Health providers' readiness for electronic health records adoption: A cross-sectional study of two hospitals in northern Ghana

Health professionals' perceptions of electronic health records system: a mixed method study in Ghana

BACKGROUND

Electronic Health Record systems (EHRs) offer significant benefits and have transformed healthcare in developed countries. However, their implementation and adoption in low- and middle-income countries (LMICs) remains low due to challenges and competing interests. Health professionals' perception of EHRs can influence their adoption and continued use. The objectives of this study are to explore the perception of health professionals regarding implemented EHR systems in three hospitals in Ghana and identify factors influencing their perception and satisfaction.

METHODS

In this study, we employed a concurrent mixed method design to collect data from study participants from May to June 2023. The quantitative part employed a descriptive-survey and the qualitative (in-depth interview) techniques was applied. After obtaining written informed consent from each respondent, a structured survey questionnaire was filled out by the health professionals from three hospitals. An a priori power calculation was used to determine the sample size for the quantitative component. Two hundred and sixty-three (263) health professionals completed the questionnaire from the three facilities. A purposive sampling technique was used to select fifteen [1] participants for the interviews. A semi-structured interview guide was used for the in-depth interviews. The interviews were audio recorded, transcribed, and coded into themes using QSR Nvivo 12 software before thematic content analysis.

RESULTS

Our findings revealed that 213 (80.99%) health professionals perceived the EHRs as beneficial to patients and were generally satisfied. An overwhelming majority, 197 (74.90%) of the health professionals, were satisfied with its use and expressed interest in continuing to use the system. The majority of health professionals viewed the EHRs to have improved their work and workflow processes and provided the desired results. However, few other health professionals were dissatisfied with the system because they viewed the EHRs as frustrating due to unstable internet connectivity and power supply. Other concerns were related to the privacy and confidentiality of patient information. They believe access to patient information should be on a need-to-know basis, and patient information should not be accessible to all other clinicians except those involved directly in their care processes.

CONCLUSION

The study revealed that health professionals have a positive perception of the implemented EHRs, are highly satisfied with them, and are interested in continuing to use them. However, health professionals' concerns about the unstable power supply, poor internet connectivity, security, and confidentiality of patient's information need attention, to mitigate their frustrations and boost their confidence in the system.

Usability evaluation of electronic health records at the trauma and emergency directorates at the Komfo Anokye teaching hospital in the Ashanti region of Ghana

BACKGROUND

Electronic health records (EHRs) are currently gaining popularity in emerging economies because they provide options for exchanging patient data, increasing operational efficiency, and improving patient outcomes. This study examines how service providers at Ghana's Komfo Anokye Teaching Hospital adopt and use an electronic health records (EHRs) system. The emphasis is on identifying factors impacting adoption and the problems that healthcare personnel encounter in efficiently using the EHRs system.

METHOD

A quantitative cross-sectional technique was utilised to collect data from 234 trauma and emergency department staff members via standardised questionnaires. The participants were selected using the purposive sampling method. The Pearson Chi-square Test was used to examine the relationship between respondents' acceptability and use of EHRs.

RESULTS

The study discovered that a sizable number of respondents (86.8%) embraced and actively used the EHRs system. However, other issues were noted, including insufficient system training and malfunctions (35.9%), power outages (18.8%), privacy concerns (9.4%), and insufficient maintenance (4.7%). The respondents' comfortability in using the electronic health record system (X2=11.30, p=0.001), system dependability (X2=30.74, p=0.0001), and EHR's ability to reduce patient waiting time (X2=14.39, p=0.0001) were all strongly associated with their degree of satisfaction with the system. Furthermore, respondents who said elects increase patient care (X2= 75.59, p = 0.0001) and income creation (X2= 8.48, p = 0.004), which is related to the acceptability of the electronic health records system.

CONCLUSION

The study revealed that comfort, reliability, and improved care quality all had an impact on the EHRs system's acceptability and utilization. Challenges, including equipment malfunctions and power outages, were found. Continuous professional training was emphasized as a means of increasing employee confidence, as did the construction of a power backup system to combat disruptions. Patient data privacy was highlighted. In conclusion, this study highlights the relevance of EHRs system adoption and usability in healthcare. While the benefits are obvious, addressing obstacles through training, technical support, and infrastructure improvements is critical for increasing system effectiveness.

Healthcare providers' perception towards utilization of health information applications and its associated factors in healthcare delivery in health facilities in Cape Coast Metropolis, Ghana

BACKGROUND

Information and communication technology (ICT) has significantly advanced global healthcare, with electronic health (e-Health) applications improving health records and delivery. These innovations, including electronic health records, strengthen healthcare systems. The study investigates healthcare professionals' perceptions of health information applications and their associated factors in the Cape Coast Metropolis of Ghana's health facilities.

