An assessment of the appropriateness of smartcare electronic medical record system in the delivery of HIV/AIDS services: a case study of six (6) health facilities in Lusaka district of Zambia

Abstract

Background: Human Immune Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) situation in Zambia remains a challenge. Pevalence of HIV among adults 15-59 years is 12.3 percent. Due to this high burden of disease, the Government of Zambia, through support from CDC, introduced SmartCare, an electronic health records system to help link up services and improve information availability for management of patients. Using an implementation research approach, this study assessed the appropriateness of using SmartCare electronic health records system in the delivery of antiretroviral therapy services for HIV infected individuals. Methods: This was a qualitative case study based on perceptions and experiences of healthcare workers who had been using SmartCare. Using In-depth interviews, a total of 17 healthcare workers were interviewed across six sampled sites from a wide range of environments where SmartCare has been implemented. A purposive sampling approach using maximum variation and critical case criteria was used. Qualitative data was collected across Lusaka District between December, 2017 and January, 2018. Results: findings demonstrated that SmartCare electronic health records has contributed to patient tracking and follow up, particularly better monitoring of CD4 counts, adherence to treatment and monitoring missed appointments. Pre-defined reports and automatically generated notifications have been critical in providing this information. SmartCare has also contributed to improving retention of patients in care through reduced patient’s waiting time, helped in the provision of uninterrupted care across health facilities using care cards and has enhanced ongoing monitoring of possible indications of drugs resistance and loss of patients from care. However, from a planning point of view, there is no structured way of using information from SmartCare to support planning of ART services. Lastly, there is no evidence that data from SmartCare were aggregated and used at the national level for policy making and analysis. This is mainly attributed to the notion that SC is a donor driven system and that the traditional HMIS is the recommended system for the government and is therefore the preferred system. Conclusion: To a great extent, SmartCare produced desired outcomes in line with its vision. Improvements in access to patient information to support clinical decisions and enhanced patient tracking for better monitoring of CD4 counts and adherence to treatment were key. However, there are gaps that impact its optimal use which require a framework to be developed to guide proper use of SC at different levels. Key terms: SmartCare, Implementation Research, CD4, HIV/AIDS