Improving continuity of HIV/AIDS care through electronic health records in resource-limited settings: A Botswana perspective

Objective: To investigate barriers to the effective use of electronic health records (EHR) to improve health outcomes for HIV/AIDS care treatment in health centres in rural areas of Botswana. Methods: In a qualitative study interviews were held with 57 staff members at 32 health centres in rural and remote areas of the country. Closed and open-ended questions were used to gain insights into the implementation and use of the EHR system. Transcripts were analysed and evaluated using thematic coding and structured around themes through NVivo 11 data analysis software. Themes covered were: changes in nursing practice; EHR system support; non-use of EHR; lack of leadership commitment to EHR use; and risks of using EHR. Results: A large majority of staff were confident users of the EHR, despite limited training. Many nursing staff reported changes in administrative duties as documentation with EHR was different from that used in paper-based records and reports to management. Lack of appropriate support led to challenges in consistent operation and management of the EHR system. There were risks of data corruption through equipment failures and security vulnerabilities. The EHR system could not communicate with outside healthcare providers or facilities, leading to loss of patient follow up and delays in obtaining results of laboratory tests. Conclusion: Progress has been made with a national EHR system to support HIV management in Botswana within small local facilities. However, nurses’ perspectives indicate limitations in staff training, insufficient support for health centres, and lost communication between facilities. Such barriers led to continued delays in treatment and fragmentation of health records. These areas should be addressed in further development.