METHODS

We used a descriptive cross-sectional study design to collect data from 632 healthcare professionals (HCPs), in the three purposively selected health facilities in the Cape Coast municipality of Ghana, in July 2022. Shapiro-Wilk test was used to check the normality of dependent variables. Descriptive statistics were used to report means with corresponding standard deviations for continuous variables. Proportions were also reported for categorical variables. Bivariate regression analysis was conducted to determine the factors influencing the Benefits of Information Technology (BoIT); Barriers to Information Technology Use (BITU); and Motives of Information Technology Use (MoITU) in healthcare delivery. Stata SE version 15 was used for the analysis. A p-value of less than 0.05 served as the basis for considering a statistically significant accepting hypothesis.

RESULTS

Healthcare professionals (HCPs) generally perceived moderate benefits (Mean score (M) = 5.67) from information technology (IT) in healthcare. However, they slightly agreed that barriers like insufficient computers (M = 5.11), frequent system downtime (M = 5.09), low system performance (M = 5.04), and inadequate staff training (M = 4.88) hindered IT utilization. Respondents slightly agreed that training (M = 5.56), technical support (M = 5.46), and changes in work procedures (M = 5.10) motivated their IT use. Bivariate regression analysis revealed significant influences of education, working experience, healthcare profession, and IT training on attitudes towards IT utilization in healthcare delivery (BoIT, BITU, and MoITU). Additionally, the age of healthcare providers, education, and working experience significantly influenced BITU. Ultimately, age, education, working experience, healthcare profession, and IT training significantly influenced MoITU in healthcare delivery.

CONCLUSIONS

Healthcare professionals acknowledge moderate benefits of IT in healthcare but encounter barriers like inadequate resources and training. Motives for IT use include staff training and support. Bivariate regression analysis shows education, working experience, profession, and IT training significantly influence attitudes towards IT adoption. Targeted interventions and policies can enhance IT utilization in the Cape Coast Metropolis, Ghana.

The Experiences of Strategic Purchasing of Healthcare in Nine Middle-Income Countries: A Systematic Qualitative Review

BACKGROUND

Efforts to move towards universal health coverage (UHC) aim to rebalance health financing in ways that increase efficiency, equity, and quality. Resource constraints require a shift from passive to strategic purchasing (SP). In this paper, we report on the experiences of SP in public sector health insurance schemes in nine middle-income countries to understand what extent SP has been established, the challenges and facilitators, and how it is helping countries achieve their UHC goals.

METHODS

We conducted a systematic search to identify papers on SP. Nine countries were selected for case study analysis. We extracted data from 129 articles. We used a common framework to compare the purchasing arrangements and key features in the different schemes. The evidence was synthesised qualitatively.

RESULTS

Five countries had health technology assessment (HTA) units to research what services to buy. Most schemes had reimbursement mechanisms that enabled some degree of cost control. However, we found evidenced-based changes to the reimbursement mechanisms only in Thailand and China. All countries have some form of mechanism for accreditation of health facilities, although there was considerable variation in what is done. All countries had some strategy for monitoring claims, but they vary in complexity and the extent of implementation; three countries have implemented e-claim processing enabling a greater level of monitoring. Only four countries had independent governance structures to provide oversight. We found delayed reimbursement (six countries), failure to provide services in the benefits package (four countries), and high out-of-pocket (OOP) payments in all countries except Thailand and Indonesia, suggesting the schemes were failing their members.

CONCLUSION

We recommend investment in purchaser and research capacity and a focus on strong governance, including regular engagement between the purchaser, provider and citizens, to build trusting relationships to leverage the potential of SP more fully, and expand financial protection and progress towards UHC.

End-users' perspectives on factors affecting implementation and utilization of the Iranian electronic health record system: a qualitative study in a developing country

BACKGROUND

As one of the most important information technologies for storing, managing, and exchanging health information, the electronic health record (EHR) plays a major role in the health system. However, these systems in developing countries have been associated with multidimensional issues. The purpose of the present study was the assessment of nonclinical end-users' points of view on the implementation and utilization of the Iranian electronic health record system.

METHODS

This was a large qualitative study conducted in 2021 for 7 months from February to August. In this study, data were collected through in-depth semi-structured interviews with 70 non-clinical end-users in 22 public and six private hospitals of West Azerbaijan province in Iran. To analyze the data, the thematic analysis method was used.

