title: Is transcription of data on antiretroviral treatment from electronic to paper-based registers reliable in Malawi?
abstract: METHODS
  Antiretroviral treatment (ART) clinics at one central hospital, three district hospitals and one mission hospital in the central and southern regions of Malawi.
  
  
  OBJECTIVE
  To measure the extent of inaccuracies in the transcription of case registration and recorded deaths between electronic medical data (EMR) and paper registers. This was done to inform the Ministry of Health on the reliability of the paper-based system as backup in case of EMR failure.
  
  
  METHODS
  Retrospective analysis of routine programme data.
  
  
  RESULTS
  A total of 31 763 registrations and 2922 deaths in the EMR were compared with those in the paper registers. In one hospital, up to 24% of overall case registrations were missing from the paper registers. At other sites, the differences were minor and included duplicate patients who should have been classified as 'transfer in' patients in the paper register. There were major differences in the number of registered deaths in two of the five facilities.
  
  
  CONCLUSIONS
  There are varying degrees of agreement between the EMR and paper registers which compromise the use of the latter as a backup solution in case of EMR failure. The reasons for this unreliability and ways forward to address the problem are discussed.
authors.affiliation: Baobab Health Trust, Lilongwe, Malawi.
authors.forename: O J
authors.initials: OJ
authors.lastname: Gadabu
authors.affiliation: Baobab Health Trust, Lilongwe, Malawi.
authors.forename: C V
authors.initials: CV
authors.lastname: Munthali
authors.affiliation: Médecins Sans Frontières, Brussels, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
authors.affiliation: Médecins Sans Frontières, Brussels, Belgium ; Center for International Health, University of Bergen, Bergen, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Gudmund-Hinderaker
authors.affiliation: Department of HIV/AIDS, Ministry of Health, Lilongwe, Malawi.
authors.forename: A
authors.initials: A
authors.lastname: Jahn
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; The Lighthouse Trust, Lilongwe, Malawi.
authors.forename: H
authors.initials: H
authors.lastname: Twea
authors.affiliation: Baobab Health Trust, Lilongwe, Malawi.
authors.forename: A
authors.initials: A
authors.lastname: Gondwe
authors.affiliation: Baobab Health Trust, Lilongwe, Malawi.
authors.forename: S
authors.initials: S
authors.lastname: Mumba
authors.affiliation: Queen Elizabeth Central Hospital, Lilongwe, Malawi.
authors.forename: M
authors.initials: M
authors.lastname: Lungu
authors.affiliation: Queen Elizabeth Central Hospital, Lilongwe, Malawi.
authors.forename: K
authors.initials: K
authors.lastname: Malisita
authors.affiliation: Department of HIV/AIDS, Ministry of Health, Lilongwe, Malawi.
authors.forename: E
authors.initials: E
authors.lastname: Mhango
authors.affiliation: Department of HIV/AIDS, Ministry of Health, Lilongwe, Malawi.
authors.forename: S D
authors.initials: SD
authors.lastname: Makombe
authors.affiliation: Department of HIV/AIDS, Ministry of Health, Lilongwe, Malawi.
authors.forename: L
authors.initials: L
authors.lastname: Tenthani
authors.affiliation: Centres for Disease Control and Prevention, Lilongwe, Malawi.
authors.forename: L
authors.initials: L
authors.lastname: Mwalwanda
authors.affiliation: Centre for Monitoring Evaluation Division, Ministry of Health, Lilongwe, Malawi.
authors.forename: C
authors.initials: C
authors.lastname: Moyo
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: G P
authors.initials: GP
authors.lastname: Douglas
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Z L
authors.initials: ZL
authors.lastname: Lewis
authors.affiliation: Department of HIV/AIDS, Ministry of Health, Lilongwe, Malawi.
authors.forename: F
authors.initials: F
authors.lastname: Chimbwandira
keywords: Malawi; electronic medical record; paper register; transcription