Perceptions of Healthcare Workers on the Electronic Health Record System of Sexually Transmitted Disease Clinics in Sri Lanka: A Descriptive Cross-sectional Study

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The success of EHRs depends on timely modifications based on user feedback. This cross-sectional study assessed the impacts, barriers, and areas for improvement of the Electronic Information Management System (EIMS) across twenty-three sexually transmitted disease (STD) clinics in Sri Lanka. Methods This study used stratified sampling. Data were collected via an online self-administered questionnaire from key clinic staff (n = 173) in 2022. Results The sample had a mean age of 40.9 years; 62.4% were female. Most participants had not used other electronic health systems (61%) but had received EIMS training (68.8%) and held IT qualifications (56%). EIMS was perceived to enhance communication (61.3%), data confidentiality (81.9%), work efficiency (66.5%), and error reduction (68%). However, 35% of doctors reported a negative impact on patient communication (p < 0.001), while 25% of public health inspectors (PHIs) and public health nurses (PHNs) had concerns about data confidentiality (p = 0.012). The main reported barriers were technical issues (95%) and high workload (43%). Although most respondents were confident in their computer and English literacy, 35% and 50% of nursing officers lacked computer skills and EIMS training, respectively. Additionally, 10% of PHIs/PHNs reported low English confidence. The most requested improvement was faster system speed (76%). Conclusions EIMS improved efficiency but has technical, training, and communication challenges. Interventions are needed to improve doctor–patient communication during EIMS use and strengthen computer skills among nurses and English proficiency among PHIs/PHNs. Address technical issues, reducing workload will improve EIMS use. electronic health record user perception Sri Lanka Background An Electronic Information Management System (EIMS) is a digital platform designed to store and manage various healthcare data, such as clinical notes, lab reports, and prescriptions, within a centralized database( 1 – 3 ). Globally, Electronic Health Record (EHR) systems have been widely adopted in high- and middle-income countries like the USA, UK, China, and Asian nations ( 4 ). EHR systems have demonstrated benefits at both institutional and individual levels. International studies have highlighted improvements in the accuracy of records, reductions in duplicated tests, better patient workflow, time and cost efficiency, and overall enhancements in patient care ( 4 – 6 ). Despite these advantages, the transition to EHR systems is not without challenges. Negative consequences reported include initial disruptions to doctor–patient interactions, increased workload, time-consuming documentation, and a decline in productivity during the early implementation stages. Additionally, data privacy and security remain major concerns( 7 – 9 ). Common barriers to effective EHR adoption include insufficient training, poor digital literacy among staff, resistance from senior healthcare professionals, high upfront costs, slow system performance, and weak infrastructure, especially in low-resource environments ( 7 , 8 , 10 – 13 ). However, implementing EHR in low-income Asian countries faces multiple barriers. Usual challenges include limited technological infrastructure (e.g., unreliable electricity and internet), shortages of skilled healthcare and IT personnel, lack of training, organizational and management difficulties, resistance from healthcare workers, and concerns about data privacy and security( 14 ). In Sri Lanka, specific issues such as unreliable internet connectivity, hardware shortages, software limitations, and inadequate user training have also been observed( 3 , 11 , 12 ). Recommendations for overcoming these challenges include regular and comprehensive training programs, improving system usability, involving end-users in system design, and developing low-cost, locally appropriate solutions( 9 , 12 , 15 , 16 ). Enhancing network infrastructure and addressing interface difficulties are also key to ensuring successful implementation and user satisfaction( 7 , 8 , 10 , 12 , 17 ). In Sri Lanka, while earlier EHR initiatives faced limited success, more recent projects such as the Health Information Management System (HHIMS) have led to partial computerization in selected hospitals( 2 , 3 , 12 , 15 , 18 ). Sri Lanka’s National STD/AIDS Control Program (NSACP), with support from the Global Fund, implemented EIMS in 2017 to enhance the management of sexually transmitted infections (STIs) and HIV ( 13 , 18 , 19 ). Initially piloted clinics at Colombo, Kalutara, and Balapitiya, the system was expanded to 23 STD clinics by the end of 2020( 18 ). EIMS now supports a comprehensive range of services from patient registration and diagnosis to treatment, contact tracing, and data reporting( 5 ). Various healthcare