A Digital Competence-based Framework for Evaluating and Enhancing Electronic Health Record Utilization in Hospital Settings: Evidence from a Low- and Middle-Income Country

<ns5:p>Background Electronic Health Record (EHR) systems are critical for improving healthcare delivery; however, their effective utilization remains limited in many settings due to inadequate digital competence among healthcare professionals. Methods This study developed a digital competence–based framework using empirical data from healthcare workers in hospitals in the Greater Bushenyi region of Uganda. A mixed framework development approach was applied, integrating statistical analysis, theoretical models (Self-Determination Theory, DigComp), and expert validation using the Delphi technique. Results The findings revealed that human, organizational, technical, and system factors significantly influence digital competence and EHR utilization. Human factors emerged as the strongest predictor of healthcare service delivery outcomes. The proposed framework positions digital competence as a central mediating mechanism linking EHR utilization determinants to service delivery. Conclusions The framework provides a practical tool for assessing workforce readiness, identifying competence gaps, and guiding targeted interventions to improve EHR utilization. It is particularly relevant for healthcare systems in low- and middle-income countries.</ns5:p>