Implementation of Provider-Based Electronic Medical Records and Improvement of the Quality of Data in a Large HIV Program in Sub-Saharan Africa
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Date
2012
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
Starting in June 2010 the Infectious Diseases Institute (IDI) clinic (a large urban HIV out-patient facility)
switched to provider-based Electronic Medical Records (EMR) from paper EMR entered in the database by data-entry clerks.
Standardized clinics forms were eliminated but providers still fill free text clinical notes in physical patients’ files. The
objective of this study was to compare the rate of errors in the database before and after the introduction of the providerbased
EMR.
Methods and Findings: Data in the database pre and post provider-based EMR was compared with the information in the
patients’ files and classified as correct, incorrect, and missing. We calculated the proportion of incorrect, missing and total
error for key variables (toxicities, opportunistic infections, reasons for treatment change and interruption). Proportions of
total errors were compared using chi-square test. A survey of the users of the EMR was also conducted. We compared data
from 2,382 visits (from 100 individuals) of a retrospective validation conducted in 2007 with 34,957 visits (from 10,920
individuals) of a prospective validation conducted in April–August 2011. The total proportion of errors decreased from
66.5% in 2007 to 2.1% in 2011 for opportunistic infections, from 51.9% to 3.5% for ART toxicity, from 82.8% to 12.5% for
reasons for ART interruption and from 94.1% to 0.9% for reasons for ART switch (all P,0.0001). The survey showed that 83%
of the providers agreed that provider-based EMR led to improvement of clinical care, 80% reported improved access to
patients’ records, and 80% appreciated the automation of providers’ tasks.
Conclusions: The introduction of provider-based EMR improved the quality of data collected with a significant reduction in
missing and incorrect information. The majority of providers and clients expressed satisfaction with the new system. We
recommend the use of provider-based EMR in large HIV programs in Sub-Saharan Africa.
Description
Keywords
Electronic Medical Records, Data, HIV Program, Sub-Saharan Africa
Citation
Castelnuovo B, Kiragga A, Afayo V, Ncube M, Orama R, et al. (2012) Implementation of Provider-Based Electronic Medical Records and Improvement of the Quality of Data in a Large HIV Program in Sub-Saharan Africa. PLoS ONE 7(12): e51631. doi:10.1371/journal.pone.0051631