Assessing the Potential for Transforming Health in Uganda through an Electronic Health Data Sharing Platform and Data Science

Health institutions worldwide, including the World Health Organization (WHO), have recognised that adoption and innovative use of information from electronic medical records will be necessary to provide equitable care to the growing population of the world. Uganda is committed to meeting this goal, however, there are challenges to developing and implementing electronic health record data capture and analysis systems, especially as implementation of these systems have mostly occurred in high-income countries where challenges are different.

In this project, we will assess whether or not Uganda is ready to implement an electronic health record data capture system at the point of care that can centrally process information through statistical analysis and provide important information to care providers and public health practitioners to support healthcare delivery. This assessment involves collecting information from key stakeholders about barriers, facilitators, costs and other 'readiness' factors, such as acceptability and training of the healthcare professionals who will enter data into the system. We will map these measures to known models of electronic health record adoption readiness and technology adoption success. We will also assess the opinions of the community on how their health information should be handled and used. Additionally, we will look at the technology components of this system that may already exists and determine the costs to provide all necessary components. Finally, we conduct analyses to determine how long it will take to see benefits in terms of cost savings in healthcare provision.

The Ministry of Health in Uganda has recommended a 'stepped' approach to adopting electronic health records, we will therefore focus on areas of greatest concern to the Ministry of Health. While Uganda has a number of important health concerns, such as child and maternal health and cancer, we will focus predominantly on malaria and HIV, and also look at scope for other infections. The reason for this choice is that these infections are still some of the leading health problems in Uganda, and they are treatable. This means that if successful implementation of electronic health record data capture occurred, combined with faster, more efficient and effective treatment due to processing those data and providing key information, such as who to target for testing and treatment, we could reduce costs to the health system and increase human health.

The findings of the study will be shared with the scientific community and provided to the Uganda Ministry of Health as a report. The Ministry of Health plans to use this report as a guide to developing their electronic medical record and information analysis platform.

eHealth is now recognised as an essential component to enabling universal healthcare delivery. It is also a cost effective means to implement public health interventions, especially in low and middle income countries; however, high-costs and other initial barriers to implementation often leave low and middle income countries, with sparse or ineffective systems. Uganda has suffered from extensive deployment of unconnected pilot electronic health record (EHR) data capture systems, which are currently not usable centrally to direct care and public health activities. The Ministry of Health (MoH), would therefore like to implement a national data capture hub to process these data to support care and public health interventions. This project proposes to evaluate the needs, costs, barriers, facilitators, and readiness to adoption of such a system before implementation.

We will collect data through electronic questionnaires to all 5548 health service providers in Uganda, conduct interviews with a care provider at up to 5% of facilities, complete a literature review and conduct stakeholder focus groups in order to collect data on readiness, costs, barriers and facilitators for adoption. Utilising the data collected we will map readiness for adoption to well-established theories of EHR readiness in order to determine what implementation is possible. We will also conduct a cost benefit analysis of implementation and maintenance of an electronic medical data capture system.

These data will be shared with the scientific community through publication and presentation. We will also provide a report to the Uganda Ministry of Health to serve as a map for moving their eHealth agenda forward. This project will have significant impact on implementation of eHealth in Uganda and the potential for more effective and efficient care provision.

This evaluation of the readiness of Uganda for implementing electronic health records and appropriately processing data to support both healthcare and public health will have significant impact on a number of levels across the country.

Impact for the Ugandan People: By carrying out this assessment of readiness, barriers, facilitators, and costs, we will support the Ministry of Health in developing a robust and informed delivery plan for implementation. This will prevent overspending on unnecessary elements and underspending, which could result in abandonment of the project. It will also help ensure successful implementation. This will mean that public funds will be appropriately spent and the result will include advancement in the delivery of care.

Impact for the Ministry of Health and Other Partners: The Ministry of Health (MoH) and their partners in Uganda (e.g., WHO, CDC, NGOs) will have increased confidence and direction to effectively implement electronic health record solutions to more efficient, effective and widespread care. This project will provide guidance in the most effective and timely roll out of the proposed project and will direct appropriate spending, training and investment.

Impact for Ugandan Researchers: Successful delivery of this project will raise the national and international profile of academic researchers in Uganda, which may result in greater research opportunities.

Impact for Health Informatics Researchers: This project will serve as an exemplar evaluation of the feasibility of implementing an EHR and data processing system in a low-income country setting. This is currently of great interest within Health Informatics research, however, there are few studies of this size and depth reported on in the literature. Both our successes and lessons learned will support the direction of future researchers' projects.

While the direct impacts of this project appear modest, the secondary impacts, in example how the Ugandan EHR and data processing platform are implemented, will be vast.