title: Implementation of provider-based electronic medical records and improvement of the quality of data in a large HIV program in Sub-Saharan Africa.
abstract: BACKGROUND
  Starting in June 2010 the Infectious Diseases Institute (IDI) clinic (a large urban HIV out-patient facility) switched to provider-based Electronic Medical Records (EMR) from paper EMR entered in the database by data-entry clerks. Standardized clinics forms were eliminated but providers still fill free text clinical notes in physical patients' files. The objective of this study was to compare the rate of errors in the database before and after the introduction of the provider-based EMR.
  
  
  RESULTS
  Data in the database pre and post provider-based EMR was compared with the information in the patients' files and classified as correct, incorrect, and missing. We calculated the proportion of incorrect, missing and total error for key variables (toxicities, opportunistic infections, reasons for treatment change and interruption). Proportions of total errors were compared using chi-square test. A survey of the users of the EMR was also conducted. We compared data from 2,382 visits (from 100 individuals) of a retrospective validation conducted in 2007 with 34,957 visits (from 10,920 individuals) of a prospective validation conducted in April-August 2011. The total proportion of errors decreased from 66.5% in 2007 to 2.1% in 2011 for opportunistic infections, from 51.9% to 3.5% for ART toxicity, from 82.8% to 12.5% for reasons for ART interruption and from 94.1% to 0.9% for reasons for ART switch (all P<0.0001). The survey showed that 83% of the providers agreed that provider-based EMR led to improvement of clinical care, 80% reported improved access to patients' records, and 80% appreciated the automation of providers' tasks.
  
  
  CONCLUSIONS
  The introduction of provider-based EMR improved the quality of data collected with a significant reduction in missing and incorrect information. The majority of providers and clients expressed satisfaction with the new system. We recommend the use of provider-based EMR in large HIV programs in Sub-Saharan Africa.
authors.affiliation: Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda. bcastelnuovo@idi.co.ug
authors.forename: Barbara
authors.initials: B
authors.lastname: Castelnuovo
authors.forename: Agnes
authors.initials: A
authors.lastname: Kiragga
authors.forename: Victor
authors.initials: V
authors.lastname: Afayo
authors.forename: Malisa
authors.initials: M
authors.lastname: Ncube
authors.forename: Richard
authors.initials: R
authors.lastname: Orama
authors.forename: Stephen
authors.initials: S
authors.lastname: Magero
authors.forename: Peter
authors.initials: P
authors.lastname: Okwi
authors.forename: Yukari C
authors.initials: YC
authors.lastname: Manabe
authors.forename: Andrew
authors.initials: A
authors.lastname: Kambugu
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D020000:Decision Support Systems, Clinical; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006678:HIV; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D016730:Program Development; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires