DIGITALIZATION OF CLINICAL PROCESSES FOR PATIENT MANAGEMENT AT KENYATTA NATIONAL HOSPITAL, NAIROBI CITY COUNTY: DIGITAL HEALTH AND SOCIO-DEMOGRAPHIC DETERMINANTS
Abstract
Purpose of Study: This study assessed the level of digitalization in patient management and examined socio-demographic determinants influencing digital health systems use among healthcare workers at Kenyatta National Hospital (KNH), Nairobi City County, Kenya.
Problem Statement: Digitalization of clinical processes is critical for enhancing healthcare delivery, yet gaps persist in system integration and consistent utilization, particularly in low-resource settings.
Methodology: A cross-sectional study design was employed among 327 healthcare workers in the outpatient department, selected through stratified sampling. Data was collected using semi-structured questionnaires and key informant interviews. Quantitative analysis involved descriptive statistics, chi-square tests, Fisher's exact tests, and binary logistic regression, while qualitative data was analyzed thematically.
Result: The overall digitalization level was high (82.9%), with 70.9% of respondents reporting full utilization of digital systems. Billing functions were most frequently used (22%), while clinical reporting features remained underutilized. Educational attainment (p=0.035) and professional cadre (p<0.001) were significantly associated with digital systems use, whereas age (p=0.331) and gender (p=0.659) showed no statistically significant association. Binary logistic regression revealed that socio-demographic factors collectively did not significantly predict digitalization levels (p=0.246). Qualitative findings highlighted resistance among older staff, improved competency through further education, and systemic challenges including inadequate training and limited system interoperability. KNH demonstrates substantial progress in digital health adoption, though utilization varies across clinical functions and professional groups.
Recommendation: Targeted interventions should enhance digital competencies, improve system integration, and address function-specific gaps to achieve holistic digital transformation in patient management.
Keywords: Digitalization, Clinical Processes, Patient Management, Health Information Systems, Socio-Demographic Determinants, Healthcare Workers
References
Adeola, O., & Evans, O. (2018). Digital health: ICT and health in Africa. Aktual'ni Problemy Ekonomiky= Actual Problems in Economics, (208), 66-83.
Adetoyi, O. E., & Raji, O. A. (2020). Electronic health record design for inclusion in sub-Saharan Africa medical record informatics. Scientific African, 7, 1-5.
Aldosari, B., Al-Mansour, S., Aldosari, H., & Alanazi, A. (2018). Assessment of factors influencing nurses acceptance of electronic medical record in a Saudi Arabia hospital. Informatics in Medicine Unlocked, 10, 82-88.
Amulega, V. O. (2018). Determinants of Use of Electronic Medical Records Systems to Deliver HIV Care in Kenya (Doctoral dissertation, University of Nairobi).
Awad, A., Trenfield, S. J., Pollard, T. D., Ong, J. J., Elbadawi, M., McCoubrey, L. E., & Basit, A. W. (2021). Connected healthcare: Improving patient care using digital health technologies. Advanced Drug Delivery Reviews, 178, 113958.
Bakibinga, P., Kamande, E., Kisia, L., Omuya, M., Matanda, D. J., & Kyobutungi, C. (2020). Challenges and prospects for implementation of community health volunteers' digital health solutions in Kenya: a qualitative study. BMC Health Services Research, 20(1), 1-12.
Cerchione, R., Centobelli, P., Riccio, E., Abbate, S., & Oropallo, E. (2023). Blockchain's coming to hospital to digitalize healthcare services: Designing a distributed electronic health record ecosystem. Technovation, 120, 1-33.
Duplaga, M. (2018). A cross-sectional study assessing determinants of the attitude to the introduction of eHealth services among patients suffering from chronic conditions. BMC Medical Informatics and Decision Making, 15(1), 1-15.
Frost, M. J., Tran, J. B., Khatun, F., Friberg, I. K., & Rodríguez, D. C. (2018). What does it take to be an effective national steward of digital health integration for health systems strengthening in low-and middle-income countries? Global Health: Science and Practice, 6(Supplement 1), S18-S28.
Gunn, P. J., Marks, J. R., Au, L., Waterman, H., Spry, P. G., & Harper, R. A. (2018). Acceptability and use of glaucoma virtual clinics in the UK: a national survey of clinical leads. BMJ Open Ophthalmology, 3(1), 1-7.
