Evaluating a scalable model for implementing electronic health records in resource-limited settings

J Am Med Inform Assoc. 2010 May-Jun;17(3):237-44. doi: 10.1136/jamia.2009.002303.


Current models for implementing electronic health records (EHRs) in resource-limited settings may not be scalable because they fail to address human-resource and cost constraints. This paper describes an implementation model which relies on shared responsibility between local sites and an external three-pronged support infrastructure consisting of: (1) a national technical expertise center, (2) an implementer's community, and (3) a developer's community. This model was used to implement an open-source EHR in three Ugandan HIV-clinics. Pre-post time-motion study at one site revealed that Primary Care Providers spent a third less time in direct and indirect care of patients (p<0.001) and 40% more time on personal activities (p=0.09) after EHRs implementation. Time spent by previously enrolled patients with non-clinician staff fell by half (p=0.004) and with pharmacy by 63% (p<0.001). Surveyed providers were highly satisfied with the EHRs and its support infrastructure. This model offers a viable approach for broadly implementing EHRs in resource-limited settings.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ambulatory Care Information Systems / economics
  • Ambulatory Care Information Systems / organization & administration*
  • Community Participation
  • Consumer Behavior
  • Cost Control
  • Developing Countries*
  • Electronic Health Records / economics
  • Electronic Health Records / organization & administration*
  • HIV Infections
  • Health Plan Implementation / economics
  • Health Plan Implementation / organization & administration*
  • Health Planning Technical Assistance
  • Humans
  • Models, Organizational
  • Outcome Assessment, Health Care*
  • Time and Motion Studies
  • Uganda