Abstract:
Background: The implementation of new technology can interrupt establishedworkflows in health care settings.
The Quality of Maternal Care (QUALMAT) project has introduced an electronic clinical decision support
system (eCDSS) for antenatal care (ANC) and delivery in rural primary health care facilities in Africa.
Objective: This study was carried out to investigate the influence of the QUALMAT eCDSS on the workflow
of health care workers in rural primary health care facilities in Ghana and Tanzania.
Design: A direct observation, time-and-motion study on ANC processes was conducted using a structured
data sheet with predefined major task categories. The duration and sequence of tasks performed during ANC
visits were observed, and changes after the implementation of the eCDSS were analyzed.
Results: In 24 QUALMAT study sites, 214 observations of ANC visits (144 in Ghana, 70 in Tanzania) were
carried out at baseline and 148 observations (104 in Ghana, 44 in Tanzania) after the software was implemented
in 12 of those sites. The median time spent combined for all centers in both countries to provide ANC at
baseline was 6.5 min [interquartile range (IQR) 4.0 10.6]. Although the time spent on ANC increased in
Tanzania and Ghana after the eCDSS implementation as compared to baseline, overall there was no significant
increase in time used for ANC activities (0.51 min, p 0.06 in Ghana; and 0.54 min, p 0.26 in Tanzania)
as compared to the control sites without the eCDSS. The percentage of medical history taking in women who
had subsequent examinations increased after eCDSS implementation from 58.2% (39/67) to 95.3% (61/64)
pB0.001 in Ghana but not in Tanzania [from 65.4% (17/26) to 71.4% (15/21) p 0.70].
Conclusions: The QUALMAT eCDSS does not increase the time needed for ANC but partly streamlined
workflow at sites in Ghana, showing the potential of such a system to influence quality of care positively.
