Abstract
Setting: Human immunodeficiency virus (HIV) clinics in
five hospitals and five health centres in Lusaka, Zambia,
which transitioned from daily entry of paper-based data
records to an electronic medical record (EMR) system by
dedicated data staff (Electronic-Last) to direct real-time
data entry into the EMR by frontline health workers
(Electronic-First).
Objective: To compare completeness and accuracy of
key HIV-related variables before and after transition of
data entry from Electronic-Last to Electronic-First.
Design: Comparative cross-sectional study using existing
secondary data.
Results: Registration data (e.g., date of birth) was 100%
complete and pharmacy data (e.g., antiretroviral therapy
regimen) was 90% complete under both approaches.
Completeness of anthropometric and vital sign data was
75% across all facilities under Electronic-Last, and this
worsened after Electronic-First. Completeness of TB
screening and World Health Organization clinical staging
data was also 75%, but improved with Electronic-First.
Data entry errors for registration and clinical consultations decreased under Electronic-First, but errors increased for all anthropometric and vital sign variables.
Patterns were similar in hospitals and health centres.
Conclusion: With the notable exception of clinical consultation data, data completeness and accuracy did not
improve after transitioning from Electronic-Last to Electronic-First. For anthropometric and vital sign variables,
completeness and accuracy decreased. Quality improvement interventions are needed to improve Electronic-First
implementation.
