Users’ perception on factors contributing to electronic medical records systems use: a focus group discussion study in healthcare facilities setting in Kenya

Background Electronic medical records systems (EMRs) adoption in healthcare to facilitate work processes have become common in many countries. Although EMRs are associated with quality patient care, patient safety, and cost reduction, their adoption rates are comparatively low. Understanding factors associated with the use of the implemented EMRs are critical for advancing successful implementations and scale-up sustainable initiatives. The aim of this study was to explore end users’ perceptions and experiences on factors facilitating and hindering EMRs use in healthcare facilities in Kenya, a low- and middle-income country. Methods Two focus group discussions were conducted with EMRs users (n = 20) each representing a healthcare facility determined by the performance of the EMRs implementation. Content analysis was performed on the transcribed data and relevant themes derived. Results Six thematic categories for both facilitators and barriers emerged, and these related to (1) system functionalities; (2) training; (3) technical support; (4) human factors; (5) infrastructure, and (6) EMRs operation mode. The identified facilitators included: easiness of use and learning of the system complemented by EMRs upgrades, efficiency of EMRs in patient data management, responsive information technology (IT) and collegial support, and user training. The identified barriers included: frequent power blackouts, inadequate computers, retrospective data entry EMRs operation mode, lack of continuous training on system upgrades, and delayed IT support. Conclusions Users generally believed that the EMRs improved the work process, with multiple factors identified as facilitators and barriers to their use. Most users perceived system functionalities and training as motivators to EMRs use, while infrastructural issues posed as the greatest barrier. No specific EMRs use facilitators and/or barriers could be attributed to facility performance levels. Continuous evaluations are necessary to assess improvements of the identified factors as well as determine emerging issues.publishedVersio

Comparative Performance Analysis of Different Fingerprint Biometric Scanners for Patient Matching

Unique patient identification within health services is an operational challenge in healthcare settings. Use of key identifiers, such as patient names, hospital identification numbers, national ID, and birth date are often inadequate for ensuring unique patient identification. In addition approximate string comparator algorithms, such as distance-based algorithms, have proven suboptimal for improving patient matching, especially in low-resource settings. Biometric approaches may improve unique patient identification. However, before implementing the technology in a given setting, such as health care, the right scanners should be rigorously tested to identify an optimal package for the implementation. This study aimed to investigate the effects of factors such as resolution, template size, and scan capture area on the matching performance of different fingerprint scanners for use within health care settings. Performance analysis of eight different scanners was tested using the demo application distributed as part of the Neurotech Verifinger SDK 6.0

Developing a National-Level Concept Dictionary for EHR Implementations in Kenya

The increasing adoption of Electronic Health Records (EHR) by developing countries comes with the need to develop common terminology standards to assure semantic interoperability. In Kenya, where the Ministry of Health has rolled out an EHR at 646 sites, several challenges have emerged including variable dictionaries across implementations, inability to easily share data across systems, lack of expertise in dictionary management, lack of central coordination and custody of a terminology service, inadequately defined policies and processes, insufficient infrastructure, among others. A Concept Working Group was constituted to address these challenges. The country settled on a common Kenya data dictionary, initially derived as a subset of the Columbia International eHealth Laboratory (CIEL) / Millennium Villages Project (MVP) dictionary. The initial dictionary scope largely focuses on clinical needs. Processes and policies around dictionary management are being guided by the framework developed by Bakhshi-Raiez et al. Technical and infrastructure-based approaches are also underway to streamline workflow for dictionary management and distribution across implementations. Kenya's approach on comprehensive common dictionary can serve as a model for other countries in similar settings

Building comprehensive and sustainable health informatics institutions in developing countries: Moi University experience

Current approaches for capacity building in Health Informatics (HI) in developing countries mostly focus on training, and often rely on support from foreign entities. In this paper, we describe a comprehensive and multidimensional capacity-building framework by Lansang & Dennis, and its application for HI capacity building as implemented in a higher-education institution in Kenya. This framework incorporates training, learning-by-doing, partnerships, and centers of excellence. At Moi University (Kenya), the training dimensions include an accredited Masters in HI Program, PhD in HI, and HI short courses. Learning-by-doing occurs through work within MOH facilities at the AMPATH care and treatment program serving 3 million people. Moi University has formed strategic HI partnerships with Regenstrief Institute, Inc. (USA), University of Bergen (Norway), and Makerere University (Uganda), among others. The University has also created an Institute of Biomedical Informatics to serve as an HI Center of Excellence in the region. This Institute has divisions in Training, Research, Service and Administration. The HI capacity-building approach by Moi provides a model for adoption by other institutions in resource-limited settings

Social, demographic and healthcare factors associated with stage at diagnosis of cervical cancer: cross-sectional study in a tertiary hospital in Northern Uganda.

