Adoption of electronic health record systems to enhance the quality of healthcare in low-income countries: a systematic review

Abstract

Background: Electronic health record (EHR) systems are mentioned in several studies as tools for improving healthcare quality in developed and developing nations. However, there is a research gap in presenting the status of EHR adoption in low-income countries (LICs). Therefore, this study systematically reviews articles that discuss the adoption of EHR systems status, opportunities and challenges for improving healthcare quality in LICs.

Methods: We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses in articles selected from PubMed, Science Direct, IEEE Xplore, citations and manual searches. We focused on peer-reviewed articles published from January 2017 to 30 September 2022, and those focusing on the status, challenges or opportunities of EHR adoption in LICs. However, we excluded articles that did not consider EHR in LICs, reviews or secondary representations of existing knowledge. Joanna Briggs Institute checklists were used to appraise the articles to minimise the risk of bias.

Results: We identified 12 studies for the review. The finding indicated EHR systems are not well implemented and are at a pilot stage in various LICs. The barriers to EHR adoption were poor infrastructure, lack of management commitment, standards, interoperability, support, experience and poor EHR systems. However, healthcare providers' perception, their goodwill to use EMR and the immaturity of health information exchange infrastructure are key facilitators for EHR adoption in LICs.

Conclusion: Most LICs are adopting EHR systems, although it is at an early stage of implementation. EHR systems adoption is facilitated or influenced by people, environment, tools, tasks and the interaction among these factors.

Keywords: Electronic Health Records.

Figure 1

PRISMA 2020 flow diagram illustrating the overall selection process to show studies included and excluded (modified from Page et al 30). LICs, low-income countries; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.