Factors Impacting EHR Implementation: A Case Study in Belize

Electronic health record systems are a tool used throughout healthcare organizations to provide safe and efficient patient care. They are used to record and retrieve patient information related to health history, diagnostics, and treatment plans. Electronic health records have become increasingly integrated into healthcare practice and are demonstrative of safe and quality care. Healthcare organizations that do not have electronic health record systems in place jeopardize safe and efficient patient care. In addition, access and financial means to implement electronic health record systems in developing countries are challenging as resources are often restricted. This project aims to identify factors that impact electronic health record implementation of a private clinic setting in Belize. The theory of bureaucratic caring (1989) and Havelock’s theory of change (1973) were the paradigms used to guide the project. A single, explanatory case study approach was utilized in the project design to gain a holistic view of the problem and to develop potential interventions. Semistructured interviews were conducted among 12 stakeholders using a modified version of the Agency for Healthcare Research and Quality’s Qualitative Interview Questions for Electronic Health Record Implementation. Inductive thematic analysis, based on Braun and Clarke’s (2006) six-phase approach, was used to draw themes and interpret results from stakeholder interviews. Participants were divided into three groups to assess differences and similarities in responses: healthcare providers, administrative personnel, and management team. Three main themes—(a) electronic health record infrastructure operations, (b) education and training, and (c) organizational structure—and 10 subthemes emerged.. A comparison of responses between the three groups revealed mostly similarities. Stakeholders demonstrated support for the initiative while also offering considerations for a successful implementation strategy within the setting in Belize.