A case study to investigate the challenges of EMR implementation in four district Hospitals in Rwanda

Abstract

Purpose: Although there are numerous documented advantages and benefits in incorporating electronic medical record (EMR) in patient care management, 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, including Rwanda. Method: A cross sectional study was conducted to investigate the challenges of EMR implementation in 4 urban district hospitals in Kigali, Rwanda. The study was designed to understand the EMR users’ system knowledge, and factors surrounding their satisfaction. A questionnaire with Likert-scale and open-ended questions was administered to hospital workers who used EMR on daily basis. Results: 64 respondents completed the questionnaires. The study showed most respondents were in favor of EMR. All respondents unanimously accepted the importance for hospitals to use EMR systems. A significant of percentage of respondents preferred the EMR over manual paper based systems and would recommend EMR to other users. This results indicated in general users have positive attitude towards EMR, regardless their professional category or the amount of EMR training they have received. People found EMR system was easy to navigate and perform data entry. Despite the general favorable opinion, EMR did not affect the productivity of staff. It is evident that insufficient training was still a major implementation gap. Not only a significant portion of users did not receive any EMR training, among the ones who had, the majority only had less than 20 hours training. Most respondents requested to add or enhance the functions to the EMR system, possibly include report generation and billing; which could probably increase the productivity too. Conclusions: Overall, there is positive attitude about the contributions of an EMR system and system usage and user satisfaction is largely influenced by perceived usefulness. More training should be provided to the users. Features and functions of EMR should also be customized to meet the needs of individual departments. Internet connectivity and computer maintenance services remain a challenge. Effort should be provided to maintain and support EMR on ongoing basis. It will be beneficial to establish a central help desk that can support the implementation and to streamline the support process. Adopting evidence-based best implementation practices from other similar programs that was proven successful could also be beneficial. Similar study to include more hospitals and more samples as EMR rolls out to more hospitals should be conducted to quantify any resulting change in attitudes. Other important areas of EMR worth studying include cost, efficiency, accuracy, and data quality.