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A Comparison of Electronic Medical Record Data to Paper Records in Antiretroviral Therapy Clinic in Ethiopia: What is affecting the Quality of the Data?

BACKGROUND: Anti-Retroviral Therapy (ART) care is a lifelong treatment, which needs accurate and reliable data collected for long period of time. Poor quality of medical records data remains a challenge and is directly related to the quality of care of patients. To improve this, there is an increasi...

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Autores principales: Abiy, Rahel, Gashu, Kassahun, Asemaw, Tarekegn, Mitiku, Mebratu, Fekadie, Berhanu, Abebaw, Zeleke, Mamuye, Adane, Tazebew, Ashenafi, Teklu, Alemayehu, Nurhussien, Fedilu, Kebede, Mihiretu, Fritz, Fleur, Tilahun, Binyam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: University of Illinois at Chicago Library 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6194098/
https://www.ncbi.nlm.nih.gov/pubmed/30349630
http://dx.doi.org/10.5210/ojphi.v10i2.8309
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author Abiy, Rahel
Gashu, Kassahun
Asemaw, Tarekegn
Mitiku, Mebratu
Fekadie, Berhanu
Abebaw, Zeleke
Mamuye, Adane
Tazebew, Ashenafi
Teklu, Alemayehu
Nurhussien, Fedilu
Kebede, Mihiretu
Fritz, Fleur
Tilahun, Binyam
author_facet Abiy, Rahel
Gashu, Kassahun
Asemaw, Tarekegn
Mitiku, Mebratu
Fekadie, Berhanu
Abebaw, Zeleke
Mamuye, Adane
Tazebew, Ashenafi
Teklu, Alemayehu
Nurhussien, Fedilu
Kebede, Mihiretu
Fritz, Fleur
Tilahun, Binyam
author_sort Abiy, Rahel
collection PubMed
description BACKGROUND: Anti-Retroviral Therapy (ART) care is a lifelong treatment, which needs accurate and reliable data collected for long period of time. Poor quality of medical records data remains a challenge and is directly related to the quality of care of patients. To improve this, there is an increasing trend to implement electronic medical record (EMR) in hospitals. However, there is little evidence on the impact of EMR on the quality of health data in low- resource setting hospitals like Ethiopia. This comparative study aims to fill this evidence gap by assessing the completeness and reliability of paper-based and electronic medical records and explore the challenges of ensuring data quality at the Anti-Retroviral Therapy (ART) clinic at the University of Gondar Referral Hospital in Northwest Ethiopia. METHODS: An institution-based comparative cross-sectional study, supplemented with a qualitative approach was conducted from February 1 to March 30, 2017 at the ART clinic of the University of Gondar Hospital. A total of 250 medical records having both electronic and paper-based versions were collected and assessed. A national ART registration form which consists of 40 ART data elements was used as a checklist to assess completeness and reliability dimensions of data quality on medical records of patients on HIV care. Kappa statistics were computed to describe the level of data agreement between paper-based and electronic records across patient characteristics. In-depth interviews were conducted using semi-structured questionnaires with ten key informants to explore the challenges related with the quality of medical records. Responses of the key informant interviews were analyzed using thematic analysis. RESULTS: The overall completeness of medical records was 78% with 95% CI (70.8% - 85.1%) in paper-based and 76% with 95%CI (67.8% - 83.2%) EMR. The data reliability measured in Kappa statistics shows strong agreements on the socio-demographic data such as educational status 0.93 (0.891, 0.963), WHO staging 0.86 (0.808, 0.906); general appearance 0.83 (0.755, 0.892) and patient referral record 0.87 (0.795, 0.932). The major challenges hindering good data quality was the current side by side dual data documentation practice (the need to document both on the paper and the EMR for a single record), patient overload and low data documentation practice of health workers. CONCLUSION: The overall completeness of ART medical records was still slightly better in paper-based records than EMR. The main reason affecting the EMR data quality was the current dual documentation practice both on the paper and electronic for each patient in the hospital and the high load of patients in the clinic. The hospital management need to decide to use either the paper or the electronic system and build the capacity of health workers to improve data quality in the hospital.
