1.3.1. Barriers and challenges encountered in the implementation of EHRS in developing countries
The results of this review shed insight into the challenges in successfully implementing EHRS. A wide range of environmental and social factors that obstruct the proper implementation of EHRS have been discovered through a rigorous study of data gathered from diverse research sources.
One crucial social factor is the shortage of healthcare professionals with the information and communication technology (ICT) expertise required to build and maintain EHRS throughout their operational life. However, another challenge is that there need to be recognized career routes for health informatics experts in the public healthcare system. Additionally, resistance from healthcare professionals who view these systems as intensive work procedures or possible risks to their jobs adds to the social challenges. Other social factors affect EHRS implementation efforts, such as governmental structure changes and cabinet ministers. In many countries, political unrest requires more commitment to developing public services like healthcare and its related functions.
Policies, rules, and standards-related problems are environmental factors that affect the implementation of EHRS. These issues result from the need for harmony and coordination among diverse government programs and strategies. Furthermore, the problem is worsened by the need for a defined national strategy for implementing EHRS.
The implementation process is made more challenging by technological obstacles. The obstacles include a lack of internet access in remote places, an unpredictable electrical supply that cannot sustain the systems, an insufficient distribution of ICT gear between urban and rural areas, and a need for more equipment, including PCs, printers, and networking devices. The complexity of implementation is also influenced by cost-related considerations, such as the expenditures associated with purchasing and maintaining effective EHRS.
The analysis's findings are shown in Table 2, which lists the key challenges to implementation by their categories and distributions. These results significantly impact policies and decisions, eventually encouraging improved healthcare outcomes. They have significant implications for the efficient implementation of comprehensive EHRS.
Table 2
key challenges to implementation of EHRS in developing countries
Category
|
Factors
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References
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Social
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Resistance to change
Age factor
|
(Bawack and Kala Kamdjoug, 2018; Fritz et al., 2015; Furusa and Coleman, 2018; Hoque et al., 2017; Hossain et al., 2019; Khan et al., 2012; Muinga et al., 2018; Salameh et al., 2019; Yusif et al., 2022)
|
Lack of perceived direct benefit
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Change of government and organizational structure
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Inadequate health personnel with ICT skills
|
Lack of health informatics personnel
Risks of health professionals becoming overly dependent on technology
|
Environment
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Lack of coordination and harmony between various government policies and strategies
|
(Furusa and Coleman, 2018; Muinga et al., 2018; Parks et al., 2019; Yusif and Soar, 2014)
|
Lack of specific national strategies
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The lack of standards governing the development and implementation of EHRS
Lack of technical support
Bureaucracy
|
Technological
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Inadequate distribution of ICT hardware between urban and rural areas
Outdated or incompatible systems
|
(Furusa and Coleman, 2018; Katurura and Cilliers, 2018; Khan et al., 2012; Kiri and Ojule, 2020; Salameh et al., 2019; Srivastava, 2016)
|
Insufficient equipment
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limited internet connectivity in remote locations
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Unstable electricity supply
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Cost factors (software updates, maintenance, implementation)
Privacy and security concerns
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1.3.2. Critical success factors that can facilitate the successful implementation of EHRS in Tanzania's public healthcare sector
Critical success factors must be met for EHRS to be implemented successfully in Tanzania's public health care system and address the challenges above. This study identified critical success criteria and offered implementation plans for each. The project's critical success factors are those that must be met in order to accomplish the project's goals. This study found factors typical in EHRS implementation projects in developing countries, even if the content filtering services for each project may vary.
Attracting and Retaining Health Informatics Professionals
Attracting and retaining ICT specialists is essential to ensuring the effective adoption and ongoing operation of EHRS in the public healthcare sector [47]. Doing this not only takes care of the issues with user commitment and training but also guarantees the availability of skilled employees to operate and maintain these systems [22, 68] efficiently. In order to entice ICT experts to seek employment in the healthcare industry, one effective strategy is to provide clear career pathways with attractive rewards and incentives particularly tailored for health informaticians [55].
