Facilitators and Barriers to the Implementation of Electronic Health Systems by Health Care Workers at Primary Health Care Clinics in the City of Johannesburg

Abstract

Background: The use of electronic health systems has dominated debates regarding their usefulness in improving health systems since the advent of the internet. As with most developing countries, South Africa has implemented an electronic health strategy and digital health strategy since 2012, which have been fraught with challenges from the beginning. The most prevalent challenge relates to network infrastructure, followed by the willingness of the health care personnel to use eHealth systems. Additionally, public health care governance is fragmented in South Africa, with most provinces providing health care through the local authority/municipality as well as from the provincial governments in provinces. This has led to uneven and non-coordinated health care provisioning as seen in the case of the City of Johannesburg. Aim: The aim of this study was to understand the status of eHealth systems within public health clinics in the City of Johannesburg, including understanding the facilitators and barriers to the implementation of eHealth from the point of view of the nurses and doctors in the public health clinics. Methods: An exploratory qualitative research design was employed in this study. Key informant interviews were conducted with 5 operations managers, 5 professional nurses, 1 data clerk and 1 doctor within the City of Johannesburg health district’s sub-districts. Two senior sub-district managers were also interviewed as key informants. In addition, a group discussion was conducted with senior district officials responsible for the implementation of research as well as electronic health systems within the City of Johannesburg. Data was transcribed verbatim and thematic analysis used to analyse the data. Results: The findings indicated that eHealth is currently not being implemented fully in the City of Johannesburg. Although another pilot of eHealth is currently underway, there is limited awareness of it by health care workers within the City of Johannesburg. Willingness to embrace digital interventions as well as digital literacy, were the most commonly cited individual facilitating factors as well as barriers. Access to reference tools such as standard operating procedures and implementation guidelines, coupled with management support for implementation were noted as important organisational level facilitators which were also barriers where they were absent. The technological factors indicated as both facilitators and barriers related predominantly to network access and access to the tools of the trade, being the computers and hardware needed to implement eHealth. Factors related to the ease of use of viii eHealth specifically relating to the design of the system, its ability to interface with other systems as its ability to mirror the clinical workflow of the clinic were indicated as the most compelling factors that contributed to either the use or the lack thereof of electronic health systems. Conclusions: This study revealed that the implementation of eHealth within the City of Johannesburg is fragmented, with health care workers having limited knowledge and understanding of the status of implementation, which further contributes to their ability or inability to support and embrace implementation. In order to create an environment conducive to successful implementation, it is important for the officials responsible for eHealth implementation to jointly develop and implement a unified electronic health system that serves all members of the population and integrates with the provincial health department.