Kessy Eusebi Cornelius, Kibusi Stephen Mathew, Ntwenya Julius Edward
School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania.
Front Digit Health. 2024 Feb 12;5:1259268. doi: 10.3389/fdgth.2023.1259268. eCollection 2023.
Tanzania has shown some improvements in the adoption of electronic medical record (EMR) systems in public health facilities; however, the rate of utilization of data generated from EMRs among health managers is not well documented. This study aims to assess the use of electronic medical record systems data in decision-making among health managers at public primary health facilities in Dodoma Region, Central Tanzania.
A facility-based quantitative cross-sectional analytical study was conducted among 308 randomly selected health managers. A self-administered questionnaire supplemented with documentary review was used. Descriptive summary statistics and bivariable and multivariable logistic regression analyses (crude and adjusted odds ratios) were used. A -value of <0.05 was used to declare statistically significant associations.
Overall, more than a third (40.6%) of the health managers, that is 174 of the 308 included in the study, reported using data generated by EMR systems in decision-making. One-third (33.4%) of the health managers were adequately using data generated by EMR systems, of which 39.3% used data to support continuous quality improvement initiatives. Among the facilities visited, only nine (30%) had good documented EMR systems data use. Access to computers [adjusted odds ratio (AOR) = 4.72, 95% confidence interval (CI): 1.65, 13.48, -value () = 0.004] and discussions on EMRs during meetings (AOR = 2.77, 95% CI: 1.01, 7.58, = 0.047) were independent predictors of EMR system data use. Those who reported having EMR systems in all working areas were seven times more likely to use EMR system data (AOR = 7.23, 95% CI: 3.15, 16.59, = 0.001). The respondents with good perceived EMR system information quality were more likely to use EMR system data (AOR = 2.84, 95% CI: 1.50, 5.39, = 0.001) than those with poor perception. Furthermore, health managers who had excellent knowledge of computers and data use had higher odds of using EMR system data (AOR = 1.84, 95% CI: 3.38, 10.13, = 0.001) compared with their counterparts.
The findings of this study indicate that utilization of EMR system data in decision-making among health managers was optimal. It was found that training in itself is insufficient to improve use of EMR, which points to more organizational aspects of work routine as a challenge. Hence, a comprehensive approach that addresses these factors is essential for maximizing EMR system data use in decision-making.
坦桑尼亚在公共卫生设施采用电子病历（EMR）系统方面已取得一些进展；然而，卫生管理人员对电子病历所产生数据的利用率情况尚无充分记录。本研究旨在评估坦桑尼亚中部多多马地区公立基层卫生机构的卫生管理人员在决策过程中对电子病历系统数据的使用情况。
对308名随机抽取的卫生管理人员开展了一项基于机构的定量横断面分析研究。采用了一份自填式问卷并辅以文献回顾。使用了描述性汇总统计以及双变量和多变量逻辑回归分析（粗比值比和调整比值比）。采用<0.05的P值来判定具有统计学意义的关联。
总体而言，超过三分之一（40.6%）的卫生管理人员，即研究纳入的308人中的174人，报告在决策过程中使用了电子病历系统生成的数据。三分之一（33.4%）的卫生管理人员充分利用了电子病历系统生成的数据，其中39.3%利用数据来支持持续质量改进举措。在所走访的机构中，只有9家（30%）有完善记录的电子病历系统数据使用情况。能使用计算机[调整比值比（AOR）=4.72，95%置信区间（CI）：1.65，13.48，P值（P）=0.004]以及在会议期间就电子病历进行讨论（AOR=2.77，95%CI：1.01，7.58，P=0.047）是电子病历系统数据使用的独立预测因素。报告在所有工作区域都有电子病历系统的人员使用电子病历系统数据的可能性高出7倍（AOR=7.23，95%CI：3.15，16.59，P=0.001）。认为电子病历系统信息质量良好的受访者比认为质量差的受访者更有可能使用电子病历系统数据（AOR=2.84，95%CI：1.50，5.39，P=0.001）。此外，与同行相比，对计算机和数据使用有出色知识的卫生管理人员使用电子病历系统数据的几率更高（AOR=1.84，95%CI：3.38，10.13，P=0.001）。
本研究结果表明，卫生管理人员在决策过程中对电子病历系统数据的利用情况处于最佳水平。研究发现培训本身不足以提高电子病历的使用，这表明日常工作的更多组织层面是一项挑战。因此，应对这些因素的综合方法对于在决策中最大限度地利用电子病历系统数据至关重要。
