Exploring user experience and use of the OpenMRS HIV electronic medical record in primary healthcare facilities of Rwanda: a qualitative study. (Preprint)

Abstract

The adoption and usability of an electronic medical record (EMR) is a critical step towards its successful implementation and enhancing quality care. Use and usability of EMRs are rarely documented in primary healthcare settings. This study explored users’ experience in the use and usability of OpenMRS, an EMR used in HIV care in Rwanda for over 13 years.

To determine the user experience of the EHR in long term use, the factors that were facilitators and barriers to use and recommendations for improvements.

We used two qualitative methods: key informant interviews; and facility and specific task observations of EMR use in health facilities. We interviewed at least one nurse and a data manager or data entry clerk in 12 health centers. We analyzed data from key-informant interviews and observations using an informed grounded theory together with thematic analysis, grouping our findings into themes and sub-themes.

The OpenMRS EMR was used, together with paper-based registers and patient cards, in HIV care. Participants were generally able to perform tasks in OpenMRS EMR easily, although nurses could complete fewer tasks than data managers. Participants thought the system was useful, helped them retrieve patient information easily, and were able to create pre-formatted reports. Barriers to using the system included limited staff trained to use it, staff turnover, limited infrastructure, and double data entry requirements. Suggestions for more effective use of the system were work-based trainings, facility supervisions, improved infrastructure and decentralized technical support.

Staff from health centers experienced the OpenMRS EMR as a useful system that improves healthcare delivery process and patient care. The use of the EMR could be improved by increasing infrastructure, human resources capacity and technical support.