Implementation and Use of Clinical Decision Support System in Malawi National ART EMR System

The introduction of Malawi national antiretroviral therapy (NART) electronic medical record (EMR) system has improved the management and reporting of ART patient data. Designed to aid in decision-making by providers for individual patients in their care, the system has been integrated with a Clinical Decision Support System (CDSS). NART EMR system was introduced in 2006, and by 2021, it had been extended to over 206 healthcare facilities in the country. Despite several evaluations conducted on the NART EMR, there has been limited attention given to evaluating the implementation and usage of the CDSS within the NART EMR system. Hence, the study sought to establish how CDSS in the NART EMR system has been implemented and used by healthcare providers in Malawi to improve decision making on an individual patient on antiretroviral therapy (ART) at any point in time. The study employed a qualitative methodology, gathering data through observations, interviews, and an in-depth analysis of the system. The study establishes that smooth integration of CDSS in EMR system into regular and normal clinical workflow contributes to the success of CDSS use. Despite the successes of CDSS in EMR system, issues of system quality and information quality must be addressed during design and implementation of the CDSS to enhance efficiency and effectiveness of the system. The study suggests that those responsible for implementation should prioritize improving the underlying logic of the clinical decision support intervention in order to address existing concerns and improve the accuracy of the provided information. Additionally, the study recommends active consultation with the system's real users during the implementation process.