Objective

To evaluate the implementation of a novel electronic medical record (EMR) system for management of non-communicable diseases (NCD) (hypertension (HTN) and diabetes mellitus (DM)) in health facilities in informal settlements in Nairobi. Questions of interest were on the use of, perception of the HCWs, and scalability and sustainability of the EMR system.

Method

The study utilised a descriptive and analytical implementation evaluation through a convergent parallel mixed-methods design in 33 health facilities in the informal settlements in Nairobi County, Kenya. We carried out semi-structured interviews with the county and sub-county health management staff (n = 9), facility in-charges (n = 8), healthcare workers (HCW) (n = 35), and project staff (n = 7). Additionally, quantitative analysis, trend analysis, critical evaluation and costing were done. Qualitative data were analysed thematically using NVIVO while quantitative data were analysed using Excel and Stata software.

Results

The EMR system significantly improved data capture and management of HTN and DM patients. The system helped clinicians to adhere to treatment and management guidelines and in clinical decision making. Most HCWs had a positive attitude and perceptions about the EMR system, and it was a good initiative for improving the quality and standardisation of care. The data captured made it easier to generate health facility and clinics reports which were essential for planning and decision-making processes. A critical audit of the EMR system features showed adequate general design features (data elements, structure and organisation, ease of use, accessibility, interfaces, confidentiality, access limitation, accuracy and integrity).

Discussion

Use of the EMR helped in improving patients care. The technology not only enhanced assurance of patients’ information safety and availability but also supported in clinical decision making and standardisation of care. Successful implementation of the technology is dependent on positive perception and attitude of the HCWs. While the initial cost of setting and managing the EMR is high, future maintenance cost could be lower, making it sustainable in the long run. However, it is vital for future implementors to source for adequate funds to run it to completion if it is to achieve its objective.

中文翻译：

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改善高血压和糖尿病的管理：肯尼亚内罗毕县的电子病历系统的实施评估。

目的

评估在内罗毕非正式住区的卫生设施中管理非传染性疾病（NCD）（高血压（HTN）和糖尿病（DM））的新型电子病历（EMR）系统的实施情况。令人关注的问题是关于医护人员的使用，看法以及电子病历系统的可扩展性和可持续性。

方法

该研究在肯尼亚内罗毕县的非正式住区中的33个卫生机构中采用了融合的并行混合方法设计，通过描述性和分析性实施评估。我们对县和县以下卫生管理人员（n = 9），设施主管（n = 8），医护人员（HCW）（n = 35）和项目人员（n = 7）。此外，还进行了定量分析，趋势分析，关键评估和成本计算。使用NVIVO对定性数据进行主题分析，同时使用Excel和Stata软件对定量数据进行分析。

结果

EMR系统大大改善了HTN和DM患者的数据捕获和管理。该系统帮助临床医生遵守治疗和管理指南以及进行临床决策。大多数医护人员对EMR系统持积极态度和看法，这是提高护理质量和标准化的良好举措。捕获的数据使生成医疗机构和诊所报告变得更加容易，这对于计划和决策过程至关重要。对EMR系统功能的关键审核显示出足够的常规设计功能（数据元素，结构和组织，易用性，可访问性，接口，机密性，访问限制，准确性和完整性）。

讨论区

使用EMR有助于改善患者护理。该技术不仅增强了对患者信息安全性和可用性的保证，而且还支持临床决策和护理标准化。该技术的成功实施取决于医护人员的积极看法和态度。虽然设置和管理EMR的初始成本很高，但未来的维护成本可能会更低，从长远来看使其可持续。但是，对于未来的实施者来说，至关重要的是要获得足够的资金，以使其达到目标。