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
Date
2019
Authors
Mwanza, Lovemore
Journal Title
Journal ISSN
Volume Title
Publisher
The University 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
Description
Thesis
Keywords
Medical records , Electronic medical records