Benefits and Challenges of EMR Implementations in Low Resource Settings: a State-of-the-art Review

Overview

Journal BMC Med Inform Decis Mak

Publisher Biomed Central

Specialty Medical Informatics

Date 2016 Sep 8

PMID 27600269

Citations 40

Authors

Badeia Jawhari

Dave Ludwick

Louanne Keenan

David Zakus

Robert Hayward

Affiliations

Soon will be listed here.

Abstract

Background: The intent of this review is to discover the types of inquiry and range of objectives and outcomes addressed in studies of the impacts of Electronic Medical Record (EMR) implementations in limited resource settings in sub-Saharan Africa.

Methods: A state-of-the-art review characterized relevant publications from bibliographic databases and grey literature repositories through systematic searching, concept-mapping, relevance and quality filter optimization, methods and outcomes categorization and key article analysis.

Results: From an initial population of 749 domain articles published before February 2015, 32 passed context and methods filters to merit full-text analysis. Relevant literature was classified by type (e.g., secondary, primary), design (e.g., case series, intervention), focus (e.g., processes, outcomes) and context (e.g., location, organization). A conceptual framework of EMR implementation determinants (systems, people, processes, products) was developed to represent current knowledge about the effects of EMRs in resource-constrained settings and to facilitate comparisons with studies in other contexts.

Discussion: This review provides an overall impression of the types and content of health informatics articles about EMR implementations in sub-Saharan Africa. Little is known about the unique effects of EMR efforts in slum settings. The available reports emphasize the complexity and impact of social considerations, outweighing product and system limitations. Summative guides and implementation toolkits were not found but could help EMR implementers.

Conclusion: The future of EMR implementation in sub-Saharan Africa is promising. This review reveals various examples and gaps in understanding how EMR implementations unfold in resource-constrained settings; and opportunities for new inquiry about how to improve deployments in those contexts.

Citing Articles

The Cancer Tracking System (CATSystem): Study protocol of a randomized control trial to evaluate a systems level intervention for cervical cancer screening, treatment, referral and follow up in Kenya.

Maloba M, Finocchario-Kessler S, Wexler C, Staggs V, Maosa N, Babu S PLoS One. 2025; 20(2):e0318941.

PMID: 39965035 PMC: 11835318. DOI: 10.1371/journal.pone.0318941.

Nurses' Perception towards Electronic Medical Records System: An Integrative Review of Barriers and Facilitators.

Maawati F, Iswanti D, Saifudin I, Dedi B Iran J Public Health. 2025; 54(1):62-73.

PMID: 39902365 PMC: 11787828. DOI: 10.18502/ijph.v54i1.17575.

Assessing the factors militating against the effective implementation of electronic health records (EHR) in Nigeria.

Babatope A, Adewumi I, Ajisafe D, Adepoju K, Babatope A Sci Rep. 2024; 14(1):31398.

PMID: 39733158 PMC: 11682428. DOI: 10.1038/s41598-024-83009-y.

"Following the data": perceptions of and willingness to use clinical decision support tools to inform HIV care among Haitian clinicians.

Secor A, Justafort J, Torrilus C, Honore J, Kiche S, Sandifer T Health Policy Technol. 2024; 13(3).

PMID: 39555144 PMC: 11567668. DOI: 10.1016/j.hlpt.2024.100880.

Cardiovascular Imaging in the Era of Precision Medicine: Insights from Advanced Technologies - A Narrative Review.

Manoel P, Dike I, Anis H, Yassin N, Wojtara M, Uwishema O Health Sci Rep. 2024; 7(11):e70173.

PMID: 39479287 PMC: 11522615. DOI: 10.1002/hsr2.70173.

References

Tierney W, Sidle J, Diero L, Sudoi A, Kiplagat J, Macharia S . Assessing the impact of a primary care electronic medical record system in three Kenyan rural health centers. J Am Med Inform Assoc. 2015; 23(3):544-52. PMC: 7839922. DOI: 10.1093/jamia/ocv074. View

Rotich J, Hannan T, Smith F, Bii J, Odero W, Vu N . Installing and implementing a computer-based patient record system in sub-Saharan Africa: the Mosoriot Medical Record System. J Am Med Inform Assoc. 2003; 10(4):295-303. PMC: 181978. DOI: 10.1197/jamia.M1301. View

Braitstein P, Einterz R, Sidle J, Kimaiyo S, Tierney W . "Talkin' about a revolution": How electronic health records can facilitate the scale-up of HIV care and treatment and catalyze primary care in resource-constrained settings. J Acquir Immune Defic Syndr. 2009; 52 Suppl 1:S54-7. DOI: 10.1097/QAI.0b013e3181bbcb67. View

