The usability of an electronic health record in a public healthcare facility in South Africa
DOI:
https://doi.org/10.7196/SAMJ.2025.v115i11.3126Keywords:
electronic medical record, low and middle income countries, usability, implementation, engagement, user experience, NHIAbstract
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.
References
1. Senbekov M, Saliev T, Bukeyeva Z, et al. The recent progress and applications of digital technologies in healthcare: A review. Int J Telemed Applications 2020:1-18. https://doi.org/10.1155/2020/8830200
2. Stoumpos AI, Kitsios F, Talias MA. Digital transformation in healthcare: Technology acceptance and its applications. Int J Environmental Res Public Health 2023;20(4):3407. https://doi.org/10.3390/ ijerph20043407
3. Pendrakowska P. Inequity pandemic: The lost generation of the digital transformation. Oberserver Research Foundation, 2021. https://www.orfonline.org/expert-speak/inequity-pandemic (accessed 7 July 2024).
4. HolstC,SukumsF,RadovanovicD,NgowiB,NollJ,WinklerAS.Sub-SaharanAfrica–thenewbreeding ground for global digital health. Lancet Dig Health 2020;2(4):e160-e162. https://doi.org/10.1016/S2589- 7500(20)30027-3
5. Woldemariam MT, Jimma W. Adoption of electronic health record systems to enhance the quality of healthcare in low-income countries: A systematic review. BMJ Health Care Inform 2023;30(1):e100704. https://doi.org/10.1136/bmjhci-2022-100704
6. Kaboré SS, Ngangue P, Soubeiga D, et al. Barriers and facilitators for the sustainability of digital health interventions in low and middle-income countries: A systematic review. Frontiers Digital Health 2022;4:014375. https://doi.org/10.3389/fdgth.2022.1014375
7. Gumede S, Dyers R. User experience of an electronic medical record: A cross-sectional study in the public health sector of the Western Cape, South Africa. J Health Inform Afr 2024;11(2):1-16. https://doi. org/10.12856/JHIA-2024-v11-i2-491
8. Weeks RV. Electronic health records: Managing the transformation from a paper-based to an electronic system. J Contemp Manage 2013;10:135-155.
9. Katurura MC, Cilliers L. Electronic health record system in the public health care sector of South Africa: A systematic literature review. Afr J Primary Health Care Fam Med 2018;10(1):1-8. https://doi. org/10.4102/phcfm.v10i1.1746
10. Genesis Centre for Health Policy. Evaluation of the phase 1 implementation of the interventions in the National Health Insurance pilot districts in South Africa: Final evaluation report. Genesis, July 2019. https://www.genesis-analytics.com/projects/evaluating-nhi-phase-1-implementation-for-department- of-health (accessed 9 February 2022).
11. Katuu S. Transforming South Africa’s health sector: The eHealth Strategy, the implementation of electronic document and records management systems (EDRMS) and the utility of maturity models. J Sci Technol Policy Manage 2016;7(3):330-345. https://doi.org/10.1108/JSTPM-02-2016-0001
12. PatientsKnowBest.PatientsKnowBest,2024.https://patientsknowbest.com/(accessed7July2024).
13. AdeniyiAO,ArowoogunJO,ChidiR,OkoloCA,BabawarunO.Theimpactofelectronichealthrecords on patient care and outcomes: A comprehensive review. World J Advanced Res Rev 2024;21(2):1446-
1455. https://doi.org/10.30574/wjarr.2024.21.2.0592
14. Enahoro QE, Ogugua JO, Anyanwu EC, Akomolafe O, Odilibe IP, Daraojimba AI. The impact of
electronic health records on healthcare delivery and patient outcomes: A review. World J Advanced Res
Rev 2024;21(2):451-460. https://doi.org/10.30574/wjarr.2024.21.2.0478
15. Hajesmaeel-Gohari S, Khordastan F, Fatehi F, Samzadeh H, Bahaadinbeigy K. The most used
questionnaires for evaluating satisfaction, usability, acceptance, and quality outcomes of mobile health.
BMC Medical Inform Decision Making 2022;22(1):1-9. https://doi.org/10.1186/s12911-022-01764-2
16. Brooke J. SUS: A ‘quick and dirty’ usability scale. In: Jordan PW, Thomas B, McClelland IL, Weerdmeester B, eds. Usability Evaluation in Industry. London: CRC Press, 1996:207-212. https://doi.
org/10.1201/9781498710411-35
17. Sauro J, Lewis JR. Standardised usability questionnaires. In: Sauro J, Lewis JR. Quantifying the User Experience. Burlington: Morgan Kaufmann, 2012;185-240. https://doi.org/10.1016/b978-0-12-384968- 7.00008-4
18. Broekhuis M, van Velsen L, Hermens H. Assessing usability of eHealth technology: A comparison of usability benchmarking instruments. Int J Med Inform 2019;128:24-31. https://doi.org/10.1016/j. ijmedinf.2019.05.001
19. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42(2):377-381. https://doi.org/10.1016/j.jbi.2008.08.010
20. HarrisPA,TaylorR,MinorBL,etal.TheREDCapconsortium:Buildinganinternationalcommunityof software partners. J Biomed Inform 2019;95:103208. https://doi.org/10.1016/j.jbi.2019.103208
21. Schlosser S, Mays A. Mobile and dirty: Does using mobile devices affect the data quality and the response process of online surveys? Soc Sci Computer Rev 2018;36(2):212-230. https://doi. org/10.1177/0894439317698437
22. Meskó B, Drobni Z, Bényei É, Gergely B, Győrffy Z. Digital health is a cultural transformation of traditional healthcare. MHealth 2017;3:31-38. https://doi.org/10.21037/mhealth.2017.08.07
23. KatururaMC,CilliersL.ElectronichealthrecordsysteminthepublichealthcaresectorofSouthAfrica: A systematic literature review. Afr J Prim Health Care Fam Med 2018;10(1):1-8. https://doi.org/10.4102/ phcfm.v10i1.1746
Downloads
Published
Issue
Section
License
Copyright (c) 2025 D de Villiers, L Martin, V M Beeka, M Ismail, S Mdletshe, N Mongalo, N Mponda, W Conradie, M Al-Ubaydli, M Xenou, J Edge
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
