Institute of Medical Informatics, University of Münster, Münster, Germany.
JMIR Med Inform. 2015 May 25;3(2):e22. doi: 10.2196/medinform.4106.
Electronic medical record (EMR) systems are increasingly being implemented in hospitals of developing countries to improve patient care and clinical service. However, only limited evaluation studies are available concerning the level of adoption and determinant factors of success in those settings.
The objective of this study was to assess the usage pattern, user satisfaction level, and determinants of health professional's satisfaction towards a comprehensive EMR system implemented in Ethiopia where parallel documentation using the EMR and the paper-based medical records is in practice.
A quantitative, cross-sectional study design was used to assess the usage pattern, user satisfaction level, and determinant factors of an EMR system implemented in Ethiopia based on the DeLone and McLean model of information system success. Descriptive statistical methods were applied to analyze the data and a binary logistic regression model was used to identify determinant factors.
Health professionals (N=422) from five hospitals were approached and 406 responded to the survey (96.2% response rate). Out of the respondents, 76.1% (309/406) started to use the system immediately after implementation and user training, but only 31.7% (98/309) of the professionals reported using the EMR during the study (after 3 years of implementation). Of the 12 core EMR functions, 3 were never used by most respondents, and they were also unaware of 4 of the core EMR functions. It was found that 61.4% (190/309) of the health professionals reported over all dissatisfaction with the EMR (median=4, interquartile range (IQR)=1) on a 5-level Likert scale. Physicians were more dissatisfied (median=5, IQR=1) when compared to nurses (median=4, IQR=1) and the health management information system (HMIS) staff (median=2, IQR=1). Of all the participants, 64.4% (199/309) believed that the EMR had no positive impact on the quality of care. The participants indicated an agreement with the system and information quality (median=2, IQR=0.5) but strongly disagreed with the service quality (median=5, IQR=1). The logistic regression showed a strong correlation between system use and dissatisfaction (OR 7.99, 95% CI 5.62-9.10) and service quality and satisfaction (OR 8.23, 95% CI 3.23-17.01).
Health professionals' use of the EMR is low and they are generally dissatisfied with the service of the implemented system. The results of this study show that this dissatisfaction is caused mainly and strongly by the poor service quality, the current practice of double documentation (EMR and paper-based), and partial departmental use of the system in the hospitals. Thus, future interventions to improve the current use or future deployment projects should focus on improving the service quality such as power infrastructure, user support, trainings, and more computers in the wards. After service quality improvement, other departments (especially inter-dependent departments) should be motivated and supported to use the EMR to avoid the dependency deadlock.
电子病历 (EMR) 系统在发展中国家的医院中越来越多地被采用，以改善患者护理和临床服务。然而，关于这些环境中采用水平和成功的决定因素，只有有限的评估研究可用。
本研究旨在评估在埃塞俄比亚实施的综合 EMR 系统的使用模式、用户满意度水平以及卫生专业人员对该系统的满意度的决定因素，该系统同时使用 EMR 和纸质病历进行平行记录。
采用基于 DeLone 和 McLean 信息系统成功模型的定量、横断面研究设计来评估在埃塞俄比亚实施的 EMR 系统的使用模式、用户满意度水平和决定因素。应用描述性统计方法分析数据，并使用二元逻辑回归模型确定决定因素。
对来自五家医院的 422 名卫生专业人员进行了调查，其中 406 名（96.2%的应答率）作出了回应。在应答者中，76.1%（309/406）在实施和用户培训后立即开始使用该系统，但只有 31.7%（98/309）的专业人员在研究期间（实施后 3 年）报告使用 EMR。在 12 项核心 EMR 功能中，大多数受访者从未使用过其中 3 项功能，并且他们也不知道其中 4 项核心 EMR 功能。结果发现，61.4%（190/309）的卫生专业人员对 EMR 总体不满意（中位数=4，四分位距（IQR）=1），使用 5 级李克特量表进行评估。与护士（中位数=4，IQR=1）和卫生管理信息系统（HMIS）工作人员（中位数=2，IQR=1）相比，医生更不满意（中位数=5，IQR=1）。在所有参与者中，64.4%（199/309）认为 EMR 对护理质量没有积极影响。参与者表示同意系统和信息质量（中位数=2，IQR=0.5），但强烈不同意服务质量（中位数=5，IQR=1）。逻辑回归显示系统使用与不满之间存在很强的相关性（OR 7.99，95%CI 5.62-9.10）和服务质量与满意度之间存在很强的相关性（OR 8.23，95%CI 3.23-17.01）。
卫生专业人员对 EMR 的使用水平较低，他们普遍对实施系统的服务不满意。本研究结果表明，这种不满主要是由服务质量差、当前实施的双重记录（EMR 和纸质记录）以及医院部分部门使用该系统引起的。因此，未来改善当前使用或未来部署项目的干预措施应侧重于改善服务质量，例如电力基础设施、用户支持、培训以及病房中的更多计算机。在服务质量得到改善后，应激励和支持其他部门（特别是相互依存的部门）使用 EMR，以避免依赖关系的僵局。
