Abstract:
Current models for implementing electronic health
records (EHRs) in resource-limited settings may not be
scalable because they fail to address human-resource
and cost constraints. This paper describes an
implementation model which relies on shared
responsibility between local sites and an external three-
pronged support infrastructure consisting of: (1)
a national technical expertise center, (2) an
implementer’s community, and (3) a developer’s
community. This model was used to implement an open-
source EHR in three Ugandan HIV-clinics. Preepost
timeemotion study at one site revealed that Primary
Care Providers spent a third less time in direct and
indirect care of patients (p<0.001) and 40% more time
on personal activities (p1⁄40.09) after EHRs
implementation. Time spent by previously enrolled
patients with non-clinician staff fell by half (p1⁄40.004)
and with pharmacy by 63% (p<0.001). Surveyed
providers were highly satisfied with the EHRs and its
support infrastructure. This model offers a viable
approach for broadly implementing EHRs in resource-
limited settings.