Establishing degree programs in health informatics by universities and other educational institutions is the first important step in this quest [65]. These programs can provide ICT workers with the knowledge and skills required to manage the particular problems and requirements of the healthcare industry by providing specific education and training in health informatics. In addition to creating a pipeline of competent workers, this will raise the general standard of the health informatics workforce.
In addition, the healthcare industry needs to encourage jobs in health informatics[8, 27] in several ways, such as by rewarding healthcare employees who actively engage in the training and deployment of EHRS with enticing incentives, promotions, and pay grade increases. These incentives may work as powerful motivators, enticing medical practitioners to adopt health informatics positions and actively participate in the effective adoption of EHRS into their routine practices.
Healthcare firms may show the potential for development and success in health informatics by laying out a clear career progression path. Opportunities for specialization, leadership positions, and participation in research and innovation fall under this category. ICT workers looking for long-term career chances and job satisfaction might be attracted to and kept by such opportunities for recognition and growth.
Additionally, maintaining health informatics experts requires developing a culture of continual professional growth and constant learning[8, 73]. Access to pertinent training courses, seminars, and workshops helps people stay current on their knowledge while improving their ability to use ICT tools and systems efficiently.
Collaborative Approach for Successful EHRS Implementation
All parties involved, including government organizations, healthcare professionals, and EHRS developers, must collaborate to implement EHRS [12, 25]. It is essential to create solutions that are appropriate and scalable to fulfill the requirements of the target organization. Stakeholders may establish a feeling of ownership by encouraging cooperation and including users in the development process, which will boost their dedication to the project's success.
The requirement for substantial system training needs to be improved due to user engagement in creating EHRS. The system becomes more in line with the needs and workflows of healthcare professionals when they actively participate in its design and development. As a result, healthcare professionals will be better aware of the system's features, facilitating a more effortless transfer and adoption process.
Furthermore, for the successful adoption of EHRS, government participation and support are essential [21]. Governments should coordinate efforts among all stakeholders, provide financial resources, and support the implementation process. Governments may show their commitment to EHRS services and provide a unified and stable strategy by actively participating in their deployment. This engagement increases political clout and reduces the possibility of long-term changes in the government's commitment to the project.
In order to maintain ongoing financial and legal support for the implementation and maintenance of EHRS initiatives at the national level, a consistent commitment from the government is also necessary. Governments may lay the foundation for the implementation of EHRS and guarantee its long-term sustainability by investing sufficient resources and passing appropriate legislation.
Regular communication channels between stakeholders should be developed to promote collaboration and ownership, comprising platforms for exchanging opinions, expressing worries, and resolving problems. Participating end users in the testing and piloting phases enable real-world input and validation, resulting in system enhancements and improved user satisfaction.
Overall, a cooperative strategy, including the government, healthcare professionals, and software providers of EHRS, is essential for the effective adoption of EHRS. Stakeholders may create solutions that collectively address the organization's unique demands, provide a feeling of ownership, and strengthen the commitment to the project via active engagement. EHRS deployment may be efficiently organized, improving healthcare delivery and patient outcomes by promoting government leadership, facilitating user interaction, and assuring continuous commitment.
Exploring Alternative Connectivity and Power Solutions for EHR Implementation
It is necessary to conduct a thorough analysis and invest in alternative infrastructure facilities to implement EHRS in locations with low internet access [21, 47]. Healthcare facilities operating in such areas should consider alternate connection options to ensure the successful transmission of medical data. One possible strategy is investigating the possibility of using outdated technologies like 2G and 3G to transmit EHRS. Before making any decisions, assessing the strengths and weaknesses of the infrastructure and technologies already in use is essential.
