The usability of an electronic health record in a public healthcare facility in South Africa

Background. An electronic health record (EHR) is a record of patient health information generated by encounters in healthcare delivery settings, and it plays a crucial role in the digital evolution of healthcare. EHRs, such as ‘Patients Know Best’ (PKB), are commonly used in health systems of developed countries, but are lacking in developing countries. Challenges and opportunities surrounding EHRs in Africa have been identified, but limited literature exists on how these factors may impact the practical use of digital health technologies within South Africa (SA). Objectives. To determine the usability of the PKB platform, as indicated by the patients and clinical staff registered on PKB at the Breast and Endocrine Surgery Clinic, Tygerberg Hospital (TBH). In addition, this study aimed to determine patients’ and clinical staff’s level of engagement with the PKB platform. Level of engagement was compared with a similar patient user group in the UK. Methods. A prospective cohort study was conducted at the Breast and Endocrine Surgery Clinic, TBH. One hundred and fifty participants, including clinic patients and staff, were enrolled. Demographic information was collected at the time of recruitment, and a questionnaire measuring perceived PKB usability was administered electronically 6 weeks post enrolment. User engagement metrics were recorded during the study. Demographic and user engagement data from 49 patients using PKB in the UK were used for comparison purposes. Statistical analysis allowed for a description of the sample’s demographics, a comparison of engagement levels between groups, an assessment of PKB platform usability and the identification of factors associated with completing the questionnaire. Results. During the study period, 42% of SA participants registered on PKB, 26% logged in and 20% completed the usability questionnaire, for which an adequate PKB usability score was determined. The 45 - 54-year age group engaged most, with a maximum range of 11 - 20 logins recorded. The PKB feature most frequently accessed was the message/consultation feature. By comparison, almost all (96%) UK participants completed registration and logged in. The 55 - 64-year age group engaged most, with a maximum range of over 120 logins recorded. Laboratory results were the most frequently accessed feature. Conclusion. Implementing an EHR system such as PKB without necessary adaptations in the current SA public healthcare system environment is not feasible. Adaptations required include allowing patients access to the EHR system without an email address, integrating the EHR system with existing information technology infrastructure and streamlining hospital digital notes with EHR systems to enhance patient engagement and reduce healthcare worker burden.