40–45. - PubMed
    1. Cebul RD, Love TE, Jain AK, Hebert CJ (2011) Electronic health records and quality of diabetes care. N Engl J Med 365: 825–833. - PubMed
    1. Douglas GP, Gadabu OJ, Joukes S, Mumba S, McKay MV, et al.. (2010) Using touchscreen electronic medical record systems to support and monitor national scale-up of antiretroviral therapy in Malawi. PLoS Med 7. - PMC - PubMed
    1. Rotich JK, Hannan TJ, Smith FE, Bii J, Odero WW, et al. (2003) Installing and implementing a computer-based patient record system in sub-Saharan Africa: the Mosoriot Medical Record System. J Am Med Inform Assoc 10: 295–303. - PMC - PubMed

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