Factors affecting the utilisation of electronic medical records system in Malawian central hospitals

BACKGROUND: In Malawi, paper-based medical record-keeping has been observed to exacerbate challenges related to accessing patient records and patient tracking. Despite the introduction of electronic medical record (EMR) systems in 2001, paper-based records continue to be in use. Some health workers prefer paper-based records to EMRs. This study assessed factors that affect the use of EMRs in Malawi, particularly at Queen Elizabeth and Kamuzu Central Hospitals. It further investigated the reasons why paper-based records are still in use despite the numerous associated disadvantages. The extent to which EMRs contribute to patient care was also analysed. METHODS: In this cross-sectional study, 111 randomly selected health workers were interviewed, using a semistructured questionnaire, at the 2 largest central hospitals in Malawi, where EMRs were first introduced in the country. Focus group discussions were conducted to gather further information on factors identified during the individual interviews. RESULTS AND CONCLUSIONS: Differences in age, gender, and previous computer experience were not associated with differences in EMR usage. However, education and employment levels has a positive association with EMR usage. Hardware and connectivity problems, as well as lack of training and managerial support negatively affected the use of EMRs. EMRs were found to improve data quality and efficiency in patient management.