OBJECTIVE: To examine patient and primary healthcare factors and stage at diagnosis in women with cervical cancer in Northern Uganda with the intention to identify factors that are associated with advanced stages in order to inform policies to improve survival from cervical cancer in low income and middle income countries. DESIGN: Cross-sectional hospital-based study. SETTING: Tertiary, not-for-profit private hospital in postconflict region. PARTICIPANTS: Consecutive tissue-diagnosed symptomatic patients with cervical attending care. Of 166 patients, 149 were enrolled and analysed. PRIMARY OUTCOME: Cervical cancer stage at diagnosis. RESULTS: Most women were diagnosed at stages III (45%) or IV (21%). After controlling for age, marital status, educational attainment and number of biological children, there was evidence for association between advanced stage at diagnosis and pre-referral diagnosis of cancer by primary healthcare professionals (adjusted OR (AOR)=13.04:95% CI 3.59 to 47.3), and financial difficulties precluding prompt help seeking (AOR=5.5:95% CI 1.58 to 20.64). After adjusting for age, marital status and educational attainment, women with 5-9 biological children (AOR=0.27:95% CI 0.08 to 0.96) were less likely to be diagnosed with advanced stage (defined as stages III/IV) cancer. In this pilot study, there was no statistical evidence for associations between stage at diagnosis, and factors such as age at diagnosis and marital status. CONCLUSIONS: This study is a first attempt to understand the descriptive epidemiology of cervical cancer in rural Ugandan settings. Understanding individual patient factors, patients' behavioural characteristics and healthcare factors associated with advanced stage at diagnosis is essential for targeted effective public health interventions to promote prompt health seeking, diagnosis at early stage and improved survival from cervical cancer.The work was supported by Training Health Researchers into Vocational Excellence (THRiVE) in East Africa, Grant number 087540, funded by Wellcome Trust.This is the final version of the article. It first appeared from the BMJ Group via http://dx.doi.org/10.1136/bmjopen-2015-00769

Model-Driven Automatic Question Generation for a Gamified Clinical Guideline Training System

Clinical practice guidelines (CPGs) are a cornerstone of modern medical practice since they summarize the vast medical literature and provide care recommendations based on the current best evidence. However, there are barriers to CPG utilization such as lack of awareness and lack of familiarity of the CPGs by clinicians due to ineffective CPG dissemination and implementation. This calls for research into effective and scalable CPG dissemination strategies that will improve CPG awareness and familiarity. We describe a model-driven approach to design and develop a gamified e-learning system for clinical guidelines where the training questions are generated automatically. We also present the prototype developed using this approach. We use models for different aspects of the system, an entity model for the clinical domain, a workflow model for the clinical processes and a game engine to generate and manage the training sessions. We employ gamification to increase user motivation and engagement in the training of guideline content. We conducted a limited formative evaluation of the prototype system and the users agreed that the system would be a useful addition to their training. Our proposed approach is flexible and adaptive as it allows for easy updates of the guidelines, integration with different device interfaces and representation of any guideline.acceptedVersio

An echo cardiographic evaluation of pulmonary pressures in hemodialysis patients at Kenyatta National Hospital, Nairobi, Kenya

Background. A high prevalence of pulmonary hypertension (PH) in patients with end-stage renal disease (ESRD) has been noted. In these patients, PH increases morbidity and mortality and worsens prognosis post-renal transplant. Its aetiopathogenesis may be multifactorial, involving the process of hemodialysis itself.Objective. To determine the prevalence of PH among patients with ESRD undergoing hemodialysis at Kenyatta National Hospital (KNH), using Doppler echocardiography.Design. 117 patients were consecutively recruited into this cross-sectional study. Medical history was used to exclude patients with possible PH of known aetiology. Patients were examined for features of fluid overload. Each patient then underwent hemodialysis followed by echocardiography within two hours. Hemoglobin was measured.Setting. The Renal Unit, KNH, a tertiary hospital in NairobiSubjects. Patients undergoing regular hemodialysis within the renal unit, thirteen years and above, who gave written informed consent or assent.Results. 63.2% of the participants were male. Mean age was 44 years. Prevalence of PH among ESRD patients was 32.5%, with a median PASP of 47.3mmHg and a range of 36.1–79 mmHg. A strong association between PH and EF of less than 50%, as a marker of LV dysfunction, was demonstrated.Conclusion. The prevalence of PH among end-stage renal disease patients was high. This suggests an indication for routinely screening hemodialysis patients for PH

