Rotich JK et al. 2003 "Installing and implementing a computer-based patient record system in sub-Saharan Africa: the Mosoriot Medical Record System."

Rotich JK, Hannan TJ, Smith FE, et al. Installing and implementing a computer-based patient record system in sub-Saharan Africa: the Mosoriot Medical Record System. J Am Med Inform Assoc 2003;10(4):295-303.
"The authors implemented an electronic medical record system in a rural Kenyan health center. Visit data are recorded on a paper encounter form, eliminating duplicate documentation in multiple clinic logbooks. Data are entered into an MS-Access database supported by redundant power systems. The system was initiated in February 2001, and 10,000 visit records were entered for 6,190 patients in six months. The authors present a summary of the clinics visited, diagnoses made, drugs prescribed, and tests performed. After system implementation, patient visits were 22% shorter. They spent 58% less time with providers (p,0.001) and 38% less time waiting (p = 0.06). Clinic personnel spent 50% less time interacting with patients, two thirds less time interacting with each other, and more time in personal activities. This simple electronic medical record system has bridged the "digital divide." Financial and technical sustainability by Kenyans will be key to its future use and development."

To describe the implementation of an electronic medical record in a rural Kenyan health center.

Type Clinic
Primary care
Type Specific
Internal medicine and pediatrics
Small and/or medium
Type of Health IT
Electronic medical records (EMR)
Type of Health IT Functions
Information on the patient and visit, including laboratory results and pharmacy information, were recorded on a paper encounter form and then entered into a database. Reports were generated from the database.
Workflow-Related Findings
Prior to implementation, patients would take paper medical records home. No patient files were maintained by the clinic. After implementation, many patients would not remember to bring their paper forms to the receptionist so that it could be entered into the EMR. Vigilance by the clerks and other staff reduced the problem, as did making changes in the clinic procedures.
"Patients spent substantially less time with their provider (5 vs. 12 minutes before the [implementation])" and providers spent one-sixth of their workday with patients instead of one-third before the implementation.
"Providers also spent two thirds less time interacting with other staff." They had substantially more time for personal activities.
After implementation, clerks spent "more time searching for information (3% vs. 0.5%)."
Reporting allowed the clinic staff to notice and respond to a cluster of sexually transmitted diseases in one village and a low rate of child immunizations in another village.
Before implementation, creating required reports by hand from paper records "took a clerk two weeks. Now they take just minutes."
Study Design
Pre-postintervention (no control group)
Study Participants
Study participants included staff and patients of the clinic for the six months after implementation.