Fraser H, Thomas D, Tomaylla J, Garcia N, Lecca L, Murray M . Adaptation of a web-based, open source electronic medical record system platform to support a large study of tuberculosis epidemiology. BMC Med Inform Decis Mak. 2012; 12:125. PMC: 3531253. DOI: 10.1186/1472-6947-12-125. View

Tierney W, Rotich J, Smith F, Bii J, Einterz R, Hannan T . Crossing the "digital divide:" implementing an electronic medical record system in a rural Kenyan health center to support clinical care and research. Proc AMIA Symp. 2002; :792-5. PMC: 2244335. View

Were M, Emenyonu N, Achieng M, Shen C, Ssali J, Masaba J . Evaluating a scalable model for implementing electronic health records in resource-limited settings. J Am Med Inform Assoc. 2010; 17(3):237-44. PMC: 2995711. DOI: 10.1136/jamia.2009.002303. View

Nucita A, Bernava G, Bartolo M, Masi F, Giglio P, Peroni M . A global approach to the management of EMR (electronic medical records) of patients with HIV/AIDS in sub-Saharan Africa: the experience of DREAM software. BMC Med Inform Decis Mak. 2009; 9:42. PMC: 2749819. DOI: 10.1186/1472-6947-9-42. View

Millard P, Bru J, Berger C . Open-source point-of-care electronic medical records for use in resource-limited settings: systematic review and questionnaire surveys. BMJ Open. 2012; 2(4). PMC: 3391372. DOI: 10.1136/bmjopen-2011-000690. View

Azubuike M, Ehiri J . Health information systems in developing countries: benefits, problems, and prospects. J R Soc Promot Health. 1999; 119(3):180-4. DOI: 10.1177/146642409911900309. View

10.

Kamadjeu R, Tapang E, Moluh R . Designing and implementing an electronic health record system in primary care practice in sub-Saharan Africa: a case study from Cameroon. Inform Prim Care. 2005; 13(3):179-86. DOI: 10.14236/jhi.v13i3.595. View

11.

Mohammed-Rajput N, Smith D, Mamlin B, Biondich P, Doebbeling B . OpenMRS, a global medical records system collaborative: factors influencing successful implementation. AMIA Annu Symp Proc. 2011; 2011:960-8. PMC: 3243141. View

12.

Tierney W, Rotich J, Hannan T, Siika A, Biondich P, Mamlin B . The AMPATH medical record system: creating, implementing, and sustaining an electronic medical record system to support HIV/AIDS care in western Kenya. Stud Health Technol Inform. 2007; 129(Pt 1):372-6. View

13.

Mamlin B, Biondich P, Wolfe B, Fraser H, Jazayeri D, Allen C . Cooking up an open source EMR for developing countries: OpenMRS - a recipe for successful collaboration. AMIA Annu Symp Proc. 2007; :529-33. PMC: 1839638. View

14.

Hannan T, Tierney W, Rotich J, Odero W, Smith F, Mamlin J . The MOSORIOT medical record system (MMRS) phase I to phase II implementation: an outpatient computer-based medical record system in rural Kenya. Stud Health Technol Inform. 2001; 84(Pt 1):619-22. View

15.

Kalogriopoulos N, Baran J, Nimunkar A, Webster J . Electronic medical record systems for developing countries: review. Annu Int Conf IEEE Eng Med Biol Soc. 2009; 2009:1730-3. DOI: 10.1109/IEMBS.2009.5333561. View

16.

Castelnuovo B, Kiragga A, Afayo V, Ncube M, Orama R, Magero S . Implementation of provider-based electronic medical records and improvement of the quality of data in a large HIV program in Sub-Saharan Africa. PLoS One. 2013; 7(12):e51631. PMC: 3524185. DOI: 10.1371/journal.pone.0051631. View

17.

Hannan T, Rotich J, Odero W, Menya D, Esamai F, Einterz R . The Mosoriot medical record system: design and initial implementation of an outpatient electronic record system in rural Kenya. Int J Med Inform. 2000; 60(1):21-8. DOI: 10.1016/s1386-5056(00)00068-x. View

18.

Akanbi M, Ocheke A, Agaba P, Daniyam C, Agaba E, Okeke E . Use of Electronic Health Records in sub-Saharan Africa: Progress and challenges. J Med Trop. 2014; 14(1):1-6. PMC: 4167769. View

19.

Grant M, Booth A . A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J. 2009; 26(2):91-108. DOI: 10.1111/j.1471-1842.2009.00848.x. View

20.

Fritz F, Tilahun B, Dugas M . Success criteria for electronic medical record implementations in low-resource settings: a systematic review. J Am Med Inform Assoc. 2015; 22(2):479-88. PMC: 11737103. DOI: 10.1093/jamia/ocu038. View