title: Evaluating a scalable model for implementing electronic health records in resource-limited settings.
abstract: Current models for implementing electronic health records (EHRs) in resource-limited settings may not be scalable because they fail to address human-resource and cost constraints. This paper describes an implementation model which relies on shared responsibility between local sites and an external three-pronged support infrastructure consisting of: (1) a national technical expertise center, (2) an implementer's community, and (3) a developer's community. This model was used to implement an open-source EHR in three Ugandan HIV-clinics. Pre-post time-motion study at one site revealed that Primary Care Providers spent a third less time in direct and indirect care of patients (p<0.001) and 40% more time on personal activities (p=0.09) after EHRs implementation. Time spent by previously enrolled patients with non-clinician staff fell by half (p=0.004) and with pharmacy by 63% (p<0.001). Surveyed providers were highly satisfied with the EHRs and its support infrastructure. This model offers a viable approach for broadly implementing EHRs in resource-limited settings.
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA. mwere@regenstrief.org
authors.forename: Martin C
authors.initials: MC
authors.lastname: Were
authors.forename: Nneka
authors.initials: N
authors.lastname: Emenyonu
authors.forename: Marion
authors.initials: M
authors.lastname: Achieng
authors.forename: Changyu
authors.initials: C
authors.lastname: Shen
authors.forename: John
authors.initials: J
authors.lastname: Ssali
authors.forename: John P M
authors.initials: JP
authors.lastname: Masaba
authors.forename: William M
authors.initials: WM
authors.lastname: Tierney
mesh_terms: D000555:Ambulatory Care Information Systems / Q000191:economics / Q000458:organization & administration*; D003256:Community Participation; D003258:Consumer Behavior; D003363:Cost Control; D003906:Developing Countries; D057286:Electronic Health Records / Q000191:economics / Q000458:organization & administration*; D015658:HIV Infections; D006284:Health Plan Implementation / Q000191:economics / Q000458:organization & administration*; D006290:Health Planning Technical Assistance; D006801:Humans; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D013996:Time and Motion Studies; D014454:Uganda