ElectronicHealthcare

ElectronicHealthcare 11(1) June 2012 : e14-e24
Feature

An Electronic Medical Record (EMR) Implementation Framework for HIV Care and Treatment Facilities in Ethiopia

Mikael Gebre-Mariam, Elizabeth Borycki, Andre Kushniruk and Mary Ellen Purkis

Abstract

Purpose: Implementing electronic medical record (EMR) systems is a complex process that is receiving more focus in developing countries to help understaffed and overcrowded health facilities deal with the HIV/AIDS epidemic. Despite growing evidence of EMR systems implementation in various developing countries to support acute and chronic disease management, use of these systems by clinicians for patient monitoring and management is limited in many sub-Saharan African countries.

Methods: We undertook an exploratory-grounded theory study to explore clinician-perceived benefits of EMRs in antiretroviral therapy (ART) clinics at four hospitals in Ethiopia. The study was designed to understand the process, technology, social and organizational challenges associated with EMR implementation in resource-limited areas.

Results: The research found the attitude of ART clinicians toward the implementation of EMR systems overwhelmingly positive. Clinician-perceived benefits associated with EMR use included improved continuity of care; timely access to a complete medical record; improved efficiency of patient care; fewer medication errors; improved patient confidentiality, integration of HIV programs and decision-support timelines; and increased overall job motivation. However, clinician-identified drawbacks to EMR implementation included productivity loss and negative impacts on interactions and relationships between clinicians and their patients.

Conclusion: The study adds to existing frameworks by developing an EMR implementation framework that integrates socio–organizational–technical factors addressing the complexity of healthcare institutions in developing countries. We took a bottom-up approach to understand these contextual factors in which an EMR would be embedded in order to develop a defensible conceptual framework encompassing key organizational, technological, infrastructural and user attributes essential for successful EMR implementation in a developing country context.

 

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