Collaboration between the government and Internet service providers is crucial to overcoming infrastructure challenges. In order to provide reliable connectivity for EHRS transmission, the government can collaborate with these companies to repurpose outdated technologies like General Packet Radio Service (GPRS), 2G, and 3G. By working together, it will be possible to provide connection alternatives, even in places with unreliable internet.
In places with limited internet, investigating the viability of batch update systems can be helpful. Data synchronization and transmission in batches are made possible by batch update systems, which lessen the need for constant internet access. This method minimizes interruptions to healthcare services by ensuring that crucial data is transferred and updated when connectivity is available.
In places with inconsistent access to energy, addressing power supply issues is also essential for EHRS deployment. The government should research and fund alternative power sources, including solar-powered systems and commercial diesel-powered energy generators. Even in locations with intermittent or restricted access to the electrical grid, these alternative power sources can guarantee a steady and dependable power supply to support the functioning of EHRS infrastructure.
When implementing EHRs in places with low internet access, looking for and funding alternate infrastructural facilities is essential for success. To guarantee consistent data transfer, health facilities can examine batch update systems, assess existing connectivity alternatives, and investigate repurposing outdated technology. To further help with infrastructural issues, the government is working with Internet service providers and looking at other energy sources. Healthcare companies may use EHRS successfully and enhance healthcare delivery in places with limited connection and power resources by solving these problems.
Allocating Dedicated Funds for EHRS Implementation
Costs associated with implementing EHRS in public hospitals and clinics can be a significant obstacle, mainly when governments need more financial commitments to implement EHRS. Due to high deployment costs, EHRs might be challenging to sustain and manage within healthcare organizations' already constrained operating budgets. Setting aside a particular budget for their deployment is essential to make EHRS and other e-health systems more accessible to public healthcare institutions.
A particular budget must be set out for
adopting EHRS, To ensure the success of e-health programs [34, 69]. The government has made a solid commitment to the deployment and upkeep of these systems, as evidenced by a specific budget allocation. Public hospitals and clinics can overcome budgetary limitations and successfully manage the expenditures related to adopting EHRS by securing designated funds for its implementation.
When EHRS implementation expenses are appropriately budgeted, they consider the upfront implementation costs and ongoing maintenance, training, and system updates. It enables healthcare organizations to carefully manage financial resources, assuring the EHRS's long-term viability. This designated cash can aid in defraying costs for staff training, infrastructure development, data transfer, and the purchase of gear and software.
With a budget for implementing EHRS, healthcare organizations may be able to succeed. If sufficient funds are not committed, the significant expenses associated with implementing and maintaining EHRS may compromise system operation, performance, and security. Governments may reduce these risks and assist the effective adoption and use of EHRS by realizing the significance of dedicated financing.
Governments must participate in thorough financial planning, create a distinct budget, and routinely assess the cash they have been given to guarantee that sufficient resources will be accessible throughout the EHR project's deployment and maintenance phases. The government must maintain a consistent funding commitment to accommodate changing requirements, new technology, and continuous system improvements.
Allocating specialized funds is necessary to overcome financial restrictions and guarantee that the implementation of the EHRS is successful. Creating separate funds for EHRS in public hospitals and clinics should be a top priority for governments. As a result, adopting EHRS will be more economical and sustainable, enabling healthcare organizations to manage related expenditures efficiently. Governments may successfully integrate EHRS into the healthcare system and show their commitment to enhancing healthcare via digital transformation by securing specific financing.
Developing Context-Specific Strategies for E-Health Implementation in Tanzania
Making sure that policies, strategies, and frameworks are appropriate for the particular context and difficulties of the country is one crucial success factor in the implementation of e-health services in Tanzania[53, 72]. In order to encourage uniform procedures and prevent problems with interoperability across healthcare providers, it is essential to build national frameworks specially designed for introducing e-health technologies, such as EHRS. The existing research highlights the necessity of creating EHRS implementation policies, strategies, and frameworks that address the problems and difficulties encountered in nations like Tanzania. Adopting frameworks and strategies primarily from industrialized nations with sophisticated systems will not produce the intended outcomes.
