Abstract:
Background
Electronic Health Record Systems (EHRs) are being rolled out nationally in many low- and
middle-income countries (LMICs) yet assessing actual system usage remains a challenge.
We employed a nominal group technique (NGT) process to systematically develop high quality indicators for evaluating actual usage of EHRs in LMICs.
Methods
An initial set of 14 candidate indicators were developed by the study team adapting the
Human Immunodeficiency Virus (HIV) Monitoring, Evaluation, and Reporting indicators for mat. A multidisciplinary team of 10 experts was convened in a two-day NGT workshop in
Kenya to systematically evaluate, rate (using Specific, Measurable, Achievable, Relevant,
and Time-Bound (SMART) criteria), prioritize, refine, and identify new indicators. NGT steps
included introduction to candidate indicators, silent indicator ranking, round-robin indicator
rating, and silent generation of new indicators. 5-point Likert scale was used in rating the
candidate indicators against the SMART components.
Results
Candidate indicators were rated highly on SMART criteria (4.05/5). NGT participants settled
on 15 final indicators, categorized as system use (4); data quality (3), system interoperability
(3), and reporting (5). Data entry statistics, systems uptime, and EHRs variable concor dance indicators were rated highest. Conclusion
This study describes a systematic approach to develop and validate quality indicators for
determining EHRs use and provides LMICs with a multidimensional tool for assessing suc cess of EHRs implementations.
