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Electronic health records (EHRs) are digital medical charts. They contain information such as a patient’s demographics, medical history, and progress notes. The United States leads the world in EHR adoption. As of 2019, 96 percent of American hospitals use an EHR. Though the goal of digitizing medical records was to increase quality, safety, and efficiency in healthcare service delivery, EHRs have been criticized for doing the opposite.

Notably, in 2018, Atul Gawande published a scathing piece in the New Yorker condemning the EHR implementation at Partners Healthcare (now Mass General Brigham). Common criticisms of American EHRs include poor user experience, limited interoperability, and high costs.

African Countries Can Do Things Differently

The continent is currently experiencing the fastest rates of digital transformation of any region in the world. Internet penetration and mobile phone utilization are expanding rapidly, creating a more enabling environment for digital technology adoption. The COVID-19 pandemic has highlighted the potential of technology-enabled service delivery, particularly in the healthcare sector.

EHR adoption in African countries has so far been largely motivated by the need to respond to infectious diseases, especially HIV and MDR-TB. As African countries undergo the epidemiological transition, shifting the burden of disease from infectious to non-communicable and chronic diseases, EHR adoption is likely to expand further. Like patients with HIV or MDR-TB, patients with chronic diseases such as diabetes require consistent touch points with the healthcare system. This type of care requires reliable, longitudinal tracking of medical records. This is where EHRs come in.

3 Ways to avoid American EHR Pitfalls

1.   Strategize at the National Level

National systems lead to centralized data repositories that improve patient care and inform healthcare decision making. In the United States, hospitals and clinics select their own EHR systems, with no national or state-level vendor selection process. This has resulted in data fragmentation and interoperability challenges. A typical patient, who sees multiple providers in multiple locations, is left with parts of their medical record scattered across disparate systems.

African governments are leading the way in a different approach. In Rwanda, the Ministry of Health partnered with Partners in Health to establish a national EHR. Data collected in Rwandan EHRs flows to just two locations, meaning patient records will be accessible, even if patients seek care from multiple providers. Data formatting is also standardized, avoiding the state-level differences in data definitions that make it difficult for the United States to track national health trends.

2.   Select Open Source Tools

The top EHR systems in the United States are proprietary, meaning that vendors charge license fees for use of the software. EHR vendors also largely control access to the knowledge required to customize their solutions and can therefore set the price for implementation services. High costs of EHR adoption and maintenance can be prohibitive, particularly for smaller clinics.

In Africa, open source software (OSS) has the potential to keep costs lower. Not only does OSS avoid license fees, it provides much more flexibility in who can complete software development. Because OSS can be edited by anyone with the appropriate skillset, pricing is more competitive and governments or healthcare organizations have more negotiating power. For example, the Kenyan government selected a team of developers in India to customize the OpenMRS platform for the KenyaEMR project.

3.   Design for healthcare workers and patients

Usability is one of the greatest challenges with American EHRs. Though EHR companies prioritize user-centered design, they are required to accommodate too many diverse user types. In the United States, EHRs must facilitate service delivery for patients and providers, provide scheduling capabilities, manage billing, and record all of the data required by insurance providers and regulators. It’s no wonder users report they are complex and difficult to use. To minimize the risk of physician burnout, African nations should prioritize the needs of patients and healthcare providers and keep data collection workflows as simple and streamlined as possible.

EHR adoption may not be an immediate priority for all African nations, which vary greatly in terms of economic development, technology infrastructure, and digital literacy. For many countries, scarce resources may be better spent on other health initiatives including vaccination programs, infectious disease response, and combating the ongoing COVID-19 pandemic. However, as more and more countries look to digitize their health records, incorporating their EHR rollout into national strategy, selecting open source tools, and designing for patients and providers can set them on a path to success.

Elaina Faust is a digital health and ICT4D professional based in Washington, D.C.