An Architectural Design for Aggregated Healthcare Reporting From Electronic Medical Record Systems to the National Electronic Healthcare Reporting System. A Case Study of Uganda Ministry of Health

Abstract

In Uganda, there has been notable adoption of Information and Communication Technology (ICT), especially Electronic Medical Record (EMR) systems. Pilot studies have paved the way for the implementation of UgandaEMR, primarily used by government healthcare providers for disease surveillance and electronic reporting to DHIS2, the national electronic healthcare reporting system. Despite strong endorsement by the Ministry of Health (MoH), private healthcare providers have been slow to adopt UgandaEMR, citing diverse requirements, notably advanced financial capabilities. A major challenge with alternative EMR systems is their inability to directly exchange routine aggregate healthcare data with DHIS2, a functionality already achieved by UgandaEMR. This gap leads to reporting delays to the MoH, negatively impacting disease surveillance and resource allocation. This study addressed three key objectives: understanding challenges in aggregated data reporting from diverse EMR systems to DHIS2 and identifying architectural needs, designing an application architecture for data exchange between alternative EMR systems and DHIS2, and implementing this design for proof-of-concept. Through an inductive approach, a survey of 20 purposively selected healthcare providers was conducted using questionnaires, with descriptive statistics used for analysis. The analysis revealed numerous challenges in report aggregation, including spending more than three hours consolidating reports, duplicate entries, data incompleteness and inaccuracy, and reliance on unreliable data sources such as simultaneous paper and EMR system usage.

To enhance EMR system capabilities, several strategies were identified, including developing an auto-synchronization service for report automation, integrating MoH report formats into EMR systems, and adopting interoperability standards for seamless data exchange. A prototype was developed to demonstrate these strategies' effectiveness, showing that enhancing alternative EMR systems' capabilities enabled timely submission of aggregate healthcare data to the MoH, thereby improving disease surveillance and resource allocation efficiency.