RESULTS

The study results indicated that technical, human, cultural, managerial, and financial readiness are the most important factors affecting the implementation of EHRs in Iran. Among the mentioned factors, technical and human readiness were emphasized more by the users. Also, technical, organizational, human, and managerial factors were identified as factors influencing EHRs utilization, and technical and organizational factors had a stronger role in the system utilization.

CONCLUSIONS

According to the results, several factors influence EHR implementation and adequate utilization in Iran. To achieve the predetermined goals of this system, implementation issues and problems of using the system should be considered and solved.

Nurses' Attitudes and Factors Affecting Use of Electronic Health Record in Saudi Arabia

(1) Background: Nurses' attitudes toward electronic health records (EHRs) is a very valuable issue that needs to be evaluated, understood, and considered one of the main factors that can lead to its improvement or handicap its implementation. This study aimed to assess nurses' attitudes toward EHRs and associated factors that affect the implementation of EHRs in different hospitals in Saudi Arabia. (2) Methods: A cross-sectional study was utilized to collect data from 297 nurses working in public hospitals and primary healthcare centers in Ha'il Province from January to May 2023. Data were collected using the Nurses' Attitudes Towards Computerization questionnaire and a sociodemographic and work-related characteristics sheet. (3) Results: Most of the participants' attitude scores (81.1%, n = 241) were more than or equal to 60, representing positive attitudes, whereas 18.9% (n = 56) of the nurses' scores were less than 60, which is interpreted as negative attitudes. There was a significant relationship between nurses' attitudes toward EHRs and a participants' sex, where males had a more positive attitude than females (p < 0.001). Particularly, young nurses and those who had previous computer experience had a more positive attitude than older nurses and those who had no computer experience (p = 0.044 and < 0.001, respectively). Saudi nurses holding a master's degree had significantly more positive attitudes toward EHRs than non-Saudi nurses holding a bachelor's or diploma degree (p = 0.007 and 0.048, respectively). Nurses with less experience (less than five years) in the nursing field had a significantly positive attitude. Multiple linear regression showed that sex (p = 0.038), level of education (p = 0.001), and previous computer experience (p < 0.001) were independent factors of nurses' knowledge of EHRs. (4) Conclusion: The majority of nurses had positive overall attitudes toward using EHRs. Nurses who are Saudi nationals, male, younger, have previous computer experience, and have less than five years of experience had a more positive attitude toward EHRs than nurses who are non-Saudi, female, older, have no computer experience, have bachelor's or diploma degree, and have less than five years of experience, respectively. Sex, education level, and previous computer experience were independent factors of nurses' knowledge of EHRs.

Awareness and readiness of mental healthcare providers to implement telemental health services and associated factors at public referral hospitals in Addis Ababa City, Ethiopia

OBJECTIVE

To assess the awareness and readiness of mental healthcare providers to implement telemental health services and the associated factors at public referral hospitals in Addis Ababa City, Ethiopia.

STUDY DESIGN

A cross-sectional study was conducted among mental health professionals working at public referral hospitals in Addis Ababa City from 4 May to 10 June 2022.

PARTICIPANTS

A total of 413 (55.7% male and 44.3% female) health professionals participated in the study. The study participants were selected using a simple random sampling technique. All mental healthcare providers working at public referral hospitals in Addis Ababa City were considered as the source population. Mental healthcare providers who meet the inclusion criteria were considered the study population. Having a minimum diploma qualification and 6 months or more of work experience and giving written consent were considered the inclusion criteria.

OUTCOME MEASURE

The main outcome measure was awareness and readiness to implement telemental health services.

RESULT

A total of 413 participants were enrolled, with a response rate of 90.6%. The prevalence of good awareness towards telemental health services was 41% (95% CI 37%, 47%). Being female (adjusted OR (AOR)=0.34; 95% CI 0.15, 0.76), having poor information technology support (AOR=0.32; 95% CI 0.11, 0.99) and having electronic health technology experience (AOR=1.21; 95% CI 1.1, 2.44) were significantly associated with awareness of telemental health services, whereas computer access at the workplace (AOR=0.04; 95% CI 0.003, 0.55) and awareness (AOR=4.34; 95% CI 1.02, 18.48) and attitude (AOR=1.01; 95% CI 1.03, 2.19) towards telemental health services were the variables that showed statistically significant association with readiness of mental healthcare providers for telemental health services.

CONCLUSION

Although majority of healthcare providers in this survey were prepared to implement telemental health services, there was typically little awareness among mental healthcare providers.

