Abstract:
Abstract Introduction: Electronic Medical Record system (EMRs) is a technology that completely
replaces the paper-based medical record system in healthcare institutions. It is important for
improving the quality of health care information. Globally, the implementation of EMR is
increasing both in developed and developing countries including Ethiopia. Even though EMR
was started in Ethiopia, it couldn’t sustain in many healthcare facilities. Therefore, this
evaluation study was conducted to identify the barriers.
Objectives: This study aimed to evaluate the EMR system at public hospitals under Addis
Ababa City Administration Health Bureau (AACAHB), Addis Ababa, Ethiopia.
Method: An institutional-based single case study design with a concurrent mixed method was
conducted from May 16 to June 15 using availability, accommodation, and acceptability
dimensions from the access framework. For acceptability, a total of 321 health professionals
were selected by simple random sampling technique and participated in this study. The
collected quantitative data were entered into EPI-Data version 4.6 and transferred to SPSSsoftware
version
25
for
analysis.
Bivariable
and
multivariable
logistic
regression
was
computed
considering
the P-value <0.05 to identify statistically significant factors. For qualitative, a
purposive sampling technique was used to select 6 key informants for the availability of
resources and 10 health professionals for in-depth interviews of accommodation and
acceptability. An interview guide was used for collecting qualitative data. The collected data
was cross-checked with field notes, verbatim transcription was carried out and exported to
OPEN CODE software version 4.03 for analysis using themes.
Result: The overall process of the EMR system was 63.8% according to the judgment
parameter in which availability of resources, accommodation of EMR, and acceptability
contributed 70.8%, 58.3%, and 62.3% respectively. The acceptability of EMR among health
professionals was 67.7% with 95% CI (62.3, 72.7). Work experience [AOR=2.408, 95%
CI(1.202, 4.824)], Prior EMR training [AOR=3.845, 95% CI(1.935, 7.639)], Managerial
support [AOR=4.031, 95% CI (2.135, 7.610)], having good knowledge of EMR [AOR=3.895,
95%CI (1.652, 9.181)], and favorable attitude towards EMR [AOR=4.977, 95%CI (2.587,
9.573)] were significantly associated with acceptability of EMR.
Conclusion and recommendation: The overall process of EMR was fair based on judgment,
which needs further improvement. Essential resources like EMR user guidelines, scanners,
printers, Uninterrupted Power Supply (UPS), and computers were not adequate. It needs the
allocation of an adequate budget for further fulfilling resources and materials. EMR system is
not convenient for modifying pre-existing patient medical information. Work experience, EMR
training, knowledge about EMR, favorable attitude towards EMR, and managerial support were
significantly associated with the acceptability of EMR.
Keywords: Process evaluation, Availability, Accommodation, Acceptability, EMR, Ethiopia.