workers, including Public Health Inspectors (PHIs), nurses, Medical Laboratory Technologists (MLTs), pharmacists, and doctors, use the system in separate phases of patient care( 5 ). EIMS has improved clinical data management and enabled the generation of reliable national statistics through the Strategic Information Management (SIM) unit of NSACP( 5 , 19 ). As Sri Lanka moves further into digital healthcare, the perception of healthcare staff remains crucial to successful EIMS adoption( 5 , 6 , 15 , 19 , 20 ). While an initial study in 2019 explored user experiences at three pilot sites( 5 ), the current study aims to gather broader insights following the island-wide expansion of EIMS. Still certain STD clinics in Sri Lanka finds it difficult to establish the EIMS and maintaining it due to distinct reasons such as lack of uninterrupted internet connection. Thus, it is important to know the user perception on this EHR system to make it more user friendly. This study evaluates how user perceptions have evolved in response to ongoing training initiatives, increased system familiarity, and enhancements made to EIMS based on early feedback. This study aimed to describe perceptions of health staff on positive and negative impacts, barriers to successful maintenance of EIMS, and areas for further improvement in EIMS in the STD clinics in Sri Lanka. Methods A descriptive cross-sectional study was conducted from October 2020 to March 2023 to examine user perceptions of the Electronic Information Management System (EIMS) across 23 STD clinics in Sri Lanka where the system was established by the end of 2020, including locations such as Colombo, Kalutara, Balapitiya, Avissawella, Matale, Ragama, Gampaha, Negombo, Kurunegala, Galle, Panadura, Hambantota, Jaffna, Mullaitivu, Kilinochchi, Mannar, Batticaloa, Rathnapura, Matara, Vavuniya, Kalubowila, Badulla, Ampara, and Monaragala. Data collection was carried out from April 2022 to July 2022 targeting medical officers, nursing staff, public health inspectors (PHI), Public Health Nursing Sisters (PHNS), medical laboratory technicians (MLT), Public health laboratory technicians (PHLT), and pharmacists/dispensers working in EIMS-established STD clinics who had access to the system. The inclusion criteria required staff to be working in STD clinics with established EIMS facility, while exclusion criteria eliminated healthcare staff without EIMS access or those who had not used the system for at least 2 weeks. Using the standard formula for cross-sectional studies with a 95% confidence interval and 0.05 margin of error, an initial sample size of 384 was calculated, but given the finite population of 271 eligible staff, this was corrected to 158, with a 20% non-response allowance added to reach a final sample size of 189. Stratified random sampling was employed using probability proportionate sampling, recruiting sixty-nine medical officers, forty-two nursing officers, 20 PHIs/PHNSs, 27 MLTs, 21 PHLTs, and nine pharmacists/dispensers from the updated STD clinic staff directory. A well-structured, validated, self-administered questionnaire was newly developed in English and translated into Sinhala and Tamil, with content validity obtained from expert panels including consultant venereologists and community medicine specialists, and face validity confirmed through pretesting. The questionnaire included sections on sociodemographic and occupational data, positive and negative impacts of EIMS on patient care, barriers to successful implementation, and areas needing improvement (supplementary file 1) . Data collection utilized Google Forms distributed via email, WhatsApp, or Viber based on participant preference, with facilitators identified at each clinic to enhance response rates while maintaining anonymity by not collecting personal identification details. The collected data were automatically summarized and downloaded as Microsoft Excel sheets, processed using Excel software, and then exported to SPSS version 27 for analysis, employing descriptive statistics, frequency tables, bar diagrams, chi-square tests, and Fisher's exact test for subgroup comparisons. In this study, data cleaning involved removing incomplete responses, specifically excluding six participants who had answered less than 60% of the questionnaire. Ethical approval was obtained from the Ethical Review Committee of the Post Graduate Institute of Medicine, Colombo, with institutional clearance from the National STD/AIDS Control Program Director and permissions from individual clinic consultants, while informed consent was secured through information sheets, voluntary participation was ensured, and confidentiality was maintained through password-protected data storage A total of 179 staff members responded out of 189 eligible clinic staff who were requested to participate in the study, with ten participants not responding despite three reminders, resulting in a response rate of 94.7%. However, six participants were removed from the study because they had not completed