Roach Caleigh S, Pham Ann, Shawwa Jacob J, Ho Alan, Nee Connor, Dong George, Reina Eugenio E, Brown Jessica, Kis Matthew, Chetan Shreyas, El Gendi Mona, Borden David, Starke Robert M
Department of Neurological Surgery, University of Miami, Miami, Florida, USA; Miller School of Medicine, University of Miami, Miami, Florida, USA.
Miller School of Medicine, University of Miami, Miami, Florida, USA.
World Neurosurg. 2025 Jun;198:124048. doi: 10.1016/j.wneu.2025.124048. Epub 2025 May 8.
Neurosurgical care in Uganda faces significant challenges due to workforce shortages, infrastructure limitations, and a lack of digital health tools. Implementing electronic medical records (EMRs) and telehealth could improve neurosurgical outcomes, but adoption remains low. This systematic review examines barriers and facilitators to EMR and telehealth implementation in Ugandan neurosurgery to identify opportunities for improvement.
A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines across PubMed, Google Scholar, and Scopus to identify studies published from 2007 to 2024 evaluating EMR and telehealth adoption in Uganda. Thematic analysis categorized barriers and facilitators into 10 distinct themes. Statistical analysis for frequency and correlation with technologies were performed using χ analysis and Pearson residual tests, with statistical significance set at P < 0.1.
Key barriers include technological infrastructure inefficiencies (24%), systemic and operational limitations (16%), and technical competency and training deficits (13%). Similarly, the primary facilitators include infrastructure reliability (22%), training and education investment (13%), and community engagement (13%). Notably, telehealth adoption was more significantly impacted by human resource limitations (P < 0.05), whereas EMR implementation was hindered by systemic inefficiencies (P < 0.05).
Addressing Uganda's digital health gaps requires cost-effective and scalable strategies, including mobile-based EMRs, teleconsultation frameworks, and structured workforce training. Future research should focus on developing implementation models tailored to low-resource settings, ensuring feasibility and sustainability. This study aims to contribute to the growing discourse on digital solutions for resource-limited healthcare, with a particular emphasis on innovation in global neurosurgical care.
由于劳动力短缺、基础设施限制以及缺乏数字健康工具，乌干达的神经外科护理面临重大挑战。实施电子病历（EMR）和远程医疗可改善神经外科治疗效果，但采用率仍然很低。本系统评价旨在研究乌干达神经外科实施电子病历和远程医疗的障碍与促进因素，以确定改进机会。
按照《系统评价和Meta分析的首选报告项目2020》指南，在PubMed、谷歌学术和Scopus上进行系统评价，以识别2007年至2024年发表的评估乌干达电子病历和远程医疗采用情况的研究。主题分析将障碍和促进因素分为10个不同主题。使用χ分析和Pearson残差检验对频率及与技术的相关性进行统计分析，设定统计学显著性为P < 0.1。
主要障碍包括技术基础设施效率低下（24%）、系统和运营限制（16%）以及技术能力和培训不足（13%）。同样，主要促进因素包括基础设施可靠性（22%）、培训和教育投资（13%）以及社区参与（13%）。值得注意的是，远程医疗的采用受人力资源限制影响更大（P < 0.05），而电子病历的实施则受到系统效率低下的阻碍（P < 0.05）。
解决乌干达的数字健康差距需要具有成本效益且可扩展的策略，包括基于移动设备的电子病历、远程会诊框架以及结构化的劳动力培训。未来的研究应侧重于开发适合资源匮乏环境的实施模式，确保可行性和可持续性。本研究旨在为关于资源有限的医疗保健数字解决方案的日益增多的讨论做出贡献，尤其强调全球神经外科护理的创新。
