Muinga Naomi, Magare Steve, Monda Jonathan, Kamau Onesmus, Houston Stuart, Fraser Hamish, Powell John, English Mike, Paton Chris
KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya.
e-Health and Systems Development Unit, Ministry of Health, Nairobi, Kenya.
JMIR Med Inform. 2018 Apr 18;6(2):e22. doi: 10.2196/medinform.8403.
The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system.
We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya.
We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation.
This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of sociotechnical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya.
Implementing electronic health record systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing, but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. Strategies such as creating local support teams, using local development resources, ensuring end user buy-in, and rolling out in smaller facilities before larger hospitals are being incorporated into the project. These are positive developments to help maintain momentum as the project continues. Further integration with existing open source communities could help ongoing development and implementations of the project. We hope this case study will provide some lessons and guidance for other challenging implementations of electronic health record systems as they continue across Africa.
肯尼亚政府与国际伙伴及当地组织合作，制定了电子健康战略、公立医院采用电子健康记录的特定标准和指南，并实施了两个重大的健康信息技术项目：用于整理国家医疗保健指标的地区健康信息软件版本2，以及推广肯尼亚电子病历和国际优质护理健康管理信息系统，用于管理全国600家艾滋病毒诊所。在这些项目之后，指定并开发了开放医疗记录系统电子健康记录的一个修改版本，以满足肯尼亚权力下放县运营的医疗机构的临床和行政要求，并使整理医疗保健指标并将其输入地区健康信息软件版本2系统的过程自动化。
我们旨在介绍肯尼亚公共卫生保健机构实施开源电子健康记录系统的描述性案例研究。
我们对肯尼亚电子健康政策和电子健康记录发展的现有文献进行了综述。在与卫生部、世界卫生组织及实施伙伴进行初步讨论之后，我们对实施地点进行了一系列访问，与利益相关者进行半结构化个人访谈和小组讨论，以形成该实施的历史案例研究。
本案例研究描述了驻肯尼亚的顾问与印度的开发者及项目利益相关者合作，如何在肯尼亚农村一个县的几家公立医院实施新系统。实施过程包括升级医院信息技术基础设施、培训用户，并试图获得行政和临床方面对采用该系统的认可。由于社会技术和行政问题的复杂组合，最初的部署最终缩减。从这些早期挑战中吸取教训后，该系统目前正在重新设计，并准备在肯尼亚的6个新县进行部署。
在高收入环境中实施电子健康记录系统是一个具有挑战性的过程。在肯尼亚等低收入环境中，开源软件可能会缓解软件许可的高昂成本，但临床和行政认可方面常见的挑战、充分培训用户的必要性以及持续提供技术支持的必要性在南北之间是共有的。诸如创建本地支持团队、利用本地开发资源、确保最终用户认可以及在大型医院之前先在较小设施中推出等策略正在纳入该项目。随着项目的继续，这些都是有助于保持势头的积极进展。与现有开源社区的进一步整合可能有助于该项目的持续开发和实施。我们希望本案例研究将为非洲其他具有挑战性的电子健康记录系统实施提供一些经验教训和指导。
