Abstract:
Background: The Kenyan government, working with international partners and local
organizations, has developed an eHealth strategy, specified standards, and guidelines for
electronic health record adoption in public hospitals and implemented two major health
information technology projects: District Health Information Software Version 2, for
collating national health care indicators and a rollout of the KenyaEMR and International
Quality Care Health Management Information Systems, for managing 600 HIV clinics
across the country. Following these projects, a modified version of the Open Medical
Record System electronic health record was specified and developed to fulfill the clinical
and administrative requirements of health care facilities operated by devolved counties in
Kenya and to automate the process of collating health care indicators and entering them
into the District Health Information Software Version 2 system.
Objective: We aimed to present a descriptive case study of the implementation of an
open source electronic health record system in public health care facilities in Kenya.
Methods: We conducted a landscape review of existing literature concerning eHealth
policies and electronic health record development in Kenya. Following initial discussions
with the Ministry of Health, the World Health Organization, and implementing partners,
we conducted a series of visits to implementing sites to conduct semistructured
individual interviews and group discussions with stakeholders to produce a historical
case study of the implementation.
Results: This case study describes how consultants based in Kenya, working with
developers in India and project stakeholders, implemented the new system into several
public hospitals in a county in rural Kenya. The implementation process included
upgrading the hospital information technology infrastructure, training users, and
attempting to garner administrative and clinical buy-in for adoption of the system. The
initial deployment was ultimately scaled back due to a complex mix of sociotechnical
and administrative issues. Learning from these early challenges, the system is now being
redesigned and prepared for deployment in 6 new counties across Kenya.
Conclusions: Implementing electronic health record systems is a challenging process in
high-income settings. In low-income settings, such as Kenya, open source software may
offer some respite from the high costs of software licensing, but the familiar challenges
of clinical and administration buy-in, the need to adequately train users, and the need for
the provision of ongoing technical support are common across the North-South divide.
Strategies such as creating local support teams, using local development resources,
ensuring end user buy-in, and rolling out in smaller facilities before larger hospitals are
being incorporated into the project. These are positive developments to help maintain
momentum as the project continues. Further integration with existing open source
communities could help ongoing development and implementations of the project. We
hope this case study will provide some lessons and guidance for other challenging
implementations of electronic health record systems as they continue across Africa.