Kaboré, S. S., Ngangue, P., Soubeiga, D., Barro, A., Pilabré, A. H., Bationo, N., & Savadogo, G. B. L. (2022). Barriers and facilitators for the sustainability of digital health interventions in low and middle-income countries: a systematic review. Frontiers in Digital Health, 4, 1-16.
Kalayou, M. H., Endehabtu, B. F., Guadie, H. A., Abebaw, Z., Dessie, K., Awol, S. M., Mengestie, N. D., Yeneneh, A., & Tilahun, B. (2021). Physicians' attitude towards electronic medical record systems: an input for future implementers. BioMed Research International, (1), 1-9.
Kasaie, P., Weir, B., Schnure, M., Dun, C., Pennington, J., Teng, Y., & Beyrer, C. (2020). Integrated screening and treatment services for HIV, hypertension and diabetes in Kenya: assessing the epidemiological impact and cost‐effectiveness from a national and regional perspective. Journal of the International AIDS Society, 23, 1-13.
Ladan, M. A., Wharrad, H., & Windle, R. (2019). eHealth adoption and use among healthcare professionals in a tertiary hospital in Sub-Saharan Africa: A Q-methodology study. PeerJ, 7, 1-21.
Li, J. P. O., Liu, H., Ting, D. S., Jeon, S., Chan, R. P., Kim, J. E., & Ting, D. S. (2021). Digital technology, tele-medicine and artificial intelligence in ophthalmology: A global perspective. Progress in Retinal and Eye Research, 82, 1-33.
Louis, J. (2024). Digital literacy practices and performance of health projects in Trans-Nzoia referral county hospital, Trans-Nzoia County, Kenya. International Research Journal of Business and Strategic Management, 6(2), 396-410.
Manyazewal, T., Woldeamanuel, Y., Blumberg, H. M., Fekadu, A., & Marconi, V. C. (2021). The potential use of digital health technologies in the African context: a systematic review of evidence from Ethiopia. NPJ Digital Medicine, 4(1), 125-138.
Matagi, S. O. (2024). Data integrity and evidence-informed guidance associated with the implementation of a health management information system at Kenyatta National Hospital. World Journal of Pharmaceutical Science and Research, 3(3), 41-50.
Migwa, D. O., Wakoli, L., & Odeo, M. (2022). Factors influencing User Acceptance towards E-Health in the Public Healthcare sector: A Case of Kenyatta National Hospital, Kenya. International Journal of Innovative Research and Advanced Studies, 9(7), 67-78.
Muinga, N., Magare, S., Monda, J., Kamau, O., Houston, S., Fraser, H., & Paton, C. (2018). Implementing an open source electronic health record system in Kenyan health care facilities: case study. JMIR Medical Informatics, 6(2), e8403.
Muinga, N., Magare, S., Monda, J., English, M., Fraser, H., Powell, J., & Paton, C. (2020). Digital health systems in Kenyan Public Hospitals: a mixed-methods survey. BMC Medical Informatics and Decision Making, 20(1), 1-14.
Muiruri, K. K. (2024). Determinants of Point-of-Care Technology use among Health Care Workers Offering Services at Comprehensive Care Centres in Central Kenya (Doctoral dissertation, Kenyatta University).
Musee, C. M., Sisimwo, P. K., Mweu, J. M., Maina, P., Mutua, R., & Omulogoli, G. (2024). Perceptions among nursing staff regarding computerization and computer use at Kenyatta National Hospital Kenya: a cross-sectional study.
Musyoki, H., Bhattacharjee, P., Sabin, K., Ngoksin, E., Wheeler, T., & Dallabetta, G. (2021). A decade and beyond: learnings from HIV programming with underserved and marginalized key populations in Kenya. Journal of the International AIDS Society, 24, 1-6.
Nelson, L. A., Mulvaney, S. A., Gebretsadik, T., Ho, Y. X., Johnson, K. B., & Osborn, C. Y. (2019). Disparities in the use of a mHealth medication adherence promotion intervention for low-income adults with type 2 diabetes. Journal of the American Medical Informatics Association, 23(1), 12-18.
Ngongo, B. P., Ochola, P., Ndegwa, J., & Katuse, P. (2019). The technological, organizational and environmental determinants of adoption of mobile health applications (m-health) by hospitals in Kenya. PloS One, 14(12), 1-25.
