Digitalisation of Healthcare Services in Ghana: From EMR Adoption to Routinised Use and Governance

Abstract

Electronic medical records (EMRs) are widely positioned as foundational infrastructure for digital health transformation, yet adoption and routinised use remain uneven across hospitals in many low- and middle-income settings. This qualitative study examines how interacting technological, organisational, and environmental constraints shape EMR use in five Ghanaian health facilities in the Greater Accra Region, comprising three public hospitals and two private clinics. Semi-structured interviews were conducted with 13 stakeholders, including doctors, nurses, administrators, IT and health information personnel, and policy or oversight actors between January and March 2025 and analysed using reflexive thematic analysis guided by the Technology-Organisation-Environment framework. Findings reveal a stable hybrid documentation equilibrium in which downtime, device scarcity, and system performance limitations trigger paper-first workarounds followed by delayed data entry, resulting in duplicated effort, incomplete records, and declining confidence in EMRs as authoritative clinical records. Interoperability deficits further contributed to repeated registration and testing, while governance weaknesses, including poor identity control and limited auditability, reduced trust and documentation completeness. The study contributes by modelling adoption as a routinisation process driven by interacting constraints and by operationalising Ghana’s Data Protection Act, 2012 (Act 843), and Cybersecurity Act, 2020 (Act 1038), into actionable governance requirements for scalable and trustworthy EMR implementation.