Health professionals' readiness to implement electronic medical record system in Gamo zone public hospitals, southern Ethiopia: an institution based cross-sectional study

BACKGROUND

The adoption of Electronic Medical Records (EMR) by the healthcare sector can improve patient care and safety, facilitate structured research, and effectively plan, monitor, and assess disease. EMR adoptions in low-income countries like Ethiopia were delayed and failing more frequently, despite their critical necessity. The most popular way to solve the issue is to evaluate user preparedness prior to the adoption of EMR. However, little is known regarding the EMR readiness of healthcare professionals in this study setting. Therefore, the objective of this study was to assess the readiness and factors associated with health professional readiness toward EMR in Gamo Zone, Ethiopia.

METHODS

An institution-based cross-sectional survey was conducted by using a pretested self-administered questionnaire on 416 study participants at public hospital hospitals in southern Ethiopia. STAT version 14 software was used to conduct the analysis after the data was entered using Epi-data version 3.2. A binary logistic regression model was fitted to identify factors associated with readiness. Finally, the results were interpreted using an adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p-value less than 0.05.

RESULTS

A total of 400 participants enrolled in the study, with a response rate of 97.1%. A total of 65.25% (n = 261) [95% CI: 0.60, 0.69] participants had overall readiness, 68.75% (n = 275) [95% CI: 0.64, 0.73] had engagement readiness, and (69.75%) (n = 279) [95% CI: 0.65, 0.74] had core EMR readiness. Computer skills (AOR: 3.06; 95% CI: 1.49-6.29), EMR training (AOR: 2.00; 95% CI: 1.06-3.67), good EMR knowledge (AOR: 2.021; 95% CI: 1.19-3.39), and favorable attitude (AOR: 3.00; 95% CI: 1.76-4.97) were factors significantly associated with EMR readiness.

CONCLUSION

Although it was deemed insufficient, more than half of the respondents indicated a satisfactory level of overall readiness for the adoption of EMR. Moreover, having computer skills, having EMR training, good EMR knowledge, and favorable EMR attitude were all significantly and positively related to EMR readiness.

Healthcare professionals' knowledge, attitude and its associated factors toward electronic personal health record system in a resource-limited setting: A cross-sectional study

Introduction

Electronic personal health record (e-PHR) system enables individuals to access their health information and manage it themselves. It helps patient engagement management of health information that is accessed and shared with their healthcare providers using the platform. This improves individual healthcare through the exchange of health information between patients and healthcare providers. However, less is known about e-PHRs among healthcare professionals.

Objective

Therefore, this study aimed to assess Health professionals' Knowledge and attitude and its associated factors toward e-PHR at the teaching hospital in northwest Ethiopia.

Methods

An institution-based cross-sectional study design was used to determine healthcare professionals' knowledge and attitude and their associated factors toward e-PHR systems in teaching hospitals of Amhara regional state, Ethiopia, from 20 July to 20 August 2022. Pretested structured self-administered questionnaires were used to collect the data. Descriptive statistic was computed based on sociodemographic and other variables presented in the form of table graphs and texts. Bivariable and multivariable logistic analyses were performed with an adjusted odds ratio (AOR) and 95% CI to identify predictor variables.

Result

Of the total study participants, 57% were males and nearly half of the respondents had a bachelor's degree. Out of 402 participants, ~65.7% [61–70%] and 55.5% [50–60%] had good knowledge and favorable attitude toward e-PHR systems, respectively. Having a social media account 4.3 [AOR = 4.3, 95% CI (2.3–7.9)], having a smartphone 4.4 [AOR = 4.4, 95% CI (2.2–8.6)], digital literacy 8.8 [(AOR = 8.8, 95% CI (4.6–15.9)], being male 2.7 [AOR = 2.7, 95% CI (1.4–5.0)], and perceived usefulness 4.5 [(AOR = 4.5, 95% CI (2.5–8.5)] were positively associated with knowledge toward e-PHR systems. Similarly, having a personal computer 1.9 [AOR = 1.9, 95% CI (1.1–3.5)], computer training 3.9 [AOR = 3.9, 95% CI (1.8–8.3)], computer skill 19.8 [AOR = 19.8, 95% CI (10.7–36.9)], and Internet access 6.0 [AOR = 6.0, 95% CI (3.0–12.0)] were predictors for attitude toward e-PHR systems.

Conclusion

The findings from the study showed that healthcare professionals have good knowledge and a favorable attitude toward e-PHRs. Providing comprehensive basic computer training to improve healthcare professionals' expectation on the usefulness of e-PHR systems has a paramount contribution to the advancement of their knowledge and attitude toward successfully implementing e-PHRs.

