Bostan Sarah, Johnson Owen A, Jaspersen Lena J, Randell Rebecca
Leeds University Business School, University of Leeds, Leeds, United Kingdom.
School of Healthcare, University of Leeds, Leeds, United Kingdom.
J Med Internet Res. 2024 Aug 1;26:e45242. doi: 10.2196/45242.
Low- and lower-middle-income countries account for a higher percentage of global epidemics and chronic diseases. In most low- and lower-middle-income countries, there is limited access to health care. The implementation of open-source electronic health records (EHRs) can be understood as a powerful enabler for low- and lower-middle-income countries because it can transform the way health care technology is delivered. Open-source EHRs can enhance health care delivery in low- and lower-middle-income countries by improving the collection, management, and analysis of health data needed to inform health care delivery, policy, and planning. While open-source EHR systems are cost-effective and adaptable, they have not proliferated rapidly in low- and lower-middle-income countries. Implementation barriers slow adoption, with existing research focusing predominantly on technical issues preventing successful implementation.
This interdisciplinary scoping review aims to provide an overview of contextual barriers affecting the adaptation and implementation of open-source EHR systems in low- and lower-middle-income countries and to identify areas for future research.
We conducted a scoping literature review following a systematic methodological framework. A total of 7 databases were selected from 3 disciplines: medicine and health sciences, computing, and social sciences. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The Mixed Methods Appraisal Tool and the Critical Appraisal Skills Programme checklists were used to assess the quality of relevant studies. Data were collated and summarized, and results were reported qualitatively, adopting a narrative synthesis approach.
This review included 13 studies that examined open-source EHRs' adaptation and implementation in low- and lower-middle-income countries from 3 interrelated perspectives: socioenvironmental, technological, and organizational barriers. The studies identified key issues such as limited funding, sustainability, organizational and management challenges, infrastructure, data privacy and protection, and ownership. Data protection, confidentiality, ownership, and ethics emerged as important issues, often overshadowed by technical processes.
While open-source EHRs have the potential to enhance health care delivery in low- and lower-middle-income-country settings, implementation is fraught with difficulty. This scoping review shows that depending on the adopted perspective to implementation, different implementation barriers come into view. A dominant focus on technology distracts from socioenvironmental and organizational barriers impacting the proliferation of open-source EHRs. The role of local implementing organizations in addressing implementation barriers in low- and lower-middle-income countries remains unclear. A holistic understanding of implementers' experiences of implementation processes is needed. This could help characterize and solve implementation problems, including those related to ethics and the management of data protection. Nevertheless, this scoping review provides a meaningful contribution to the global health informatics discipline.
低收入和中低收入国家在全球流行病和慢性病中所占比例较高。在大多数低收入和中低收入国家，获得医疗保健的机会有限。开源电子健康记录（EHR）的实施可被视为低收入和中低收入国家的有力推动因素，因为它可以改变医疗保健技术的提供方式。开源EHR可以通过改进为医疗保健提供、政策和规划提供信息所需的健康数据的收集、管理和分析，来加强低收入和中低收入国家的医疗保健服务。虽然开源EHR系统具有成本效益且适应性强，但它们在低收入和中低收入国家并未迅速普及。实施障碍减缓了采用速度，现有研究主要集中在阻碍成功实施的技术问题上。
本跨学科范围综述旨在概述影响低收入和中低收入国家开源EHR系统适应和实施的背景障碍，并确定未来研究的领域。
我们按照系统的方法框架进行了范围文献综述。从医学与健康科学、计算机科学和社会科学这3个学科中总共选择了7个数据库。研究结果按照PRISMA-ScR（系统评价和Meta分析扩展的范围综述的首选报告项目）清单进行报告。使用混合方法评估工具和批判性评估技能计划清单来评估相关研究的质量。对数据进行整理和总结，并采用叙述性综合方法定性报告结果。
本综述纳入了13项研究，这些研究从社会环境、技术和组织障碍这3个相互关联的角度考察了开源EHR在低收入和中低收入国家的适应和实施情况。这些研究确定了一些关键问题，如资金有限、可持续性、组织和管理挑战、基础设施、数据隐私和保护以及所有权。数据保护、保密性、所有权和伦理成为重要问题，这些问题常常被技术流程所掩盖。
虽然开源EHR有潜力加强低收入和中低收入国家的医疗保健服务，但实施充满困难。本范围综述表明，根据所采用的实施视角，会出现不同的实施障碍。对技术的主导关注分散了对影响开源EHR普及的社会环境和组织障碍的注意力。当地实施组织在解决低收入和中低收入国家实施障碍方面的作用仍不明确。需要对实施者在实施过程中的经验有全面的了解。这有助于描述和解决实施问题，包括与伦理和数据保护管理相关的问题。尽管如此，本范围综述为全球健康信息学学科做出了有意义的贡献。
