Evaluating a scalable model for implementing electronic health records in resource-limited settings

Martin C. Were, Nneka Emenyonu, Marion Achieng, Changyu Shen, John Ssali, John P.M. Masaba, William M. Tierney

Research output: Contribution to journalArticle

35 Scopus citations


Current models for implementing electronic health records (EHRs) in resource-limited settings may not be scalable because they fail to address human-resource and cost constraints. This paper describes an implementation model which relies on shared responsibility between local sites and an external threepronged support infrastructure consisting of: (1) a national technical expertise center, (2) an implementer's community, and (3) a developer's community. This model was used to implement an opensource EHR in three Ugandan HIV-clinics. Pree-post time-emotion study at one site revealed that Primary Care Providers spent a third less time in direct and indirect care of patients (p<0.001) and 40% more time on personal activities (p=0.09) after EHRs implementation. Time spent by previously enrolled patients with non-clinician staff fell by half (p=0.004) and with pharmacy by 63% (p<0.001). Surveyed providers were highly satisfied with the EHRs and its support infrastructure. This model offers a viable approach for broadly implementing EHRs in resource-limited settings.

Original languageEnglish (US)
Pages (from-to)237-244
Number of pages8
JournalJournal of the American Medical Informatics Association
Issue number3
StatePublished - May 1 2010


ASJC Scopus subject areas

  • Health Informatics

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