Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study.
Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study.
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DOI：
10.2196/medinform.8403
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发表时间：
2018-04-18
影响因子：
3.2
通讯作者：
Paton C
中科院分区：
文献类型：
--
作者：
Muinga N;Magare S;Monda J;Kamau O;Houston S;Fraser H;Powell J;English M;Paton C
肯尼亚政府与国际合作伙伴和当地组织合作，制定了电子卫生战略、具体标准和公立医院采用电子健康记录的指南，并实施了两个主要的卫生信息技术项目：地区卫生信息软件第2版，用于整理国家卫生保健指标，以及推出肯尼亚EMR和国际优质护理卫生管理信息系统，用于管理全国600个艾滋病毒诊所。在这些项目之后，指定并开发了开放医疗记录系统电子健康记录的修改版本，以满足肯尼亚权力下放县运营的医疗保健机构的临床和管理要求，并自动整理医疗保健指标并将其输入到地区卫生信息软件版本 2 系统中。我们的目的是介绍肯尼亚公共卫生保健机构实施开源电子健康记录系统的描述性案例研究。我们对肯尼亚电子医疗政策和电子健康记录开发的现有文献进行了综述。在与卫生部、世界卫生组织和实施伙伴进行初步讨论后，我们对实施地点进行了一系列访问，与利益相关者进行半结构化个人访谈和小组讨论，以形成实施的历史案例研究。本案例研究描述了肯尼亚的顾问如何与印度的开发商和项目利益相关者合作，在肯尼亚农村一个县的几家公立医院实施新系统。实施过程包括升级医院信息技术基础设施、培训用户以及尝试获得行政和临床支持以采用该系统。由于社会技术和管理问题的复杂结合，最初的部署最终被缩减。从这些早期挑战中吸取教训，该系统目前正在重新设计并准备在肯尼亚的 6 个新县部署。在高收入环境中实施电子健康记录系统是一个具有挑战性的过程。在肯尼亚等低收入国家，开源软件可能会缓解高昂的软件许可成本，但临床和管理支持的常见挑战、对用户进行充分培训的需要以及提供持续技术支持的需要在南北鸿沟中都很常见。诸如创建本地支持团队、使用本地开发资源、确保最终用户的支持以及在将大型医院纳入项目之前在较小的设施中推广等策略。这些都是积极的进展，有助于在项目继续进行时保持势头。与现有开源社区的进一步集成可以帮助该项目的持续开发和实施。我们希望这个案例研究能够为电子健康记录系统在非洲继续实施的其他具有挑战性的实施提供一些经验教训和指导。
The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of sociotechnical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya. Implementing electronic health record systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing, but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. Strategies such as creating local support teams, using local development resources, ensuring end user buy-in, and rolling out in smaller facilities before larger hospitals are being incorporated into the project. These are positive developments to help maintain momentum as the project continues. Further integration with existing open source communities could help ongoing development and implementations of the project. We hope this case study will provide some lessons and guidance for other challenging implementations of electronic health record systems as they continue across Africa.
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影响因子：
11.1
作者：
Forster M;Bailey C;Brinkhof MW;Graber C;Boulle A;Spohr M;Balestre E;May M;Keiser O;Jahn A;Egger M;ART-LINC collaboration of International Epidemiological Databases to Evaluate AIDS
通讯作者：
ART-LINC collaboration of International Epidemiological Databases to Evaluate AIDS
DOI：
10.1177/146642409911900309
发表时间：
1999-09-01
期刊：
JOURNAL OF THE ROYAL SOCIETY FOR THE PROMOTION OF HEALTH
影响因子：
--
作者：
Azubuike, MC;Ehiri, JE
通讯作者：
Ehiri, JE
影响因子：
16.1
作者：
Oluoch, Tom;Katana, Abraham;de Keizer, Nicolette
通讯作者：
de Keizer, Nicolette
DOI：
10.1016/j.ijmedinf.2014.06.003
发表时间：
2014-08-01
影响因子：
4.9
作者：
Pare, Guy;Raymond, Louis;Micheneau, Thomas
通讯作者：
Micheneau, Thomas
影响因子：
9.5
作者：
Boonstra, Albert;Boddy, David;Bell, Sheena
通讯作者：
Bell, Sheena