Introduction
According to the WHO definition, quality of healthcare is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes.1 Currently, with advancements in digital technology, most of the work in the healthcare sector is becoming digitised and efficient.2 This could significantly improve the quality of healthcare3 4 compared with the traditional approach. The electronic health record (EHR) system is at the forefront of implementation in healthcare institutions to enhance the quality of healthcare.5
The EHR system is a digital way of capturing, storing, and using patient information by authorised healthcare providers to deliver healthcare services effectively.6 EHR systems enable data-driven clinical decision-making to improve healthcare quality. Gatiti et al7 noted that the proper adoption of EHR systems could boost the quality of healthcare by enhancing patient safety and ensuring effective, efficient, timely, equitable and patient-centred care.
Despite the benefits of EHR systems, problems or unintended consequences are hampering the successful adoption and use of EHR systems in healthcare settings. The most common are physician burn-out,8–10 failure of expectations,8 EHR market saturation,8 innovation vacuum,8 data obfuscation,8 interoperability,11 privacy in data sharing,12 protracted to complete tasks,13 interruption of tasks and workarounds at point of care13 and misalignment of technology and clinical context.11 In addition to these, DeWane et al14 and Gagnon et al15 noted data duplication errors during decision-making, intermittent system delays and workflow interruptions as unintended consequences of EHR systems. Generally, unintended consequences could have a severe impact on the diagnostic and therapeutic processes undertaken by healthcare professionals at points of care, eventually jeopardising patients’ safety and well-being.13
EHR system has been used in developed countries since its inception in the USA in the 1960s.16 Since then, its impact in enhancing the quality of healthcare has been clear both in the developed and developing world. In developed countries, where EHR systems have undergone an established implementation strategy, there is increased success and health worker satisfaction and decreased delays and chances of usability being compromised.17 However, despite increased use in developed countries, multiple studies conducted in developing countries indicated the adoption of an EHR system is still lagging18; hence, multiple factors play a role in technology adoption and use. A study conducted in Kenya, Ghana, Nigeria, South Africa and Saudi Arabia indicated that EHR adoption is challenged by inadequate training,19–23 poor infrastructure,19 21–23 lack of technical support,19 21–23 poor communication between users21 and absence of regulations and implementation framework.22 Furthermore, the findings from Jung et al24 showed that EHR implementation is not an easy task even for countries advancing from developing to developed, let alone developing countries.
EHR implementation or adoption in most low-income countries (LICs) is lagging and affected by multifaceted challenges. Some of these barriers are economy,25 26 infrastructure25 and policy.26 In addition to these, healthcare professionals’ readiness,27 poor collaboration among stakeholders,28 and relying on software provided by non-governmental organizations (NGOs)28 are affecting EHR adoption in LICs. However, due to the development of open-source systems, support from international donors and homegrown software development campaign29; EHR adoption in LICs is becoming feasible and a future direction.
On top of this, there is a research gap in identifying the existing situation of EHR adoption in LICs despite some efforts made in low-middle-income and middle-income countries. Therefore, this review aimed to examine the status, challenges and opportunities of adopting EHR systems to enhance the quality of healthcare delivery in LICs. It is hoped that the review will provide effective support for the local developers, healthcare providers, different stakeholders and funders in the course of developing or adopting EHR systems. We conducted the review based on the following questions:
RQ1: What is the status of HER systems adoption in LICs?
RQ2: What are the challenges influencing the adoption of EHR systems in LICs?
RQ3: What opportunities are facilitating the adoption of EHR systems in LICs?