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Benefits and Challenges of Implementing an Electronic Medical Record System in an Urban Slum in Kenya Open Access

Descriptions

Other title
Subject/Keyword
Global health
Electronic medical records
Nairobi, Kenya
Health information system
Urban Slum
Primary care
Electronic health records
Type of item
Thesis
Degree grantor
University of Alberta
Author or creator
Jawhari, Badeia
Supervisor and department
Hayward, Robert (Medicine)
Examining committee member and department
Keenan, Louanne (Medicine)
Storey, Kate (School of Public Health)
Hayward, Robert (Medicine)
Zakus, David (Medicine/Ryerson University)
Department
Department of Medicine
Specialization

Date accepted
2016-03-23T09:25:56Z
Graduation date
2016-06:Spring 2016
Degree
Master of Science
Degree level
Master's
Abstract
This Thesis consists of two papers that explore the use of Electronic Medical Record (EMR) systems in resource-limited settings. The first paper (Chapter 2) comprises a State-of-the-Art review of the types of inquiry, settings, interventions and principal findings reported from studies of the benefits, challenges and impact of EMRs in resource-constrained environments in Sub-Saharan Africa. A systematically developed search strategy was applied to formal bibliographic databases and to grey literature retrieved with Internet search engines to yield 946 distinct communications. These were classified by literature type, method of inquiry, setting, interventions and outcomes. A subset of the most applicable articles was reviewed for principle findings from which an analytic framework was derived. This classified current knowledge into claims about the effects of systems (e.g., power, Internet, network infrastructure), people (e.g., recruitment and retention), processes (e.g., training, change management) and products (e.g., software features, user interface). The second paper (Chapter 3) reports use of descriptive qualitative methods to explore perceptions of front-line staff about the use, benefits, challenges and impact of an EMR deployed in two primary care clinics in Kibera, one of East Africa’s largest urban slums. Observations were categorized, then grouped into three major themes relating to matters of infrastructure, software, and social and organizational. One overarching theme, sustainability, permeated all categories. Although the diverse Kibera infrastructure and software challenges might have been anticipated from knowledge about conditions for successful EMR implementation, an unequivocal participant emphasis on organizational (social and cultural) considerations yielded specific observations about unique challenges to EMR use in slum settings. These and other observations were combined to form a pre- and post-implementation checklist. The checklist summarize learnings from both the literature review and the field study. Given the paucity of published reports about EMR effects in slum settings, this work will hopefully be of particular interest to clinicians and organizations working in resource-constrained settings. Many of the benefits and challenges found in this study resonate with observations originating in developed countries. Unique field findings reported here may facilitate the design and conduct of future studies about barriers and facilitators to EMR use in slum settings.
Language
English
DOI
doi:10.7939/R34T6FB4F
Rights
This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for the purpose of private, scholarly or scientific research. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
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