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BACKGROUND As healthcare facilities in Low- and Middle-Income Countries (LMICs) such as Kenya adopt Electronic Health Record (EHR) systems to improve hospital administration and patient care, it is important to understand the adoption process, identify the key stakeholders, and assess the capabilities of the systems in use. OBJECTIVE To describe the level of adoption of Electronic Health Records systems in public hospitals and understand the process of adoption from Health Management Information System (HMIS) system vendors and system users. METHODS We conducted a survey of County Health Records Information Officers (CHRIOs) in Kenya to determine the level of adoption of Electronic Health Records systems in public hospitals. We conducted site visits to hospitals to view systems in use and to interview hospital administrators and end users. We also interviewed Health Management Information System (HMIS) system vendors to understand the adoption process from their perspective. RESULTS From the survey of CHRIOs, all facilities mentioned had adopted some form of EHR. Hospitals commonly purchased systems for patient administration and hospital billing functions. Radiology and laboratory management systems were commonly standalone systems. There were varying levels of interoperability within facilities that had more than one system in operation. We only saw one in-patient EHR system in use although many vendors and hospital administrators we interviewed were planning to adopt or support such systems. From the user perspective, issues such as system usability, adequate training, availability of adequate infrastructure and system support emerged. From the vendor perspective, a wide range of services was available to the hospital though constrained by funding and the need to computerise service areas that were deemed as priority. Additionally, vendors were unable to implement some data sharing modules linking to national HMIS due to lack of appropriate policies to facilitate this and users’ lack of confidence in new technologies such as cloud services. CONCLUSIONS EHR adoption in Kenya has been underway for some years, particularly in comprehensive care clinics, and hospitals are increasing purchasing systems to support administrative functions. Considerable support from government, donors and regional health informatics organisations will be required to enable hospitals to move to full EHR adoption for in-patient care.

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