Bending the Cost Curve in Implementing Electronic Medical Record Systems: Lessons Learnt from Kenya

Ali Karisa, Mysha Sissine, Gikandi Ngibuini, Joshua Oiro, Donna Medeiros, and Bobby Jefferson


Free and Open Source health information systems, Costing Health Information Systems, Electronic Medical Records, Clinical Information Systems


Background: Through a CDC co-operative agreement, the Futures Group Kenya Health Management Information Systems (KE HMIS) project has been deploying electronic medical record (EMR) systems throughout Kenya. During 2013, our implementing team rolled out EMRs in 170 health facilities bringing the project closer to meeting the target of 300 deployments by 2015. With inherent challenges of setting up software systems coupled with limited resources, there is a need for innovative solutions to reduce the cost of EMR deployment1. Challenges: The implementation of EMRs in resource-limited settings presents several challenges including (1) software costs, (2) unreliable electricity, (3) inadequate skills capacity, (4) hardware costs, and (5) constant systems support.2-3 Each of these challenges can be met, but with a cost. Response: Several initiatives were used to minimize EMR implementation costs. Software licensing and systems support costs were minimized by focusing on developing, deploying, and using open-source products that are free of charge like IQCare EMR. Hardware, energy and maintenance costs were reduced by using thin client computer configurations when possible.3 To reduce expenses associated with training and capacity building, we identified EMR champions at each facility, used on-the-job trainings, and standardized electronic training materials. Lessons Learnt: These cost-saving initiatives have reduced expenses during the EMR implementation. KE HMIS will continue to use open-source products, increase the number of facilities using thin clients, and support EMR champions with additional training.

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