PDF(Pubmed)
Abstract：
BACKGROUND: Low- and lower-middle-income countries account for a higher percentage of global epidemics and chronic diseases. In most low- and lower-middle-income countries, there is limited access to health care. The implementation of open-source electronic health records (EHRs) can be understood as a powerful enabler for low- and lower-middle-income countries because it can transform the way health care technology is delivered. Open-source EHRs can enhance health care delivery in low- and lower-middle-income countries by improving the collection, management, and analysis of health data needed to inform health care delivery, policy, and planning. While open-source EHR systems are cost-effective and adaptable, they have not proliferated rapidly in low- and lower-middle-income countries. Implementation barriers slow adoption, with existing research focusing predominantly on technical issues preventing successful implementation.
OBJECTIVE: This interdisciplinary scoping review aims to provide an overview of contextual barriers affecting the adaptation and implementation of open-source EHR systems in low- and lower-middle-income countries and to identify areas for future research.
METHODS: We conducted a scoping literature review following a systematic methodological framework. A total of 7 databases were selected from 3 disciplines: medicine and health sciences, computing, and social sciences. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The Mixed Methods Appraisal Tool and the Critical Appraisal Skills Programme checklists were used to assess the quality of relevant studies. Data were collated and summarized, and results were reported qualitatively, adopting a narrative synthesis approach.
RESULTS: This review included 13 studies that examined open-source EHRs\' adaptation and implementation in low- and lower-middle-income countries from 3 interrelated perspectives: socioenvironmental, technological, and organizational barriers. The studies identified key issues such as limited funding, sustainability, organizational and management challenges, infrastructure, data privacy and protection, and ownership. Data protection, confidentiality, ownership, and ethics emerged as important issues, often overshadowed by technical processes.
CONCLUSIONS: While open-source EHRs have the potential to enhance health care delivery in low- and lower-middle-income-country settings, implementation is fraught with difficulty. This scoping review shows that depending on the adopted perspective to implementation, different implementation barriers come into view. A dominant focus on technology distracts from socioenvironmental and organizational barriers impacting the proliferation of open-source EHRs. The role of local implementing organizations in addressing implementation barriers in low- and lower-middle-income countries remains unclear. A holistic understanding of implementers\' experiences of implementation processes is needed. This could help characterize and solve implementation problems, including those related to ethics and the management of data protection. Nevertheless, this scoping review provides a meaningful contribution to the global health informatics discipline.
OBJECTIVE: This interdisciplinary scoping review aims to provide an overview of contextual barriers affecting the adaptation and implementation of open-source EHR systems in low- and lower-middle-income countries and to identify areas for future research.
METHODS: We conducted a scoping literature review following a systematic methodological framework. A total of 7 databases were selected from 3 disciplines: medicine and health sciences, computing, and social sciences. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The Mixed Methods Appraisal Tool and the Critical Appraisal Skills Programme checklists were used to assess the quality of relevant studies. Data were collated and summarized, and results were reported qualitatively, adopting a narrative synthesis approach.
RESULTS: This review included 13 studies that examined open-source EHRs\' adaptation and implementation in low- and lower-middle-income countries from 3 interrelated perspectives: socioenvironmental, technological, and organizational barriers. The studies identified key issues such as limited funding, sustainability, organizational and management challenges, infrastructure, data privacy and protection, and ownership. Data protection, confidentiality, ownership, and ethics emerged as important issues, often overshadowed by technical processes.
CONCLUSIONS: While open-source EHRs have the potential to enhance health care delivery in low- and lower-middle-income-country settings, implementation is fraught with difficulty. This scoping review shows that depending on the adopted perspective to implementation, different implementation barriers come into view. A dominant focus on technology distracts from socioenvironmental and organizational barriers impacting the proliferation of open-source EHRs. The role of local implementing organizations in addressing implementation barriers in low- and lower-middle-income countries remains unclear. A holistic understanding of implementers\' experiences of implementation processes is needed. This could help characterize and solve implementation problems, including those related to ethics and the management of data protection. Nevertheless, this scoping review provides a meaningful contribution to the global health informatics discipline.
