1. ELECTRONIC MEDICAL RECORDS ROLLOUT IN KENYA: Opportunities, Challenges and Emerging Trends I-TECH Kenya, University of Washington 23 RD APRIL 2015

2. AUTHORS Veronica Muthee Nancy Puttkammer Steven Wanyee Michael Davisson Sam Kang’a George Owiso Chloe Waters Willis Simon Akhwale

3. ISSUES Large-scale implementation of EMRs Heavy investments in Strategic Information – EMR implementations, Sept2012 – Sept2014 US Presidents Emergency Plan for AIDS Relief (PEPFAR) supported Stakeholders eager to see accrued benefits – Stories and lessons learnt Anticipated improvements

4. IMPROVED EFFICIENCIES

5. DESCRIPTION: EMR ROLL-OUT IN KENYA

6. EMR IMPLEMENTATIONS = 341 = 307

7. KENYAEMR IMPLEMENTATION  We were mandated to implement 300 EMRs by September 2014  The BIG question is, will these 341 EMR implementations result to Improved patient care, improved quality, improved reporting etc?

8. OPPORTUNITIES Decision support systems integrated Accurate and timely reporting at a click of a button (national, programmatic reports) Inbuilt data validation rules Automated reports for Data Quality Assessment (DQA) Continuous Quality Improvement (CQI) indicators integrated, to seamlessly support sites to use data for QI (Quality Improvement)

9. OPPORTUNITIES Decision support systems CQI indicators integrated MOH and programmatic reports

10. CHALLENGES Transfers of trained staff – necessitating continued mentorship and capacity institutionalization – Job-aids and help materials – ELearning Some facilities remained overly dependent on external support to advance on pathway toward EMR use – Upgrading from RDE to POC

11. CAPACITY BUILDING SESSION

12. CHALLENGES Usage of parallel paper-based and electronic data systems has increased the workload – MOH meticulously working towards providing the necessary guidance to sites towards going paperless Quality of patient data migrated into the EMR system wanting – RDQA assessments of data migrated into EMR

13. DATA QUALITY IMPROVEMENT 1. IN-BUILT VALIDATION RULES 2. DATA QUALITY APP 3. DQA REPORT

14. EMERGING NEEDS EMR training incorporated in pre-service training – for health care workers of various cadres to increase the match of skills and needs in the health care job market Re-thinking of DQA procedures if sites are to transition to fully paperless EMR systems Harmonize already existing DQ improvement initiatives for manual systems to incorporate comparable initiatives for electronic systems

16. EMERGING NEEDS Interoperability needs have been expressed in the facilities where there are multiple electronic databases – to address issues of redundancies Ongoing revisions to national clinical care guidelines necessitates continuous system development and underscores the importance of system flexibility

17. NEXT STEPS Integration Ownership Institutionalization of efforts to adapt and absorb technologies Site-level leadership and stakeholders support

18. ACKNOWLEDGEMENTS US Presidents Emergency Plan for AIDS Relief (PEPFAR) MOH NASCOP & DIV HIM&E MOH County Health Care Facilities Implementing partners

19. THANKS