Therapeutic turnaround times for common laboratory tests in a tertiary hospital in Kenya

Access to efficient laboratory services is critical to patient care. Turnaround Time (TAT) is one of the most important measures when judging the efficiency of any laboratory and care system. Few studies on TAT exist for inpatient care settings within low- and middle-income countries (LMICs). Methods We evaluated therapeutic TAT for a tertiary hospital in Western Kenya, using a time-motion study focusing specifically on common hematology and biochemistry orders. The aim was to determine significant bottlenecks in diagnostic testing processes at the institution. Results A total of 356 (155 hematology and 201 biochemistry) laboratory tests were fully tracked from the time of ordering to availability of results to care providers. The total therapeutic TAT for all tests was 21.5 ± 0.249 hours (95% CI). The therapeutic TAT for hematology was 20.3 ± 0.331 hours (95% CI) while that for biochemistry tests was 22.2 ± 0.346 hours (95% CI). Printing, sorting and dispatch of the printed results emerged as the most significant bottlenecks, accounting for up to 8 hours of delay (Hematology—8.3 ± 1.29 hours (95% CI), Biochemistry—8.5 ± 1.18 hours (95% CI)). Time of test orders affected TAT, with orders made early in the morning and those in the afternoon experiencing the most delays in TAT. Conclusion Significant inefficiencies exist at multiple steps in the turnaround times for routine laboratory tests at a large referral hospital within an LMIC setting. Multiple opportunities exist to improve TAT and streamline processes around diagnostic testing in this and other similar settings.publishedVersio

Farmers’ perceived pathways for further intensification of push-pull systems in Western Kenya

Push-pull technology provides farmers in East Africa with an eco-friendly strategy that increases crop yield and household income in smallholder cereal systems by controlling pests and improving soil health. Though promising for a sustainably intensified production, push-pull has been used at limited scale, primarily in maize-and sorghum-based production systems. Expanding the scope, applicability and acceptance of the practice in smallholder farming systems, will leverage the full potential of push-pull as a widely applicable sustainable farming practice. Using key informant interviews and focus group discussions, we explored farmers’ needs and perceived pathways for integrating push-pull and other sustainable intensification practices in synergy with existing cropping systems in Kisumu, Vihiga and Siaya Counties in Western Kenya. We found that farmers in the region typically grow and intercrop a variety of crops, with maize being the most common crop. Farmers commonly practice crop-livestock farming, intercropping, crop rotation, manure and fertilizer use, and use improved varieties to increase maize production. Across the counties, integration of food legumes, agroforestry and crop-livestock farming, were identified as fundamental pathways for stretching the benefits of push-pull. Limitations to farmers’ aspirations and key enablers for facilitating spontaneous adoption of identified sustainable intensification practices for push-pull farming systems are discussed

Provider alerts and reminders to improve tuberculosis care among people living with HIV in Kenya: TB Tech formative report

People living with HIV (PLHIV) have a 20-fold higher risk of dying from tuberculosis (TB) than the general population. Reducing TB morbidity and mortality among PLHIV requires identifying those with active TB and treating them, as well as preventing new TB infections among those not infected. WHO recommends screening all HIV-infected patients for symptoms of active TB infection, testing those who show symptoms, treating those with positive TB tests, and providing isoniazid preventive therapy (IPT) for those who are either asymptomatic or whose TB test results are negative. WHO classifies Kenya among the “high burden” countries for TB and notes high rates of HIV-TB co-infection. Screening and testing of HIV-infected patients for TB is the focus of this report. The TB Tech study, under USAID’s HIVCore project led by the Population Council was initiated. The study team conducted research to address: preparedness of Academic Model Providing Access to Healthcare (AMPATH) facilities and providers to screen for TB symptoms and provide IPT for symptom-negative HIV-infected patients; preparedness of AMPATH Medical Record System (AMRS) to capture and report critical indicators of IPT/TB service performance; preparedness of AMRS and other data sources to capture and report critical indicators of reminder-system performance