Venkateswaran Mahima, Nazzal Zaher, Ghanem Buthaina, Khraiwesh Reham, Abbas Eatimad, Abu Khader Khadija, Awwad Tamara, Hijaz Taghreed, Isbeih Mervett, Mørkrid Kjersti, Rose Christopher James, Frøen J Frederik
Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway.
Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
JMIR Form Res. 2022 May 13;6(5):e34021. doi: 10.2196/34021.
Digital health interventions have been shown to improve data quality and health services in low- and middle-income countries (LMICs). Nonetheless, in LMICs, systematic assessments of time saved with the use of digital tools are rare. We ran a set of cluster-randomized controlled trials as part of the implementation of a digital maternal and child health registry (eRegistry) in the West Bank, Palestine.
In the eRegTime study, we compared time spent on health information management in clinics that use the eRegistry versus the existing paper-based documentation system.
Intervention (eRegistry) and control (paper documentation) arms were defined by a stratified random subsample of primary health care clinics from the concurrent eRegQual trial. We used time-motion methodology to collect data on antenatal care service provision. Four observers used handheld tablets to record time-use data during one working day per clinic. We estimated relative time spent on health information management for booking and follow-up visits and on client care using mixed-effects linear regression.
In total, 22 of the 24 included clinics (12 intervention, 10 control) contributed data; no antenatal care visits occurred in the other two clinics during the study period. A total of 123 and 118 consultations of new pregnancy registrations and follow-up antenatal care visits were observed in the intervention and control groups, respectively. Average time spent on health information management for follow-up antenatal care visits in eRegistry clinics was 5.72 minutes versus 8.10 minutes in control clinics (adjusted relative time 0.69, 95% CI 0.60-0.79; P<.001), and 15.26 minutes versus 18.91 minutes (adjusted relative time 0.96, 95% CI 0.61-1.50; P=.85) for booking visits. The average time spent on documentation, a subcategory of health information management, was 5.50 minutes in eRegistry clinics versus 8.48 minutes in control clinics (adjusted relative time 0.68, 95% CI 0.56-0.83; P<.001). While the average time spent on client care was 5.01 minutes in eRegistry clinics versus 4.91 minutes in control clinics, some uncertainty remains, and the CI was consistent with eRegistry clinics using less, the same, or more time on client care compared to those that use paper (adjusted relative time 0.85, 95% CI 0.64-1.13; P=.27).
The eRegistry captures digital data at point of care during client consultations and generates automated routine reports based on the clinical data entered. Markedly less time (plausibly a saving of at least 18%) was spent on health information management in eRegistry clinics compared to those that use paper-based documentation. This is likely explained by the fact that the eRegistry requires lesser repetitive documentation work than paper-based systems. Adoption of eRegistry-like systems in comparable settings may save valuable and scarce health care resources.
ISRCTN registry ISRCTN18008445; https://doi.org/10.1186/ISRCTN18008445.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/13653.
数字健康干预已被证明可改善低收入和中等收入国家（LMICs）的数据质量和卫生服务。尽管如此，在低收入和中等收入国家，对使用数字工具节省的时间进行系统评估的情况却很少见。作为在巴勒斯坦约旦河西岸实施数字孕产妇和儿童健康登记册（电子登记册）的一部分，我们开展了一组整群随机对照试验。
在电子登记时间研究中，我们比较了使用电子登记册的诊所与现有的纸质文档系统在健康信息管理上所花费的时间。
干预组（电子登记册）和对照组（纸质文档）由同期电子登记质量试验中的初级保健诊所分层随机子样本确定。我们使用时间动作研究方法收集产前护理服务提供的数据。四名观察员使用手持平板电脑在每个诊所的一个工作日记录时间使用数据。我们使用混合效应线性回归估计在预约和随访就诊以及客户护理方面在健康信息管理上花费的相对时间。
在纳入的24家诊所中，共有22家（12家干预组，10家对照组）提供了数据；在研究期间，另外两家诊所没有进行产前护理就诊。干预组和对照组分别观察到123次和118次新妊娠登记和随访产前护理就诊的咨询。电子登记册诊所中随访产前护理就诊在健康信息管理上花费的平均时间为5.72分钟，而对照组诊所为8.10分钟（调整后的相对时间为0.69，95%CI为0.60 - 0.79；P <.001），预约就诊的时间分别为15.26分钟和18.91分钟（调整后的相对时间为0.96，95%CI为0.61 - 1.50；P = 0.85）。在健康信息管理的一个子类别文档记录上花费的平均时间，电子登记册诊所为5.50分钟，对照组诊所为8.48分钟（调整后的相对时间为0.68，95%CI为0.56 - 0.83；P <.001）。虽然电子登记册诊所中在客户护理上花费的平均时间为5.01分钟，对照组诊所为4.91分钟，但仍存在一些不确定性，并且置信区间表明与使用纸质文档的诊所相比，电子登记册诊所在客户护理上花费的时间可能更少、相同或更多（调整后的相对时间为0.85，95%CI为0.64 - 1.13；P = 0.27）。
电子登记册在客户咨询期间的护理点捕获数字数据，并根据输入的临床数据生成自动化常规报告。与使用纸质文档的诊所相比，电子登记册诊所在健康信息管理上花费的时间明显更少（可能至少节省18%）。这可能是因为电子登记册比纸质系统所需的重复文档工作更少。在类似环境中采用类似电子登记册的系统可能会节省宝贵且稀缺的医疗资源。
ISRCTN注册库ISRCTN18008445；https://doi.org/10.1186/ISRCTN18008445。
国际注册报告识别码（IRRID）：RR2 - 10.2196/13653。
