Determinants of utilization of electronic health records among public health facilities in Machakos county, Kenya

Abstract

The ideal electronic health system should improve patient care, reduce patient turnaround times, and allow users to leverage secondary data to enhance health care delivery and outcomes. Information technologies are starting to be accepted in the healthcare industry as instruments for enhancing accountability, efficiency, and service delivery. Several factors: the capacity building, insufficient technical support besides insufficient leadership in the healthcare sector have hindered the adoption of EHR systems. The broad objective of the study was to identify the determinants of the adoption of electronic health records in Machakos County public health facilities. The specific objectives included identifying the organizational, management, health worker, and health facility factors that affect the uptake of electronic health records in particular public health facilities. The study unit was the health facility focusing on health providers who handle data and service provision, including hospital management officers (facility in-charges, medical officers of health, and clinicians), ICT officers, and healthcare workers. The study employed a cross-sectional analytical design with a focus on the healthcare staff at the designated public health facilities. The sampling procedure used was purposive sampling and stratified random sampling technique and a total of 411 respondents were reached in the 8 health facilities selected for this study. During the study, 8 key informants were interviewed using an interview guide to obtain qualitative data. SPSS, was used to analyse the data. Chi-square test was utilized. Statistical significance tests considered a p-value of less than 0.05 to be significant. NVIVO was used for the analysis of qualitative data. The 253 (61.6%) of the participants had computers in most of the clinics/departments, with the facility has adequate hardware and software set up (p=0.041) being significant.Skills to operate the electronic health records system (p=0.035) and the health care workers having positive perception on the systems use (p=0.050) were significant. On organizational factors such as the finances needed to procure and implement an EMR system was significant (p=0.023), and the sufficiency mechanisms to build capacity for a new EMR system (p=0.041) were statistically significant. The results indicated that 291 (70.8%) of the health facilities had a core management team and there was significant association between the system being guided by an appropriate strategic framework (p=0.039), and the systems being implemented supported by all department heads (p=0.047). The study's concluded that health workers related factors such as ICT literacy, health facility factors like reliable hardware and software infrastructure, organizational factors resource availability, capacity building and technical expertise, and managerial factors such as strong commitment from leadership are key factors to ensure a successful implementation of an electronic health records system. The study recommends that it is key to provide infrastructure both hardware and software, capacity building of healthcare workers on their ICT skills and familiarize them with EMR systems. Hospital management should be actively involved in EMR planning and implementation. Establish mechanisms to regularly monitor and evaluate EMR usage, identify system gaps, and act on feedback from users to improve system performance and usability.