Process Evaluation of Electronic Medical Record System at Public Hospitals under Addis Ababa City Administration Health Bureau (AACAHB), Addis Ababa Ethiopia 2022.

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.