Organizational and health professional readiness for the implementation of electronic medical record system: an implication for the current EMR implementation in northwest Ethiopia

OBJECTIVE

The WHO developed a manual outlining the preliminary organizational and health professionals' readiness to implement electronic medical records (EMR). On the other hand, the readiness assessment in Ethiopia only includes the evaluation of health professionals, leaving out organisational readiness components. As a result, this research aimed to determine health professionals' and organizational readiness to implement EMR at a specialized teaching hospital.

METHODS

An institutional-based cross-sectional study design was conducted among 423 health professionals and 54 managers. Self-administered and pretested questionnaires were used to collect data. Binary logistic regression analysis was used to identify factors associated with health professionals' readiness for EMR implementation. An OR with a 95% CI and p<0.05 was used to determine the strength of the association and the statistical significance, respectively.

RESULTS

In this study, 53.7% management capacity, 33.3% finance and budget capacity, 42.6% operational capacity, 37.0% technology capability and 53.7% organisational alignment among the five dimensions evaluated to assess an organisation's readiness to implement an EMR system. Of 411 health professionals in this study, 173 (42.1%) with (95 CI 37.3% to 46.8%) were ready to implement an EMR system at the hospital. Sex (AOR 2.69, 95% CI 1.73 to 4.18), basic computer training (AOR 1.59, 95% CI 1.02 to 2.46), knowledge of EMR (AOR 1.88, 95% CI 1.19 to 2.97) and attitudes towards EMR (AOR 1.65, 95% CI 1.05 to 2.59) were significantly associated with health professionals' readiness towards EMR system implementation.

CONCLUSIONS

Findings showed that most dimensions of organizational readiness for EMR implementation were below 50%. This study also revealed a lower level of EMR implementation readiness among health professionals compared with previous research studies' results. To improve organisational readiness to implement an electronic medical record system, a focus on management capability, financial and budget capability, operational capability, technical capability and organisational alignment was crucial. Likewise, having basic computer training, giving special attention to female health professionals and improving health professionals' knowledge of and attitudes towards EMR could help improve the readiness level of health professionals for implementing an EMR system.

Health professionals' readiness to implement electronic medical recording system and associated factors in public general hospitals of Sidama region, Ethiopia

BACKGROUND

Electronic medical recording system is one of the information technologies that has a proven benefit to improve the quality of health service. Readiness assessment is one of the recommended steps to be taken prior to implementing electronic medical recording system to reduce the probability of failure.

OBJECTIVE

To determine the level of health professional readiness to implement Electronic medical recording system and associated factors in public general hospitals of Sidama region, 2022.

METHODOLOGY

A cross-sectional study design complemented with qualitative study was employed at three public general hospitals in Sidama region on a sample of 306 participants. A pretested self-administered questionnaire was used to collect quantitative data and in-depth interview was used for the qualitative study. Bivariate and multivariate Binary logistics regression was performed to determine predictors of readiness at α = 0.05, using an odds ratio and 95% confidence interval. Thematic analysis was done for qualitative data collected through in-depth interview.

RESULT

The overall readiness for health professionals was 36.5%. Of the study participants, 201 (73.4%) were computer literate, 176(64.23%) had good knowledge, and 204 (74.45%) had favorable attitude towards EMR. Only 31 participants had previous training (11.3%), while 64 (23%) had previous experience. EMR knowledge (AOR = 3.332; 95%CI: (1.662, 6.682)) and attitude towards electronic medical recording (AOR = 2.432; 95%CI: (1.146, 5.159)) were statistically significant predictors of readiness to implement electronic medical recording. Qualitative analysis has revealed lack of training, ease of use concerns, information security concerns, and perceived inadequacy of infrastructures including internet connectivity and electricity as common barriers for health professional readiness to implement EMR.

CONCLUSION

Health professionals' readiness in this study was low. Capacity building efforts to increase the awareness and skills of health professionals should be done before implementing the system.

