Assessment of data quality of and staff satisfaction with an electronic health record system in a developing country (Uganda): a qualitative and quantitative comparative study.

OBJECTIVES: To assess if electronic health record systems in developing countries can improve on timeliness, availability and accuracy of routine health reports and staff satisfaction after introducing the electronic system, compared to the paper-based alternative.
METHODS: The research was conducted with hospital staff of Tororo District Hospital in Uganda. A comparative intervention study with qualitative and quantitative methods was used to compare the paper-based (pre-test) to the electronic system (post-test) focusing on accuracy, availability and timeliness of monthly routine reports about mothers visiting the hospital; and staff satisfaction with the electronic system as outcome measures.
RESULTS: Timeliness: pre-test 13 of 19 months delivered to the district timely, delivery dates for six months could not be established; post-test 100%. AVAILABILITY: pre-test 79% of reports were present at the district health office; post-test 100%. Accuracy: pre-test 73.2% of selected reports could be independently confirmed as correct; post-test 71.2%. Difficulties were encountered in finding enough mothers through direct follow up to inquire on accuracy of information recorded about them. Staff interviews showed that the electronic system is appreciated by the majority of the hospital staff. Remaining obstacles include staff workload, power shortages, network breakdowns and parallel data entry (paper-based and electronic).
CONCLUSION: While timeliness and availability improved, improvement of accuracy could not be established. Better approaches to ascertaining accuracy have to be devised, e.g. evaluation of intended use. For success, organizational, managerial and social challenges must be addressed beyond technical aspects.