Ngugi, P., Babic, A., & Were, M. C. (2021a). A multivariate statistical evaluation of actual use of electronic health record systems implementations in Kenya. PLoS One, 16(9), 1-14.
Ngugi, P. N., Were, M. C., & Babic, A. (2021b). Users' perception on factors contributing to electronic medical records systems use: a focus group discussion study in healthcare facilities setting in Kenya. BMC Medical Informatics and Decision Making, 21(1), 362, 1-14.
Nyambok, V. (2024). Organizational Factors and Adoption of E-health in Public Health Facilities in Kenya: A Case of Migosi Level Four Hospital in Kisumu County (Doctoral dissertation, University of Nairobi).
Oreni, B. N., Otieno, Y. A., G. O., & Otiti, M. A. (2021). Data Quality in Health Management Information Systems at Kenyatta National Hospital in Nairobi City County, Kenya: Influence of Technological Factors. IOSR Journal of Nursing and Health Science, 10(3), 45-51.
Reiners, F., Sturm, J., Bouw, L. J., & Wouters, E. J. (2019). Sociodemographic factors influencing the use of eHealth in people with chronic diseases. International Journal of Environmental Research and Public Health, 16(4), 645.
Rho, M. J., Kim, H. S., Yoon, K. H., & Choi, I. Y. (2018). Compliance patterns and utilization of e-health for glucose monitoring: Standalone internet gateway and tablet device. Telemedicine and e-Health, 23(4), 298-304.
Samiei, V., Puteh, S. E. W., Manaf, M. R. A., Latip, K. A., & Ismail, A. (2016). Are Malaysian diabetic patients ready to use the new generation of health care service delivery? A telehealth interest assessment. The Malaysian Journal of Medical Sciences: MJMS, 23(2), 44-53.
Senbekov, M., Saliev, T., Bukeyeva, Z., Almabayeva, A., Zhanaliyeva, M., Aitenova, N., & Fakhradiyev, I. (2020). The recent progress and applications of digital technologies in healthcare: a review. International Journal of Telemedicine and Applications, 2020(1), 1-18.
Sharma, A., Harrington, R. A., McClellan, M. B., Turakhia, M. P., Eapen, Z. J., Steinhubl, S., & Peterson, E. D. (2018). Using digital health technology to better generate evidence and deliver evidence-based care. Journal of the American College of Cardiology, 71(23), 2680-2690.
Shaw, J., Agarwal, P., Desveaux, L., Palma, D. C., Stamenova, V., Jamieson, T., & Bhattacharyya, O. (2018). Beyond "implementation": digital health innovation and service design. NPJ Digital Medicine, 1(1), 48-53.
Simbini, T., Adimado, E., Adjorlolo, S., Guerrero-Torres, L., Srinivas, P., Zizhou, S., & Zerfu, T. (2026). Digital health interventions in strengthening primary healthcare systems in Sub-Saharan Africa: Insights from Ethiopia, Ghana, and Zimbabwe. PLOS Digital Health, 5(1), 1-13.
Singh, A., Jadhav, S., & Roopashree, M. R. (2020). Factors to overcoming barriers affecting electronic medical record usage by physicians. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine, 45(2), 168-171.
Ting, D. S. W., Carin, L., Dzau, V., & Wong, T. Y. (2020). Digital technology and COVID-19. Nature Medicine, 26(4), 459-461.
Van Velthoven, M. H., & Cordon, C. (2019). Sustainable adoption of digital health innovations: perspectives from a stakeholder workshop. Journal of Medical Internet Research, 21(3), e11922.
World Health Organization. (2021). Global strategy on digital health 2020-2025. https://www.who.int/docs/default-source/documents/
World Health Organization. (2025, September 25). Non-communicable diseases. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
Xia, L., Baghaie, S., & Sajadi, S. M. (2024). The digital economy: Challenges and opportunities in the new era of technology and electronic communications. Ain Shams Engineering Journal, 15(2), 102411.
Zambianchi, M., Rönnlund, M., & Carelli, M. G. (2019). Attitudes towards and use of information and communication technologies (ICTs) among older adults in Italy and Sweden: The influence of cultural context, socio-demographic factors, and time perspective. Journal of Cross-Cultural Gerontology, 34, 291-306.