Therefore, developing context-specific frameworks and policies that consider African nations' healthcare systems, infrastructural constraints, and regional needs is crucial. Standardized norms, protocols, and interoperability standards can be established at the national level by national frameworks, allowing for easy data interchange and communication across various systems and healthcare providers. It is simpler to assure the integration and interoperability of e-health systems across the nation by unifying all stakeholders under a coherent framework.
It has been recommended that professional organizations be established with the sole purpose of establishing frameworks and strategies expressly for the setting of developing countries in order to generate successful and specialized strategies. These organizations, such as healthcare professionals, policymakers, and technology specialists, can interact with relevant parties to identify the particular issues and needs of e-health adoption in Africa. These professional organizations may aid in the creation of concise, accurate, and context-specific e-health plans that complement the requirements and potential of the area by encouraging cooperation and the sharing of expertise.
Involving local experts and healthcare professionals in the policy-making process is also essential. Their opinions and direct knowledge may be extremely helpful in developing frameworks and policies that are applicable, doable, and efficient in the healthcare context in Africa. E-health systems will likely be adopted and used successfully if the opinions of individuals directly involved are considered.
For e-health to be implemented successfully in Tanzania, it is essential to address the issues through policies, strategies, and frameworks. Creating national frameworks, policies, and strategies suited explicitly to African nations' needs and difficulties is crucial, especially concerning EHRS. The formation of organizations with a focus on developing context-specific frameworks can offer the required knowledge and guarantee the clarity and accuracy of e-health plans. Africa can overcome policy and framework obstacles and pave the path for an efficient and sustainable e-health implementation that aligns with its particular context by enlisting local healthcare experts and considering the region's distinctive demands.
Fostering Acceptance, Privacy, and Interoperability in EHRS Implementation
In order to address the particular challenges linked to the adoption and usage of EHRS, legislation is essential. The public's acceptance of EHRS may be considerably increased, and legislation that controls their use and administration can guarantee the security and privacy of patient data. Resistance to adopting EHRS can be lessened by protecting patients' private information.
Creating standards for software developers is one of the main advantages of law in adopting EHRS. Legislation can require software suppliers to abide by specific standards and regulations, fostering interoperability between various EHRSs from various providers. Regardless of the EHRS that healthcare practitioners use, interoperability provides smooth data sharing and continuity of treatment and gives them access to complete patient information. Legislation promotes vendor competition while assuring a unified and integrated healthcare system by establishing interoperability requirements.
Laws may also make it easier for healthcare institutions and EHRS service providers to form service level agreements (SLAs). SLAs specify the standards for the quality of services and goods that service providers must supply and set clear expectations. Healthcare businesses may improve the overall performance and reliability of EHRS by establishing legally enforceable agreements that guarantee EHRS service providers supply high-quality services and goods. SLAs can include system availability, data security, response times, and assistance to ensure users have a good experience.
Legislation can also address privacy issues by defining precise standards for securing patient health information. The legislation improves public trust that their data is treated safely by creating strict privacy standards. By providing accurate and thorough information to healthcare practitioners, this assurance enables people to engage in their treatment and fosters active trust in EHRS.
Legislation can also be significant in establishing the accountability and responsibilities of different parties implementing EHRS. It can specify the responsibilities of healthcare institutions, software providers, and other parties participating in the EHR ecosystem, fostering transparency and guaranteeing that everyone keeps their promises.
To promote acceptability, privacy, and interoperability, legislation specifically tailored to the installation and usage of EHRS is essential. Such a law fosters the use of EHR systems by healthcare institutions while simultaneously assuring individuals of the security and privacy of their health information. The legislation offers a strong foundation for the effective deployment and management of EHRS, eventually enhancing healthcare delivery and patient outcomes. This framework is provided by requiring interoperability standards, creating service-level agreements, and resolving privacy issues.