William M Tierney1, John E Sidle2, Lameck O Diero3, Allan Sudoi3, Jepchirchir Kiplagat3, Stephen Macharia3, Changyu Shen2, Ada Yeung4, Martin C Were5, James E Slaven2, Kara Wools-Kaloustian2. 1. Departments of Medicine and Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA Center for Biomedical Informatics, Regenstrief Institute, Inc. Indianapolis, IN, USA wtierney@regenstrief.org. 2. Departments of Medicine and Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA. 3. Department of Medicine, Moi University School of Medicine, Eldoret, Kenya Department of Medicine, Moi Teaching and Referral Hospital, Eldoret, Kenya The Academic Model Providing Access to Healthcare, Eldoret, Kenya. 4. Center for Biomedical Informatics, Regenstrief Institute, Inc. Indianapolis, IN, USA. 5. Departments of Medicine and Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA Center for Biomedical Informatics, Regenstrief Institute, Inc. Indianapolis, IN, USA Department of Medicine, Moi University School of Medicine, Eldoret, Kenya Department of Medicine, Moi Teaching and Referral Hospital, Eldoret, Kenya The Academic Model Providing Access to Healthcare, Eldoret, Kenya.
Abstract
OBJECTIVE: Efficient, effective health care requires rapid availability of patient information. We designed, implemented, and assessed the impact of a primary care electronic medical record (EMR) in three rural Kenyan health centers. METHOD: Local clinicians identified data required for primary care and public health reporting. We designed paper encounter forms to capture these data in adult medicine, pediatric, and antenatal clinics. Encounter form data were hand-entered into a new primary care module in an existing EMR serving onsite clinics serving patients infected with the human immunodeficiency virus (HIV). Before subsequent visits, Summary Reports were printed containing selected patient data with reminders for needed HIV care. We assessed effects on patient flow and provider work with time-motion studies before implementation and two years later, and we surveyed providers' satisfaction with the EMR. RESULTS: Between September 2008 and December 2011, 72 635 primary care patients were registered and 114 480 encounter forms were completed. During 2011, 32 193 unique patients visited primary care clinics, and encounter forms were completed for all visits. Of 1031 (3.2%) who were HIV-infected, 85% received HIV care. Patient clinic time increased from 37 to 81 min/visit after EMR implementation in one health center and 56 to 106 min/visit in the other. However, outpatient visits to both health centers increased by 85%. Three-quarters of increased time was spent waiting. Despite nearly doubling visits, there was no change in clinical officers' work patterns, but the nurses' and the clerks' patient care time decreased after EMR implementation. Providers were generally satisfied with the EMR but desired additional training. CONCLUSIONS: We successfully implemented a primary care EMR in three rural Kenyan health centers. Patient waiting time was dramatically lengthened while the nurses' and the clerks' patient care time decreased. Long-term use of EMRs in such settings will require changes in culture and workflow.
OBJECTIVE: Efficient, effective health care requires rapid availability of patient information. We designed, implemented, and assessed the impact of a primary care electronic medical record (EMR) in three rural Kenyan health centers. METHOD: Local clinicians identified data required for primary care and public health reporting. We designed paper encounter forms to capture these data in adult medicine, pediatric, and antenatal clinics. Encounter form data were hand-entered into a new primary care module in an existing EMR serving onsite clinics serving patients infected with the human immunodeficiency virus (HIV). Before subsequent visits, Summary Reports were printed containing selected patient data with reminders for needed HIV care. We assessed effects on patient flow and provider work with time-motion studies before implementation and two years later, and we surveyed providers' satisfaction with the EMR. RESULTS: Between September 2008 and December 2011, 72 635 primary care patients were registered and 114 480 encounter forms were completed. During 2011, 32 193 unique patients visited primary care clinics, and encounter forms were completed for all visits. Of 1031 (3.2%) who were HIV-infected, 85% received HIV care. Patient clinic time increased from 37 to 81 min/visit after EMR implementation in one health center and 56 to 106 min/visit in the other. However, outpatient visits to both health centers increased by 85%. Three-quarters of increased time was spent waiting. Despite nearly doubling visits, there was no change in clinical officers' work patterns, but the nurses' and the clerks' patient care time decreased after EMR implementation. Providers were generally satisfied with the EMR but desired additional training. CONCLUSIONS: We successfully implemented a primary care EMR in three rural Kenyan health centers. Patient waiting time was dramatically lengthened while the nurses' and the clerks' patient care time decreased. Long-term use of EMRs in such settings will require changes in culture and workflow.
Authors: Kara Wools-Kaloustian; Silvester Kimaiyo; Lameck Diero; Abraham Siika; John Sidle; Constantin T Yiannoutsos; Beverly Musick; Robert Einterz; Kenneth H Fife; William M Tierney Journal: AIDS Date: 2006-01-02 Impact factor: 4.177
Authors: Christian Allen; Darius Jazayeri; Justin Miranda; Paul G Biondich; Burke W Mamlin; Ben A Wolfe; Chris Seebregts; Neal Lesh; William M Tierney; Hamish S F Fraser Journal: Stud Health Technol Inform Date: 2007
Authors: Alice Gray; Christe Henshaw; Julie Wright; Jessica Leah; David Caloia; Rachel F Spitzer; Elkanah Omenge; Benjamin Chemwolo; William M Tierney Journal: Stud Health Technol Inform Date: 2013
Authors: Benjamin Chemwolo; David Caloia; Kara Wools-Kaloustian; John Sidle; Rachel F Spitzer; Martin Were; April Bell; William M Tierney Journal: Stud Health Technol Inform Date: 2013
Authors: T J Hannan; J K Rotich; W W Odero; D Menya; F Esamai; R M Einterz; J Sidle; F Smith; W M Tierney Journal: Int J Med Inform Date: 2000-10 Impact factor: 4.046
Authors: Joseph K Rotich; Terry J Hannan; Faye E Smith; John Bii; Wilson W Odero; Nguyen Vu; Burke W Mamlin; Joseph J Mamlin; Robert M Einterz; William M Tierney Journal: J Am Med Inform Assoc Date: 2003-03-28 Impact factor: 4.497
Authors: Abraham M Siika; Joseph K Rotich; Chrispinus J Simiyu; Erica M Kigotho; Faye E Smith; John E Sidle; Kara Wools-Kaloustian; Sylvester N Kimaiyo; Winston M Nyandiko; Terry J Hannan; William M Tierney Journal: Int J Med Inform Date: 2005-06 Impact factor: 4.046
Authors: Martin C Were; Changyu Shen; Mwebesa Bwana; Nneka Emenyonu; Nicholas Musinguzi; Frank Nkuyahaga; Annet Kembabazi; William M Tierney Journal: Int J Med Inform Date: 2009-12-24 Impact factor: 4.046
Authors: Hannah H Leslie; Denisse Laos; Cesar Cárcamo; Ricardo Pérez-Cuevas; Patricia J García Journal: BMC Health Serv Res Date: 2021-02-06 Impact factor: 2.655
Authors: Philomena Ngugi; Ankica Babic; James Kariuki; Xenophon Santas; Violet Naanyu; Martin C Were Journal: PLoS One Date: 2021-01-11 Impact factor: 3.240
Authors: Naomi Muinga; Steve Magare; Jonathan Monda; Mike English; Hamish Fraser; John Powell; Chris Paton Journal: BMC Med Inform Decis Mak Date: 2020-01-06 Impact factor: 2.796