Factors influencing the availability and use of electronic medical records systems in public health facilities in Uganda: a cross-sectional assessment.

BACKGROUND: The advancement of information and communication technology (ICT) has significantly accelerated the adoption and utilisation of Electronic Medical Record (EMR) systems in both developed and developing countries. This study aimed to examine a comprehensive understanding of the current EMR systems landscape in Uganda, examining the integration of ICT into healthcare delivery and the associated factors. METHODS: A cross-sectional study design was utilised to conduct this study across 265 government-owned health facilities. Quantitative data were collected through semi-structured questionnaires, while qualitative insights were obtained via face-to-face interviews. Associations between categorical variables were assessed using linear-by-linear association and Cochrane-Armitage chi-square tests. Analysis of Variance was used for comparison of group mean differences while Tukey's HSD and Scheffe's test were used for post-hoc comparisons. Poisson regression analysis was applied to determine the factors influencing the availability and utilisation of EMR systems in health facilities. RESULTS: On average, each health facility utilised 4.81 EMR systems (SD = 1.41). Statistically significant differences in the average number of EMR systems were observed across different levels of care (P-value = 0.0108). However, interoperability between EMR systems was reported in only 10% (26/265) of facilities. Regional referral hospitals were 36% more likely to have a higher number of EMR systems compared to health centre IVs (P-value = 0.0001), while general hospitals were 12% more likely (P-value = 0.041). Facilities employing a hybrid medical records system were 1.2 times more likely to utilise EMR systems compared to those using exclusively electronic systems (P-value = 0.027). Additionally, facilities with a higher number of medical departments demonstrated a significantly positive association with EMR system usage (P-value = 0.020). CONCLUSIONS: The study identified a diverse array of EMR systems across public health facilities, many of which exhibit technical disparities and are designed to serve narrowly defined institutional interests. Critically, the absence of a unified national framework or standard guidelines governing EMR adoption and interoperability continues to hinder the seamless exchange of clinical and patient data. To advance digital health integration, it is imperative to expedite the implementation of national interoperability frameworks alongside the operationalisation of a centralised health data warehouse.