Evaluating the Impact of a Digital Hospital Information Management System on the Operational and Financial Performance of Health Facilities in Kenya

Abstract

Background: In Sub-Saharan Africa, hospital information management systems (HIMS) are predominantly paper based. Countries like Kenya are adopting digital HIMS. However, there is limited evidence about their impact. This study aimed to evaluate the impact of a digital HIMS on the operational and financial performance of Kenyan health facilities. Methods: A retrospective analysis was done using longitudinal data collected at 21 health facilities in Kenya that had actively used the outpatient and/or billing modules of the Elephant HIMS (EHIMS) for at least 9 months. Trends of operational and financial performance indicators across months 3,6,9 after EHIMS adoption were compared to pre-adoption baseline values. The Wilcoxon test was performed to determine the statistical significance of the difference between baseline and 9 months post-adoption. Results: The EHIMS had positive impact on operational performance evidenced by statistically significant reduction, between baseline and 9 months after adoption, in monthly waiting (43.55 vs 35.79 minutes) and journey times (59.90 vs 60.34 minutes). Positive impact was also observed on financial performance as shown by an increase in recorded monthly revenue (100000 vs 210000 KES) and improved tracking of unpaid revenue (0.57 vs 1.19). The above changes were associated with and not directly caused by the EHIMS. Conclusion: The EHIMS was found to have a positive impact on the performance of health facilities at the time points analysed in this study. To demonstrate the full impact of digital HIMS and for clearer attribution, further research should be done to analyse the confounding factors that affect health facility performance. Key words: digital health, electronic health records, operational, financial, performance