Implementing an Electronic Health Record System in a Tertiary Care Surgical Oncology Setup A Mixed Method Analysis

Objective: In Sri Lanka, resource limitations have led to the continued use of paper based records for patient management. We implemented a cloud based Electronic Health Record (EHR) system in a tertiary surgical oncology unit, running it alongside the existing paper system. The EHR provided authorised, real time remote access to patient data, digital theatre scheduling, and facilitated multidisciplinary team collaboration. Methods: Twentysix healthcare workers (consultants, medical officers, nursing officers, trainees, and clerical staff) completed an online questionnaire assessing the EHR usability, user satisfaction, and impact on workflow. We prospectively tracked and compared key time metrics between the paper and EHR systems, including theatre list preparation times and cancer biopsy turnaround (biopsy to diagnosis interval), to evaluate efficiency gains. Results: Most participants (84.6%) used the EHR routinely. Users rated the system as highly intuitive, user friendly, easily accessible, and simple for data entry (mean ratings ~ 4.0 out of 5). Overall satisfaction was high (mean 4.31/5), though system speed was rated slightly lower (mean 3.92), and technical glitches were noted (mean 3.65). Adequate training was associated with significantly higher satisfaction (p<0.05), and satisfaction correlated with perceived intuitiveness (r=0.43) and ease of use (r=0.60). The EHR reduced average theatre list preparation time from 4 minutes 6 seconds (paper) to 2 minutes 24 seconds, saving approximately 1 minute 42 seconds per list (p<0.001). Similarly, the median biopsy to diagnosis interval decreased from 14.95 days with the paper process to 8.40 days with the EHR notification system an average reduction of 6.55 days (p<0.001). Conclusion: Implementing a customised EHR system in a resource limited surgical oncology setting significantly improved workflow efficiency, reduced diagnostic delays, and enhanced data accessibility and team coordination. Users reported high satisfaction, but challenges such as technical limitations, infrastructure issues, and resistance to change persist. Targeted training, supportive infrastructure, and stakeholder engagement are recommended to sustain the EHR integration and promote greater adoption.