the questionnaire satisfactorily, having answered less than 60% of the questions, leaving 173 participants for the final analysis. Internal consistency analysis revealed that the subscale measuring positive and negative impacts of currently practicing EIMS in patient care consisted of four items with Cronbach's alpha of 0.583, which was below the acceptable threshold of 0.6, showing unsatisfactory internal consistency. In contrast, the subscale assessing barriers to successful implementation of EIMS in the STD clinic setup consisted of four items with Cronbach's alpha of 0.607, meeting the minimum threshold of 0.6 and demonstrating satisfactory internal consistency. Results Sociodemographic, education and occupation related characteristics The 173 participants averaged 40.94 years of age (SD = 8.90; range = 25–62), with a median age of 40 years. Women predominated (62.4%), and nearly all respondents were married (90.2%). Sinhala was the native language for most (89.6%), followed by Tamil (9.8%) and English (0.6%). Educational attainment was high: 43.4% held a certificate, technical qualification, or diploma, 34.7% had completed a university degree, and 19.1% owned postgraduate credentials, while only 2.9% reported General Certificate of Education Advanced Level (GCE A/L) as their highest qualification. A little over half (56.6%) had formal information technology training, most commonly a certificate or diploma (42.2%), while 43.4% reported no IT qualification. Doctors constituted the largest professional group (38%), followed by nursing officers (22%), medical laboratory technologists (14%), public-health inspectors or nursing sisters (12%), public-health laboratory technologists (10%), and pharmacists (5%). Participants had worked in STD clinics for an average of 5.1 years (SD = 4.98; range = 0.07–23 years; median = 3.08 years). Roles within the Electronic Information Management System (EIMS) frequently overlapped: the most common functions were STD consultation (36%) and patient registration (30%), with substantial involvement in HIV consultation (27%), bleeding (21%), statistics generation (19%), laboratory MLT (15%), drug dispensing (13%) and laboratory microscopy (10%). Just over one-third (38.4%) had previously used other electronic platforms for a mean of 29 months (SD = 21.5; range = 1–96), and two-thirds (68.8%) had received formal EIMS training, with pharmacists showing the lowest training coverage (50%). (Table 1) Table 1:Healthcare Worker Demographics, Qualifications, and Roles with EIMS in STD Clinics Characteristic Category / Metric n % Age (years) Mean (SD) 40.94 (8.90) — Median (Range) 40 (25–62) — Sex Male 65 37.6 Female 108 62.4 Marital status Married 156 90.2 Never married 15 8.7 Other 2 1.2 Mother language Sinhala 155 89.6 Tamil 17 9.8 English 1 0.6 Educational qualification GCE A/L 5 2.9 Certificate / Diploma 75 43.4 Degree 60 34.7 Postgraduate 33 19.1 IT qualification None 75 43.4 GCE O/L (IT) 7 4 GCE A/L (IT) 7 4 Certificate / Diploma (IT) 73 42.2 Degree (IT) 2 1.2 Other 9 5.2 Designation Doctor 65 38 Nursing officer 38 22 Medical laboratory technologist 24 13.9 PHI / PHNS 20 11.6 Public-health laboratory technologist 17 9.8 Pharmacist 9 5.2 Years of service in STD clinic Mean (SD) 5.10 (4.98) — Median (Range) 3.08 (0.07–23) — EIMS role participation STD consultation 62 35.8 Patient registration 52 30.1 HIV consultation 47 27.2 Bleeding 37 21.4 Statistics generation 33 19.1 Laboratory MLT 26 15 Drug dispensing 22 12.7 Laboratory microscopy 18 10.4 Other 4 2.3 Prior use of other electronic platforms (N = 172) Yes 66 38.4 No 106 61.6 Mean months ± SD (range) 29 ± 21.5 (1–96) — Received EIMS training (N = 168) Yes 119 68.8 No 49 32.2 Positive and negative impacts of EIMS in the STD clinic. The study examined four key areas of EIMS's impact on healthcare delivery in STD clinics. Impact on effective communication showed mixed results, with 61.3% of staff believing EIMS had a positive impact while 27% reported negative effects, and the rest neutral (χ² = 62.23, p < 0.001). Post hoc analysis revealed that doctors experienced significantly more negative impacts on patient communication compared to other staff categories. Impact on maintaining confidentiality was overwhelmingly positive, with 81.9% of respondents believing EIMS facilitated confidentiality maintenance, only 7% reporting negative impacts, and 11.1% neutral responses (χ² = 181.72, p < 0.001). However, PHI/PHNS staff showed significantly more concerns about confidentiality maintenance difficulties. Impact on errors in patient care demonstrated positive outcomes, with 68% of staff believing EIMS reduced errors, 8% reporting increased errors, and 24% neutral responses (χ² = 97.65, p < 0.001). No significant differences were found between staff categories for error reduction perceptions. Impact on work efficiency showed positive results, with 66.5% reporting improved efficiency, 22.5% decreased efficiency, and 11% neutral responses (χ² = 88.97, p < 0.001). Staff categories showed no