Compliance to Guidelines in Prescribing Empirical Antibiotics for Individuals with Uncomplicated Urinary Tract Infection in a Primary Health Facility of Ghana, 2019-2021

Increasing trends in antimicrobial resistance among uropathogens call for rational use of empirical antibiotics for managing uncomplicated urinary tract infections (UTIs). In Ghana, standard treatment guidelines (STGs) for UTI recommend oral ciprofloxacin or cefuroxime for 5-7 days in females and 10-14 days in males. We conducted a cross-sectional audit using electronic medical records (EMR) to assess compliance to the STGs among adults (≥18 years) with uncomplicated UTIs diagnosed in a primary health facility between October 2019 and October 2021. Among 3717 patients, 71% were females and all had complete prescription details in the EMR. Of all the patients, 83% were prescribed empirical antibiotics, of whom 88% received oral ciprofloxacin or cefuroxime. Only 68% were prescribed antibiotics for the correct duration, which was significantly lower among males (10%) compared to females (90%). Among patients who received antibiotics, 60% were prescribed in line with the STGs. The results call for feedback to physicians about poor compliance to STGs with duration of antibiotic prescribed. Recommendations on 10-14 days duration of antibiotics for males needs to be reassessed and necessary amendments to STGs can be made. Leveraging the well-established EMR system, a real-time audit-feedback mechanism can be instituted to improve compliance with STGs.

Satisfied or not satisfied? Electronic health records system implementation in Ghana: Health leaders' perspective

Background

Electronic Health Records (EHR) has been espoused to be an innovation from the paper-based system, with benefits such as fast access to patient information thereby facilitating healthcare provider communication, healthcare continuity and improved quality of care. However, it is the extent of the quality of the electronic health records that determines the access to these stated benefits. The quality of health care records indirectly contributes to patient safety because inaccurate patient data can lead to improper diagnosis and consequently wrong treatment of patients. Most hospitals in Ghana, have recently transitioned into the EHR system, hence, there is a need to assess its accuracy, impact on workflow, staff training on usage, support from the EHR team, and the overall satisfaction of the EHR system. As health leaders are at the frontline of its implementation, their views on the challenges and successes of the EHR system are imperative.

Method

This qualitative study sought to explore the views of the health leaders on the implemented electronic health records system in nine (9) hospitals within three (3) regions in Ghana. Following ethical approval, GHS-ERC:007/04/21, focus group discussions were conducted with a minimum of 10 hospital leaders in each facility. These included quasi, government and private hospitals. Data was collected between September and November 2021.

Results

The study found poor quality of records, lack of involvement of frontline clinicians in the development of the EHR system, inadequate training of staff and limited workstations as some of the challenges associated with the use of EHR in hospitals. Health leaders were generally not satisfied with the EHR system.

Conclusion

It is recommended that addressing inputs from end-users as well as circulating more computers will motivate EHR usage and acceptance. Provision of additional workstations for the various units and involvement of staff in the system development would be most prudent to enable health workers to accept the EHR system in improving the quality of care.

Sub-national variations in general service readiness of primary health care facilities in Ghana: Health policy and equity implications towards the attainment of Universal Health Coverage

Background

Service availability and readiness are critical for the delivery of quality and essential health care services. In Ghana, there is paucity of literature that describes general service readiness (GSR) of primary health care (PHC) facilities within the national context. This study therefore assessed the GSR of PHC facilities in Ghana to provide evidence to inform heath policy and drive action towards reducing health inequities.

Methods

We analysed data from 140 Service Delivery Points (SDPs) that were part of the Performance Monitoring and Accountability 2020 survey (PMA2020). GSR was computed using the Service Availability and Readiness Assessment (SARA) manual based on four out of five components. Descriptive statistics were computed for both continuous and categorical variables. A multivariable binary logistic regression model was fitted to assess predictors of scoring above the mean GSR. Analyses were performed using Stata version 16.0. Significance level was set at p<0.05.

Results

The average GSR index of SDPs in this study was 83.4%. Specifically, the mean GSR of hospitals was 92.8%, whereas health centres/clinics and CHPS compounds scored 78.0% and 64.3% respectively. The least average scores were observed in the essential medicines and standard precautions for infection prevention categories. We found significant sub-national, urban-rural and facility-related disparities in GSR. Compared to the Greater Accra Region, SDPs in the Eastern, Western, Upper East and Upper West Regions had significantly reduced odds of scoring above the overall GSR. Majority of SDPs with GSR below the average were from rural areas.

Conclusion

Overall, GSR among SDPs is appreciable as compared to other settings. The study highlights the existence of regional, urban-rural and facility-related differences in GSR of SDPs. The reality of health inequities has crucial policy implications which need to be addressed urgently to fast-track progress towards the achievement of the SDGs and UHC targets by 2030.

