Assessment of the use of electronic medical records system and barriers in Rwanda

Abstract

Background Since 2004, the global implementation of electronic medical records (EMR) systems has significantly improved healthcare delivery. However, challenges persist in achieving full EMR adoption, particularly in developing countries. In Rwanda, OpenMRS system was introduced in 2013 as a strategy to align digital health to the country's information and communication technologies (ICT)-for-development agenda. Reports from healthcare providers indicate varying EMR adoption levels in health facilities in Rwanda. This study aims to assess the current usage of EMR and identify implementation barriers in Rwandan health facilities. Methods A cross-sectional study was conducted in 257 Rwandan health facilities using an electronically designed questionnaire in Epi Info 7. Face-to-face interviews were held with 1074 participants, including facility representatives and staff from departments utilizing EMRs. The study covered all district hospitals and 44% of associated health facilities. Descriptive analysis was performed to assess EMR use, user knowledge, attitudes, and practices. Results A total of 257 health facilities were assessed (42 district hospitals and 215 health centers). All 42 district hospitals used EMRs, of which 35(83.3%) used OpenMRS while only 71 (33.0%) out of 215 health centers used EMRs of which about 55% used OpenMRS. Among 234 responses for non-use of EMRs, 98 (41.8%) had never used EMRs, 46 (19.6%) reported system damage, and 42 (17.9%) reported lack of internet. Reported barriers met by users included electricity and internet issues, limited computer access, and software glitches. Conclusion District hospitals in Rwanda showed to have widely utilized EMRs, while health centers exhibited lower utilization rates due to system unavailability or damage. OpenMRS was prevalent in hospitals, whereas health centers used diverse health systems. Respondents preferred EMRs over paper-based methods, but challenges such as internet issues, lack of user guides, power disruptions, staff shortages, and missing features hindered EMR adoption and use. Recommendations include providing comprehensive staff training, improving infrastructure (updating EMR modules, ensuring electricity and internet availability), and providing user guides to healthcare providers to enhance ICT implementation in health facilities. Trial registration: Not applicable