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spelling pubmed-61940982018-10-22 A Comparison of Electronic Medical Record Data to Paper Records in Antiretroviral Therapy Clinic in Ethiopia: What is affecting the Quality of the Data? Abiy, Rahel Gashu, Kassahun Asemaw, Tarekegn Mitiku, Mebratu Fekadie, Berhanu Abebaw, Zeleke Mamuye, Adane Tazebew, Ashenafi Teklu, Alemayehu Nurhussien, Fedilu Kebede, Mihiretu Fritz, Fleur Tilahun, Binyam Online J Public Health Inform Research Article BACKGROUND: Anti-Retroviral Therapy (ART) care is a lifelong treatment, which needs accurate and reliable data collected for long period of time. Poor quality of medical records data remains a challenge and is directly related to the quality of care of patients. To improve this, there is an increasing trend to implement electronic medical record (EMR) in hospitals. However, there is little evidence on the impact of EMR on the quality of health data in low- resource setting hospitals like Ethiopia. This comparative study aims to fill this evidence gap by assessing the completeness and reliability of paper-based and electronic medical records and explore the challenges of ensuring data quality at the Anti-Retroviral Therapy (ART) clinic at the University of Gondar Referral Hospital in Northwest Ethiopia. METHODS: An institution-based comparative cross-sectional study, supplemented with a qualitative approach was conducted from February 1 to March 30, 2017 at the ART clinic of the University of Gondar Hospital. A total of 250 medical records having both electronic and paper-based versions were collected and assessed. A national ART registration form which consists of 40 ART data elements was used as a checklist to assess completeness and reliability dimensions of data quality on medical records of patients on HIV care. Kappa statistics were computed to describe the level of data agreement between paper-based and electronic records across patient characteristics. In-depth interviews were conducted using semi-structured questionnaires with ten key informants to explore the challenges related with the quality of medical records. Responses of the key informant interviews were analyzed using thematic analysis. RESULTS: The overall completeness of medical records was 78% with 95% CI (70.8% - 85.1%) in paper-based and 76% with 95%CI (67.8% - 83.2%) EMR. The data reliability measured in Kappa statistics shows strong agreements on the socio-demographic data such as educational status 0.93 (0.891, 0.963), WHO staging 0.86 (0.808, 0.906); general appearance 0.83 (0.755, 0.892) and patient referral record 0.87 (0.795, 0.932). The major challenges hindering good data quality was the current side by side dual data documentation practice (the need to document both on the paper and the EMR for a single record), patient overload and low data documentation practice of health workers. CONCLUSION: The overall completeness of ART medical records was still slightly better in paper-based records than EMR. The main reason affecting the EMR data quality was the current dual documentation practice both on the paper and electronic for each patient in the hospital and the high load of patients in the clinic. The hospital management need to decide to use either the paper or the electronic system and build the capacity of health workers to improve data quality in the hospital. University of Illinois at Chicago Library 2018-09-21 /pmc/articles/PMC6194098/ /pubmed/30349630 http://dx.doi.org/10.5210/ojphi.v10i2.8309 Text en This is an Open Access article. Authors own copyright of their articles appearing in the Journal of Public Health Informatics. Readers may copy articles without permission of the copyright owner(s), as long as the author and OJPHI are acknowledged in the copy and the copy is used for educational, not-for-profit purposes.
spellingShingle Research Article
Abiy, Rahel
Gashu, Kassahun
Asemaw, Tarekegn
Mitiku, Mebratu
Fekadie, Berhanu
Abebaw, Zeleke
Mamuye, Adane
Tazebew, Ashenafi
Teklu, Alemayehu
Nurhussien, Fedilu
Kebede, Mihiretu
Fritz, Fleur
Tilahun, Binyam
A Comparison of Electronic Medical Record Data to Paper Records in Antiretroviral Therapy Clinic in Ethiopia: What is affecting the Quality of the Data?
title A Comparison of Electronic Medical Record Data to Paper Records in Antiretroviral Therapy Clinic in Ethiopia: What is affecting the Quality of the Data?
title_full A Comparison of Electronic Medical Record Data to Paper Records in Antiretroviral Therapy Clinic in Ethiopia: What is affecting the Quality of the Data?
title_fullStr A Comparison of Electronic Medical Record Data to Paper Records in Antiretroviral Therapy Clinic in Ethiopia: What is affecting the Quality of the Data?
title_full_unstemmed A Comparison of Electronic Medical Record Data to Paper Records in Antiretroviral Therapy Clinic in Ethiopia: What is affecting the Quality of the Data?
title_short A Comparison of Electronic Medical Record Data to Paper Records in Antiretroviral Therapy Clinic in Ethiopia: What is affecting the Quality of the Data?
title_sort comparison of electronic medical record data to paper records in antiretroviral therapy clinic in ethiopia: what is affecting the quality of the data?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6194098/
https://www.ncbi.nlm.nih.gov/pubmed/30349630
http://dx.doi.org/10.5210/ojphi.v10i2.8309
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