Impact of an electronic clinical decision support system on workflow in antenatal care: the QUALMAT eCDSS in rural health care facilities in Ghana and Tanzania

Figures & data

Table 1 Distribution of observations (n), proportion (%), and time (min) spent on major task categories at baseline in intervention and non-intervention sites in Ghana and Tanzania

		All ANC (214)		First ANC (n=70)				Follow-up ANC (n=144)
	Major task categories	Observations (n)	Time (%)^a	Observations (n)	Time (%)^a	Mean time (±SD) (min)	Median (min)	Observations (n)	Time (%)^a	Mean time (±SD) (min)	Median (min)	p
1	Welcome	50	1.8	11	1.0	1.33 (±0.65)	1.72	39	2.5	0.88 (±0.6)	1.00	0.05
2	Registration	94	6.3	58	9.1	2.20 (±2.11)	1.54	36	3.4	1.30 (±0.79)	1.00	0.12
3	History taking	129	12.1	53	14.6	3.85 (±7.71)	2.63	76	9.5	1.71 (±6.99)	0.66	<0.001
4	Physical examination	142	8.8	55	10.3	2.62 (±1.88)	1.00	87	7.3	1.14 (±0.81)	1.00	0.116
5	Vital sign	164	12.0	59	9.3	2.19 (±2.39)	2.00	105	14.7	1.92 (±1.93)	1.45	0.26
6	Obstetric examination	197	10.3	64	6.6	1.45 (±1.14)	1.00	133	14.0	1.43 (±1.10)	1.05	0.99
7	Laboratory investigation	57	14.2	35	23.6	9.45 (±12.49)	5.67	22	4.6	2.83 (±2.43)	2.00	0.001
8	Urinalysis	10	0.7	8	1.0	1.75 (±1.17)	2.00	2	0.4	3.00 (±1.41)	3.00	nd
9	Drug administration	170	12.8	58	8.3	2.01 (±2.14)	1.23	112	17.3	2.11 (±2.47)	1.16	0.86
10	Client education	181	21.1	56	16.1	4.02 (±3.53)	2.55	125	26.2	2.87 (±2.99)	2.00	0.02

^aTotal does not add up to 100% due to rounding; nd=not done due to low occurrences.

Table 2 Distribution of observations (n), proportion (%), and time (minutes) spent on major task categories before and after implementation of the eCDSS in Ghana

		Before eCDSS implementation (N=75)				After eCDSS implementation (N=64)
	Major task categories	Observations (n)	Time (%)	Mean time (±SD) (min)	Median time (min)	Observations (n)	Time (%)	Mean time (±SD) (min)	Median time (min)	p
1	Welcome	8	0.48	0.42 (±0.67)	0.20	3	0.03	0.12 (±0.03)	0.13	0.54
2	Registration	22	6.70	2.12 (±1.91)	1.32	32	11.88	5.18 (±2.93)	4.58	<0.001
3	History taking	38	7.56	1.38 (±1.70)	0.59	55	15.69	3.98 (±4.47)	1.83	<0.001
4	Physical examination	39	6.30	1.12 (±0.94)	1.00	64	12.11	2.64 (±2.70)	2.03	<0.001
5	Vital sign	45	15.49	2.39 (±2.39)	1.85	64	9.67	2.12 (±1.04)	1.99	0.62
6	Obstetric examination	60	13.09	1.51 (±1.28)	1.21	64	6.94	1.51 (±0.70)	1.37	0.12
7	Laboratory investigation	14	13.79	6.85 (±7.81)	4.88	52	22.84	6.12 (±5.12)	6.26	0.82
8	Urinalysis	0		–	–	0	–	–	–	–
9	Drug administration	52	16.09	2.15 (±2.66)	1.10	52	8.85	2.37 (±1.56)	2.13	0.004
10	Client education	60	20.49	2.37 (±2.95)	1.08	64	12.00	2.61 (±1.78)	2.20	0.004

Table 3 Distribution of observation (n), proportion (%), and time (minutes) spent on major task categories before and after implementation of the eCDSS in Tanzania

		Before eCDSS implementation (N=34)				After eCDSS implementation (N=32)
	Major task categories	Observations (n)	Time (%)	Mean time (±SD) (min)	Median time (min)	Observations (n)	Time (%)	Mean time (±SD) (min)	Median time (min)	p
1	Welcome	11	1.63	1.00 (±0.00)	1.00	27	3.07	1.06 (±0.83)	0.93	0.18
2	Registration	26	6.68	1.73 (±2.38)	1.00	25	18.07	6.72 (±3.82)	5.18	<0.001
3	History taking	24	8.01	2.25 (±2.17)	2.00	16	2.87	1.67 (±1.71)	1.02	0.09
4	Physical examination	30	8.16	1.83 (±1.05)	2.00	23	4.90	1.98 (±1.64)	1.20	0.64
5	Vital sign	34	11.28	2.24 (±3.14)	1.00	32	11.03	3.21 (±1.67)	3.02	0.001
6	Obstetric examination	34	6.83	1.35 (±1.23)	1.00	32	9.46	2.75 (±1.89)	2.17	0.002
7	Laboratory investigation	22	16.62	5.09 (±6.12)	2.00	26	27.76	9.93 (±7.56)	8.72	0.004
8	Urinalysis	10	2.67	2.25 (±1.16)	2.00	0	–	–	–	–
9	Drug administration	30	13.50	3.03 (±3.52)	2.00	28	10.53	3.50 (±3.60)	1.96	1.0
10	Client education	33	24.62	5.03 (±4.05)	3.00	27	12.31	4.24 (±2.89)	4.32	0.60

Table 4 Change in time spent after 17 months comparing intervention (with eCDSS) versus non-intervention sites in Ghana and Tanzania

	Intervention vs. non-intervention (Ghana)				Intervention vs. non-intervention (Tanzania)
Major task categories	Change in time/(min)^a	SE (min)	p	95% CI (min)	Change in time/(min)^a	SE (min)	p	95% CI (min)
Welcome	–	–	–	–	0.07	0.30	0.82	(−0.51; 0.63)
Registration	2.08	1.15	0.07	(0.20; 4.36)	1.41	1.43	0.33	(−1.43; 4.25)
History taking	1.00	2.31	0.67	(−3.57; 5.56)	−3.98	3.99	0.32	(−11.97; 4.01)
Physical examination	1.30	0.54	0.02	(0.23; 2.36)	−1.44	2.84	0.61	(−7.07; 4.19)
Vital sign	0.42	0.41	0.31	(−0.40; 1.23)	0.57	0.88	0.52	(−1.18; 2.32)
Obstetric examination	−2.03	1.10	0.07	(−4.21; 0.14)	2.14	0.56	<0.001	(1.03; 3.26)
Laboratory investigation	−4.70	3.17	0.14	(−11.01; 1.60)	2.64	5.92	0.66	(−9.19; 14.46)
Urinalysis	–	–	–	–	–	–	–	–
Drug administration	−0.01	0.53	0.99	(−1.05; 1.03)	−1.12	1.29	0.39	(−3.67; 1.43)
Client education	0.35	0.68	0.61	(−0.99; 1.69)	−2.14	1.43	0.14	(−4.97; 0.69)

^aChange in time (minutes) comparing intervention and non-intervention sites using ANOVA.

Fig. 1 Sequence of performing history (H) and examination (E) before and after implementation of the eCDSS in Ghana and Tanzania.