Evaluating Usability and Functionality of an Open-Source Electronic Medical Record System in a Tertiary Teaching Hospital in Ethiopia: A Cross-Sectional Survey

In the modern hospital, a patient's story is no longer written solely in ink on paper. Instead, it lives in a digital system known as an electronic medical record. This software acts as a central hub, storing everything from a patient's history and lab results to the medications they are taking. The promise of these systems is to make healthcare faster, safer, and more accurate by allowing doctors and nurses to access critical information instantly. However, a computer program is only as good as the people who have to use it every day. If the software is confusing, slow, or difficult to navigate, it can become a barrier rather than a help, slowing down care and frustrating the very staff meant to save lives. This is especially true in places where resources like electricity and fast internet are not always guaranteed.

A recent study conducted at St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia, looked closely at how a new, open-source medical record system was working during its early days. The researchers wanted to know if the system was actually helping the doctors, interns, and nurses who used it, or if it was creating new problems. They surveyed eighty-six healthcare workers in the hospital's internal medicine department, asking them about their daily experiences with the software. The goal was to listen to the people on the front lines to find out what was working, what was broken, and how the system could be improved to better serve patients.

The results showed that the system had become a vital part of daily hospital life. Nearly all the staff members who answered the survey used the computer system every single day, and most of them opened it multiple times just to get through their shifts. This high level of use suggests that the hospital had successfully moved away from paper records and that the staff relied on the digital system to do their jobs. However, despite this heavy reliance, the experience of using the system was often difficult. A significant number of users found it hard to navigate the software or to find the specific information they needed when they needed it. For example, one in five staff members said they struggled to locate necessary patient details, and nearly forty percent were unhappy with how slow the system was.

The challenges were not felt equally by everyone. The doctors and medical students reported significantly more trouble than the nurses. While the nurses generally found the system easier to manage, the physicians faced more frequent technical hurdles, such as the software freezing or failing to load images. In fact, more than eight out of ten doctors said they encountered technical problems while trying to use the system, compared to less than half of the nursing staff. The doctors also felt that the system did not support their specific way of working as well as the nurses felt it supported theirs. They found it particularly difficult to review medical images or write clinical notes, which are essential parts of their daily routine.

Another major issue was the training the staff received before they started using the system. Although almost everyone had attended a training session, very few felt that the instruction was excellent or even good. Only about one-third of the respondents rated the training as high quality. This suggests that the staff were often left to figure out complex software on their own, without enough guidance on how to use it effectively. The open-ended comments from the survey painted a clear picture of what was needed: faster internet connections, more computers, and software that included features the staff actually needed, such as specific forms for referrals and better ways to organize patient data.

The study concludes that simply installing a new computer system is not enough to transform healthcare. Even when staff use the system every day, significant gaps in usability and technical support can undermine its value. The researchers found that for the system to truly succeed, it needs to be redesigned with the specific needs of doctors and nurses in mind. This includes fixing the slow internet, providing better hardware, and offering training that matches the different roles of the staff. Without these changes, the digital tools intended to improve patient care may continue to cause frustration rather than relief. The path forward requires listening to the people who use the system every day and making adjustments that fit their real-world workflow.