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Effect of Electronic Health Records on Continuity of Care among Patients in Nigerian Primary Healthcare Centres

Abstract

Continuity of care is an important component of effective primary healthcare because it ensures that patients receive coordinated, consistent, and timely healthcare services across different visits and providers. Continuity of care is particularly important for patients with chronic conditions, maternal and child health needs, recurrent illnesses, and patients requiring referrals or follow-up. However, continuity of care in Nigerian primary healthcare centres may be affected by fragmented paper-based records, missing patient information, poor documentation, difficulty retrieving previous medical histories, inadequate communication between healthcare providers, and weak referral and follow-up systems. Electronic Health Records (EHRs) provide a digital approach to storing, retrieving, updating, and sharing patient health information and may improve the availability and accessibility of clinical information during subsequent encounters. Effective implementation of EHRs may therefore strengthen coordination, information continuity, clinical decision-making, referral processes, and follow-up care. Against this background, this study investigates the effect of Electronic Health Records on continuity of care among patients in Nigerian primary healthcare centres. The study will be anchored on the Donabedian Model of Healthcare Quality, Systems Theory, and the Technology Acceptance Model. The Donabedian Model explains healthcare quality through structure, process, and outcome, with EHR implementation representing an important structural and process component and continuity of care serving as a measurable outcome. Systems Theory views primary healthcare delivery as an interconnected system involving patients, healthcare workers, health records, referral networks, facilities, information systems, and health authorities, where changes in one component may influence overall service coordination. The Technology Acceptance Model explains how perceived usefulness, perceived ease of use, user acceptance, and system usability may influence healthcare workers' adoption and effective use of EHRs. Collectively, these theoretical perspectives provide a suitable framework for explaining how EHR implementation may influence continuity of care among patients in Nigerian primary healthcare centres. The study will adopt a quantitative quasi-experimental or analytical comparative research design. The study population will comprise patients receiving care in selected public and private primary healthcare centres in Nigeria, as well as healthcare workers responsible for clinical documentation and patient management. A multistage sampling technique will be used to select states, local government areas, communities, primary healthcare centres, healthcare workers, and eligible patients. EHR implementation will be assessed using indicators such as availability of electronic patient records, proportion of patient records digitized, accessibility of patient histories, completeness of electronic documentation, frequency of record updating, interoperability where applicable, information retrieval time, system reliability, data security, user training, technical support, system usability, and availability of backup systems. Continuity of care will be assessed using indicators such as availability of previous clinical information during subsequent visits, consistency of care providers where applicable, follow-up attendance, referral completion, medication and treatment history continuity, coordination between healthcare providers, documented care plans, appointment tracking, timely follow-up, and patient-reported coordination and consistency of care. Data will be collected using structured questionnaires, EHR system records, patient medical records, referral registers, appointment records, follow-up documentation, facility registers, and patient interviews. Descriptive statistics will be used to summarize patient characteristics, healthcare worker characteristics, EHR implementation levels, and continuity-of-care indicators. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of EHRs on continuity of care. Where a quasi-experimental design is adopted, continuity-of-care indicators before and after EHR implementation may be compared, or facilities using EHRs may be compared with similar facilities relying primarily on paper-based records. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that Electronic Health Records have a significant positive effect on continuity of care among patients in Nigerian primary healthcare centres. Patients receiving care in facilities with functional EHR systems are expected to experience improved availability of previous medical information, better documentation of treatment histories, more coordinated referrals, improved follow-up, and greater consistency in clinical management than patients receiving care in facilities using predominantly paper-based records. EHRs may enable healthcare workers to quickly retrieve patient histories, review previous diagnoses and treatments, monitor follow-up requirements, and make more informed clinical decisions. Electronic appointment and follow-up functions may also reduce missed visits and support timely continuity of care. However, inadequate electricity supply, poor internet connectivity, system downtime, insufficient staff training, limited technical support, high implementation costs, data-entry challenges, privacy concerns, and resistance to technological change may limit the effectiveness of EHR systems. The study therefore expects reliable, user-friendly, secure, and adequately supported EHR implementation to contribute significantly to improved continuity and coordination of care in Nigerian primary healthcare centres. The study is expected to contribute to the literature on Electronic Health Records, continuity of care, digital health, primary healthcare, health information management, patient care coordination, electronic medical records, healthcare quality, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, local government health authorities, primary healthcare centre managers, healthcare workers, health information officers, digital health programme managers, development partners, and policymakers regarding strategies for strengthening digital health systems. The study will also provide evidence-based recommendations for expanding EHR implementation in primary healthcare centres, improving electricity and internet infrastructure, strengthening healthcare worker training, providing technical support and system maintenance, improving interoperability and data exchange, strengthening data security and patient privacy, conducting routine data-quality assessments, and integrating electronic records with referral, appointment, and follow-up systems to improve continuity of care across Nigerian primary healthcare centres.

Keywords: Electronic Health Records, continuity of care, primary healthcare centres, digital health, health information management, patient care coordination, electronic medical records, healthcare quality, patient follow-up, Nigeria, public health.