Framework for the implementation of Electronic Medical Records In Public Teaching and Referral Hospitals in Kenya

Abstract

The growing global trend towards Electronic Medical Records (EMRs) is driven by the acknowledgment that healthcare is information and knowledge-based service. Providing access to reliable information which can be accessed in a timely manner is the most effective strategy for improving and facilitating the quality of healthcare delivery process. In Kenya however, healthcare providers have had a slow transition to Electronic Medical Records. Subsequently this study was set out to examine the utilization of Electronic Medical Records in provision of health care services to the clients of Public Teaching and Referral Hospitals in Kenya with a view of developing an implementation framework. The objectives of the study were to establish the type of medical records management systems existing in Public Teaching and Referral Hospitals in Kenya; examine the adequacy of the organization infrastructure in supporting the application of EMR in the provision of health care services; determine the extent to which electronic medical records are utilized in the provision of healthcare services to patients. examine the challenges encountered in the application of the EMR in the provision of health care services at these hospitals, and propose a framework of enhancing the use of EMR in public teaching and referral hospitals. The study was informed by Diffusion of Innovations theory and the Design and Implementation of Records Keeping Systems (DIRKS) Methodology. Case study research design in a qualitative approach was adopted. A sample of 90 respondents comprising 81 medical staff and 9 key informants was drawn from a target population of 463 Medical Records staff of Moi Teaching and Referral Hospital and Kenyatta National Hospital, Clinicians in charge and the two Chief Executive Officers (CEOs) as key informants using stratified and purposive sampling techniques. Semi-structured interview complemented by document review was used in data collection which was then analyzed using grounded theory. The findings established that a myriad of factors that influence the adoption EMR. These include parallel use of manual and electronic records, lack of Electronic Medical Records Implementation framework, inadequate opportunities for continuous training among the staff, lack of stakeholder's involvement in establishing EMRs, inadequate ICT infrastructure such as computers, internet connectivity and bandwidth; insufficient Government funding; fragmented implementation policy framework and high installation, maintenance and operational costs. This study therefore concludes that the two hospitals' management needs to have adequate budget allocation for enhancing and sustenance of EMRs and to support human capacity building. The study recommends that a needs assessment be conducted in the two hospitals to enable the hospital management to put in place a robust ICT infrastructure to support provision of quality healthcare services. Subsequently, the study developed a framework for implementation of EMRs that would aid in circumventing the existing challenges to successful EMRs implementation.