Maturity assessment of KenyaEMR: advancing digital health solutions through continuous improvement in Kenya

BACKGROUND: Kenya Electronic Medical Records (KenyaEMR) has improved data availability for patient services and programmatic purposes in Kenya. Maturity models provide a framework to assess health information systems (HIS) capabilities across maturity levels to ensure they are effective. This study aimed to determine KenyaEMR's current and goal maturity status, highlight gaps, and establish priorities for continuous improvement. METHODS: The HIS Stages of Continuous Improvement (SOCI) Toolkit guided KenyaEMR's maturity assessment across five HIS domains and five maturity stages: 1-emerging/ad hoc; 2-repeatable, 3-defined, 4-managed, and 5-optimized. Participants included KenyaEMR experts representing the Ministry of Health, implementing partners, donor agencies, and faith-based organizations. The consensus-building process to determine final maturity scores utilized a two-round modified Delphi process. Improvement roadmaps were developed as action plans to bridge identified gaps. The assessment occurred in August 2024. RESULTS: Thirty-two stakeholders participated in the assessment. The overall KenyaEMR average maturity score was 3.2/5. Across the five HIS domains, the highest maturity scoring domain was standards and interoperability (4.4/5) and the lowest was management and workforce (2.3/5). The other domains maturity scores include leadership and governance (2.8/5), Information and Communication Technology (ICT) infrastructure (2.9/5), data quality and use (3.7/5). Among the 39 subcomponents, 7/39 (17.9%) scored at the 5-optimized maturity stage, of which six included data exchange standards, terminology management, master facility list, unique person identity management, person data exchange, and aggregated data exchange under the standards and interoperability domain. In comparison, 6/39 (15.4%) subcomponents scored lowest at the 2-repeatable level, with three (HR policy, HIS financing plan, and resource mobilization) under the management and workforce domain. The overall goal status maturity score was 4.6/5, with all subcomponents expected to reach 4-managed or 5-optimized levels by 2027. CONCLUSIONS: KenyaEMR's overall maturity level was 3.2/5. The workforce and management domain will require attention so that national-level investments in the HIS workforce and an increase in local funding sources can decrease the high donor funding dependency by the Kenya Ministry of Health. Conducting routine assessments coupled with the upcoming promising commitments from the local government to increase digital health investments will benefit continued support for KenyaEMR as it evolves.