Open-source electronic health record systems: A systematic review of most recent advances

Open-source Electronic Health Records (OS-EHRs) are of pivotal importance in the management, operations, and administration of any healthcare organization. With the advancement of health informatics, researchers and healthcare practitioners have proposed various frameworks to assess the maturation of Open-source EHRs. The significance of OS-EHRs stems from the fact that vendor-based EHR implementations are becoming financially burdensome, with some vendors raking in more than $1 billion with one contract. Contrarily, the adoption of OS-EHRs suffers from a lack of systematic evaluation from the standpoint of a standard reference model. To this end, the Healthcare Information and Management Systems Society (HIMSS) has presented a strategic road map called EMR Adoption and Maturity (EMRAM). The HIMSS-EMRAM model proposes a stage-wise model approach that is globally recognized and can be essentially applied as a benchmark evaluation criteria for open-source EHRs. This paper offers an applied descriptive methodology over the frequently studied open-source EHRs currently operational worldwide or has the potential of adoption in healthcare settings. Besides, we also present profiling (User Support, Developer' Support, Customization Support, Technical details, and Diagnostic help) of studied OS-EHRs from developer's and user's perspectives using updated standard metrics. We carried out multi-aspect objective analysis of studied systems covering EHR functions, software based features and implementation. This review portrays systematic aspects of electronic medical record standards for open-source software implementations. As we observed in the literature, prevalent research and working prototypes lack systematic review of the HIMSS-EMRAM model and do not present evolving software features. Therefore, after the application of our assessment measures, the results obtained indicate that OS-EHRs are yet to acquire standard compliance and implementation. The findings in this paper can be beneficial in the planning and implementation of OS-EHRs projects in the future.

Audit of documentation accompanying referred maternity cases to a referral hospital in northern Ghana: a mixed-methods study

Background

Effective referral of maternity cases, which cannot be managed at the primary healthcare level, with detailed referral forms is important for reducing possible delays in the provision of higher-level healthcare. This is the first study to audit documentation or referral forms that accompany referred maternity cases to a referral hospital in the northern region of Ghana.

Materials and methods

This study employed an explanatory sequential mixed-method design, starting with a quantitative review of referral forms that accompanied all patients referred to four units (antenatal, antenatal emergency, labour and neonatal intensive care) of a referral hospital in northern Ghana. In-depth interviews were held with the heads of the four units afterwards. Descriptive statistics were computed for the quantitative data. The qualitative data was subjected to content analysis. Integration of the data occurred at the data interpretation/discussion level.

Results

A total of 217 referral forms were analysed. Nearly half of the cases were referred from the Tamale Metropolis (46.5%) and 83.9% were referred for advanced care, whilst 8.3% were referred due to a lack of medical logistics and equipment such as oxygen and skilled personnel (6%). Completion rates of the referral forms were as follows: < 50% completion (n = 81; 37.3%), 50–75% completion (n = 112; 51.6%) above 75% completion (n = 24; 11.1%). Some of the handwriting were not legible and were quite difficult to read. The key informants stated that incomplete forms sometimes delay treatment. The head of the antenatal care unit at the referral hospital suggested professional development sessions as a strategy for supporting clinicians to fill the forms as expected.

Conclusion

The Ghana Health Service should conduct regular audits, develop job aides and provide incentives for health professionals who accurately complete referral forms. Completing forms and digitizing health records can help ensure further efficiencies in the health information system and sustain good maternity referral documentation practices.

Healthcare providers' readiness for electronic health record adoption: a cross-sectional study during pre-implementation phase

BACKGROUND

The adoption of an electronic health record (EHR) in the healthcare system has the potential to make healthcare service delivery effective and efficient by providing accurate, up-to-date, and complete information. Despite its great importance, the adoptions of EHR in low-income country settings, like Ethiopia, were lagging and increasingly failed. Assessing the readiness of stakeholders before the actual adoption of EHR is considered the prominent solution to tackle the problem. However, little is known about healthcare providers' EHR readiness in this study setting. Accordingly, this research was conducted aiming at examining healthcare providers' readiness for EHR adoption and associated factors in southwestern Ethiopia.

METHODS

An institutional-based cross-sectional study was conducted from September 1 to October 30, 2021. A total of 423 healthcare providers working in public hospitals were selected using a simple random sampling technique. Multivariable logistic regression was fitted to identify determinant factors of overall healthcare providers' readiness after the other covariates were controlled.

RESULT

In this study, the overall good readiness level of EHR adoption was 52.8% (n = 204) [95% CI of 47.9% to 56.6%]. Age, computer literacy, computer access at health facilities, attitude towards EHRs, awareness about EHRs, perceived benefit, and perceived technology self-efficacy were significantly associated with the overall health care providers' readiness for the adoption of EHR using a cut point of P-value less than 0.05.

