Electronic Health Record Systems in Limited Resource Settings: A Comprehensive Evaluation of the Impilo Platform

Background: Zimbabwe has implemented the Impilo electronic health record (EHR) system since 2016 to manage the health system electronically, gather strategic information and reduce manual documentation burden.Objective: We evaluated the capacity of decentralized structures to effectively use the Impilo EHR platform, identify training needs and challenges and provide recommendations for enhancing its effectiveness and support for integrated people-centred services at the primary healthcare level.Methods: We conducted a cross-sectional, mixed-method design, applying the COM-B (Capability, Opportunity, Motivation and Behaviour) model of behavioural change.Forty-five purposively selected healthcare workers (nurses, data entry clerks, receptionists, pharmacy staff, laboratory technicians and primary counsellors) from ten healthcare facilities in Harare and Bulawayo were included in this study.Interviews were transcribed, translated and manually coded for thematic analysis using the COM-B constructs.Results: Health workers had satisfactory skills for using the Impilo EHR system but lacked troubleshooting abilities.The capacity building did not equip users with the necessary programmespecific skills.Problems such as internet connectivity, power backup, human resource shortages, interoperability issues and lack of editing rights hindered usage.The EHR system integrated primary health services but struggled with interoperability with other software and lacked data aggregation servers, limiting its effectiveness.Leadership support and user involvement were missed opportunities to enhance performance. Conclusion:This study provided key insights into the implementation of the Impilo EHR system in Zimbabwe.The system empowers healthcare professionals with timely information, improving decision-making and patient care.However, problems such as module issues, knowledge gaps, internet connectivity, interoperability, human resource shortages and power constraints hinder its full potential.We recommend addressing these handicaps, enhancing leadership support, integrating EHR usage into performance appraisals and improving system integration with other platforms to enhance accuracy and reliability.