摘要：
背景：低收入和中低收入国家占全球流行病和慢性病的比例更高。在大多数低收入和中低收入国家，获得医疗保健的机会有限。开源电子健康记录（EHR）的实施可以被理解为低收入和中低收入国家的强大推动力，因为它可以改变医疗技术的交付方式。开源EHR可以通过改善收集来增强低收入和中低收入国家的医疗保健服务，管理,以及为医疗保健提供信息所需的健康数据的分析，政策,和规划。虽然开源EHR系统具有成本效益和适应性，它们在低收入和中低收入国家并没有迅速扩散。实施障碍缓慢采用，现有的研究主要集中在阻止成功实施的技术问题上。
目的：本跨学科范围界定综述旨在概述影响低收入和中低收入国家适应和实施开源EHR系统的背景障碍，并确定未来研究的领域。
方法：我们遵循系统的方法框架进行了范围界定文献综述。总共从3个学科中选择了7个数据库：医学和健康科学，计算，和社会科学。根据PRISMA-ScR（系统审查的首选报告项目和范围审查的荟萃分析扩展）清单报告研究结果。使用混合方法评估工具和关键评估技能计划清单来评估相关研究的质量。对数据进行了整理和总结，结果被定性报道，采用叙事综合方法。
结果：本综述包括13项研究，这些研究从3个相互关联的角度考察了低收入和中低收入国家开源EHRs的适应和实施：社会环境，技术,和组织障碍。这些研究确定了关键问题，如资金有限，可持续性组织和管理挑战，基础设施,数据隐私和保护，和所有权。数据保护,保密性,所有权,道德成为重要问题，经常被技术过程所掩盖。
结论：虽然开源EHR有可能在低收入和中低收入国家环境中提高医疗保健服务，实施困难重重。这一范围审查表明，根据所采用的实施观点，不同的实施障碍出现在人们的视野中。对技术的主要关注分散了影响开源EHR扩散的社会环境和组织障碍。地方执行组织在解决低收入和中低收入国家的执行障碍方面的作用仍不清楚。需要全面了解实施者的实施过程经验。这可以帮助表征和解决实施问题，包括与道德和数据保护管理有关的内容。然而，本范围审查为全球卫生信息学学科提供了有意义的贡献.
目的：本跨学科范围界定综述旨在概述影响低收入和中低收入国家适应和实施开源EHR系统的背景障碍，并确定未来研究的领域。
方法：我们遵循系统的方法框架进行了范围界定文献综述。总共从3个学科中选择了7个数据库：医学和健康科学，计算，和社会科学。根据PRISMA-ScR（系统审查的首选报告项目和范围审查的荟萃分析扩展）清单报告研究结果。使用混合方法评估工具和关键评估技能计划清单来评估相关研究的质量。对数据进行了整理和总结，结果被定性报道，采用叙事综合方法。
结果：本综述包括13项研究，这些研究从3个相互关联的角度考察了低收入和中低收入国家开源EHRs的适应和实施：社会环境，技术,和组织障碍。这些研究确定了关键问题，如资金有限，可持续性组织和管理挑战，基础设施,数据隐私和保护，和所有权。数据保护,保密性,所有权,道德成为重要问题，经常被技术过程所掩盖。
结论：虽然开源EHR有可能在低收入和中低收入国家环境中提高医疗保健服务，实施困难重重。这一范围审查表明，根据所采用的实施观点，不同的实施障碍出现在人们的视野中。对技术的主要关注分散了影响开源EHR扩散的社会环境和组织障碍。地方执行组织在解决低收入和中低收入国家的执行障碍方面的作用仍不清楚。需要全面了解实施者的实施过程经验。这可以帮助表征和解决实施问题，包括与道德和数据保护管理有关的内容。然而，本范围审查为全球卫生信息学学科提供了有意义的贡献.