CONCLUSION

Around half of the respondents had a good level of overall healthcare providers' readiness for the adoption of EHR which was considered inadequate. This finding implied that a huge effort is required to improve readiness before the actual implementation of EHRs. The finding implied that younger-aged groups were more ready for such technology which in turn implied; the older one needs more concern. Enhancing computer literacy, confidence building to raise self-efficacy of such technology, addressing the issue of computer availability at health facilities, building a positive attitude, awareness campaign of EHR, and recognizing the usefulness of such systems were the necessary measures to improve EHR readiness in this setting. Additionally, further studies are recommended to encompass all types of EHR readiness such as organizational readiness, technology readiness, societal readiness, and so on. Additionally, exploring the healthcare provider opinion with qualitative study and extending the proposed study to other implementation settings are recommended to be addressed by future works.

Information and communication technology literacy, knowledge and readiness for electronic medical record system adoption among health professionals in a tertiary hospital, Myanmar: A cross-sectional study

Some developing countries are currently introducing and implementing an electronic medical record system (EMRs) for improvement in healthcare delivery services. Availability of information and communication technology (ICT), technical skillful staff, and strong resistance to change by the health professionals impacted the successful adoption of EMRs. This study aimed to assess the ICT literacy, knowledge, and readiness for EMRs adoption among health professionals in a tertiary hospital, Myanmar. A cross-sectional study was conducted among 118 health professionals involving in a tertiary hospital at Nay Pyi Taw, Myanmar from February to April 2020 using a stratified sampling method. The data were collected through face-to-face interviews using a pretested structured questionnaire after getting informed consent. Data were analyzed by using SPSS version 23.0. Chi-square test, Fisher's exact test, and logistic regression analysis were performed to assess the associated factors of ICT literacy, knowledge, and overall readiness for EMRs adoption. The prevalence of high ICT literacy and knowledge on EMRs among health professionals were 20.3% and 24.6% respectively. The factors associated with ICT literacy were professional, education, duration of service, and reported English language skills. Duration of service was associated with knowledge on EMRs. The overall readiness was 54.2% (core readiness 59.3% and engagement readiness 61.9%), and postgraduate [Adjusted Odds Ratio (AOR): 7.32, 95% Confidence Interval (CI): 2.26-23.68] and knowledge on EMRs (AOR: 1.27, 95% CI: 1.13-1.43) were the factors associated with overall readiness for EMRs adoption. Expanding infrastructure and provision of ICT development training are crucial for the improvement of ICT literacy. EMRs training program enabling hands-on experience should be implemented for improvement of knowledge on EMRs. In general, the overall readiness for EMRs adoption was found to be moderate. Enhancing the establishment of comprehensive on-the-job training and contextualization of curriculum in EMRs training program are recommended to improve the health professionals' readiness for EMRs adoption.

Adoption rates of electronic health records in Turkish Hospitals and the relation with hospital sizes

BACKGROUND

Nation-wide adoption of electronic health records (EHRs) in hospitals has become a Turkish policy priority in recognition of their benefits in maintaining the overall quality of clinical care. The electronic medical record maturity model (EMRAM) is a widely used survey tool developed by the Healthcare Information and Management Systems Society (HIMSS) to measure the rate of adoption of EHR functions in a hospital or a secondary care setting. Turkey completed many standardizations and infrastructural improvement initiatives in the health information technology (IT) domain during the first phase of the Health Transformation Program between 2003 and 2017. Like the United States of America (USA), the Turkish Ministry of Health (MoH) applied a bottom-up approach to adopting EHRs in state hospitals. This study aims to measure adoption rates and levels of EHR use in state hospitals in Turkey and investigate any relationship between adoption and use and hospital size.

METHODS

EMRAM surveys were completed by 600 (68.9%) state hospitals in Turkey between 2014 and 2017. The availability and prevalence of medical information systems and EHR functions and their use were measured. The association between hospital size and the availability/prevalence of EHR functions was also calculated.

RESULTS

We found that 63.1% of all hospitals in Turkey have at least basic EHR functions, and 36% have comprehensive EHR functions, which compares favourably to the results of Korean hospitals in 2017, but unfavorably to the results of US hospitals in 2015 and 2017. Our findings suggest that smaller hospitals are better at adopting certain EHR functions than larger hospitals.

CONCLUSION

Measuring the overall adoption rates of EHR functions is an emerging approach and a beneficial tool for the strategic management of countries. This study is the first one covering all state hospitals in a country using EMRAM. The bottom-up approach to adopting EHR in state hospitals that was successful in the USA has also been found to be successful in Turkey. The results are used by the Turkish MoH to disseminate the nation-wide benefits of EHR functions.