EFFECT OF EMR IMPLEMENTATION ON CLINIC TIME, PATIENT AND STAFF SATISFACTION, AND CHART COMPLETENESS IN A RESOURCE-LIMITED ANTENATAL CLINIC IN KENYA

Alice Graya, Christe Henshawa, Julie Wrighta, Jessica Leaha,

David Caloiaa, Rachel F. Spitzera, Omenge Orango

Benjamin Chemwolob, William M. Tierneyc

INTRODUCTION

Numerous studies have shown that electronic Medical Records (EMRs) are effective at helping to improve healthcare through a variety of means.

Most of these studies are performed in resource-rich countries where EMRs are being used to various degrees.

EMRs are thought to make healthcare more effective, efficient and safer.

The planned transition from written to electronic antenatal records at MTRH provided an opportunity to study whether this change improves quality of care, in terms of:

Time: Does the patient or healthcare worker spend the same amount of time during the encounter?

Satisfaction: Is the patient or healthcare worker more or less satisfied with the encounter?

Completeness: Does the ANC record do a better job of recording key information in the antenatal history?

Quality: Does use of an EMR with decision-support capabilities increase adherence to care guidelines?

METHODS

The study consisted of 3 parts: patient satisfaction questionnaire, staff satisfaction questionnaire, and a retrospective chart review.

For patient surveys, 125 (2009) and 150 (2011) patients were interviewed during their clinic visit.

Questions related to the complete time for their visit, their understanding of information presented, and overall satisfaction.

For the chart review, charts of 250 patients were examined for completeness of key indicators used in antenatal care.

Staff in the antenatal unit were also surveyed for overall satisfaction.

RESULTS

The time spent at a typical appointment, as self-reported, was significantly reduced in the post-EMR period. (Figure 1)

The majority of women waited 2-3h in 2009, while the majority of women waited 30min-1h in 2011

RESULTS

SATISFACTION

There was no difference pre- and post-EMR on patient satisfaction with their healthcare provider, visit and overall experience. All were very high both periods. (Figure 2).

SATISFACTION

COMPLETENESS

Of 250 antenatal charts reviewed, significant increases were seen in the documentation of HIV testing, malaria prophylaxis, STI history, tetanus toxoid and history of C-section.

COMPLETENESS

CONCLUSIONS

Although greater sample numbers might help show more significant trends, this pilot study was able to demonstrate a positive impact of this EMR on antenatal patient care in a resource-limited setting.

We found that implementing an EMR in an ANC in a low-resource setting resulted in more efficient care, with patients spending less time in clinic per visit.

ACKNOWLEDGEMENTS

The nurses and staff at the MTRH Antenatal Clinic and the records department

The University of Toronto Obgyn Department and the AMPATH reproductive health partnership.