Perceived value but persistent barriers: A qualitative study of healthcare worker experiences with the Impilo electronic health record system in rural Zimbabwe

Electronic Health Records (EHRs) are pivotal for improving healthcare data quality and service delivery. Despite the introduction of the Impilo EHR system at St Anne’s Mission Hospital in Brunapeg, utilisation remains low. This study aimed to explore healthcare workers’ (HCWs) experiences and identify the key barriers and facilitators to Impilo’s utilisation. A descriptive qualitative study was conducted at St Anne’s Mission Hospital. In-depth interviews were conducted with 20 HCWs authorised to use Impilo, selected via purposive sampling until thematic saturation was achieved. Thematic analysis, following the Braun and Clarke approach, was used to analyse the data. Trustworthiness was ensured through multi-coder analysis, the maintenance of an audit trail, and thick descriptive reporting. HCWs reported positive experiences related to ease of data access, improved communication, and better inventory management. However, significant barriers undermine utilisation. The analysis revealed three key themes: (1) Benefits of Impilo, (2) Multifaceted Challenges, and (3) Suggested Improvements. Challenges included pervasive technical and infrastructural issues (e.g., frequent network downtime, lack of offline functionality), human resource constraints leading to dual documentation and increased workload, and subsequent compromised data quality due to inconsistent entry. The underutilisation of the Impilo system is not due to a lack of perceived value but is primarily driven by remediable barriers related to infrastructure, training, and workflow design issues. For successful implementation, interventions must be multifaceted, addressing technical reliability (e.g., offline functionality), human capacity (continuous training and support), and organisational processes (dedicated data clerks and inclusive system redesign). This study provides a framework for improving EHR adoption in similar low-resource rural settings.