significant differences in work efficiency perceptions. (Table 2) Table 2: Impact of EIMS on health care delivery Impact Domain {N) Negative Impact Neutral Response Positive Impact Chi-Square p-value Significant Staff Category Differences Effective Communication (173) 27.00% 11.70% 61.30% χ² = 62.23 < 0.001 Doctors perceived significantly more negative Maintaining Confidentiality (171) 7.00% 11.10% 81.90% χ² = 181.72 < 0.001 PHI/PHNS perceived significantly more negative Errors in Patient Care (169) 8.00% 24.00% 68.00% χ² = 97.65 < 0.001 No significant differences (p = 0.736) Work Efficiency (173) 22.50% 11.00% 66.50% χ² = 88.97 < 0.001 No significant differences (p = 0.130) Note. All chi-square tests had degree of freedom (df) = 2. Fisher-Freeman-Halton Exact test was used for staff category comparisons. Barriers to the successful maintenance of EIMS in STD clinics. The analysis examined six key barriers to Electronic Information Management System (EIMS) usage among healthcare staff across five professional categories. Technical difficulties appeared as the most prevalent barrier, with 96% of 171 respondents experiencing this issue. This stood for a statistically significant finding (p < 0.001), though no significant differences existed between staff categories. Inadequate facilities affected 53% of 168 respondents, but this proportion was not statistically significant overall (p = 0.440), and no significant difference was found between staff categories. Computer literacy was adequate, with 88% of 162 respondents reporting sufficient skills. However, Nursing Officers showed significantly lower perceived computer literacy compared to other staff categories (p = 0.006). Training adequacy was reported by 66.5% of 164 respondents, with significant overall differences (p < 0.001). Nursing Officers again stood out as having significantly less adequate training compared to other categories (p = 0.02). English literacy was high across all groups, with 97.6% of 169 respondents reporting adequate skills. However, PHI/PHNS perceived significantly lower English literacy levels compared to other categories (p = 0.034). Higher workload and inadequate staffing affected 55.4% of 168 respondents, though this was not statistically significant overall (p = 0.165). However, significant differences existed between staff categories (p = 0.01), with Pharmacists, PHLT, PHI, and PHNS less likely to perceive this as a barrier compared to other staff groups. (Table 3) Table 3: Barriers for using EIMS. Barrier (N) Percentage experiencing barrier Statistical significance Significant differences between staff categories The most affected staff category Technical difficulties (171) 96% p < 0.001 No (p = 0.232) None (no significant difference) Inadequate facilities (168) 53% p = 0.440 No (p = 0.340) None (no significant difference) Inadequate computer literacy (162) 12% p < 0.001 Yes (p = 0.006) More Nursing Officers perceived as a barrier Inadequate training (164) 33.50% p < 0.001 Yes (p = 0.02) More Nursing Officers perceived as a barrier Inadequate English literacy (169) 2.40% p < 0.001 Yes (p = 0.034) More PHI/PHNS perceived as a barrier Higher workload/Inadequate staff (168) 55.40% p = 0.165 Yes (p = 0.01) More Doctors, MLT, Nursing Officers perceived as a barrier (compared to Pharmacists/PHLT/PHI/PHNS) Areas for Further Improvement in EIMS for STD Clinics A detailed analysis of staff feedback finds key areas for improvement in the Electronic Information Management System (EIMS) tailored for STD clinic settings in Sri Lanka. The findings reflect both quantitative survey responses and qualitative suggestions from open-ended questions. (Table 4) Table 4: Demanded improvements in EIMS. Improvement Area N % of Participants System speed 125 76.20% Training 83 50.60% Involving user ideas 76 46.30% Continuous technical support 70 42.70% Onsite support availability 69 42.10% Content improvement 49 29.90% Clinic setup 48 29.30% Format improvement 47 28.70% Most staff called for improvements in system speed, followed by requests for more training, greater incorporation of user feedback in system modifications, and more direct technical/onsite support. Discussion Sociodemographic and Education-related Characteristics Sri Lanka's economically active labor force is male (66.7%)(21); however, the sample had a female majority (62.4%), reflecting the gender distribution in nursing roles. Most participants were married (90.2%), a higher proportion than the general population(21), because teenagers and the retired were not included. The majority spoke Sinhala (89.6%), with Tamil (9.8%) and English speakers in the minority, consistent with national language policies(22). All participants had, at least, passed the GCE A/L examination. Over half (56.6%) reported IT qualification, a proportion aligned with national trends showing higher computer literacy among those with advanced education(17). Occupation-related Characteristics Using proportional sampling, the study included representation from all major staff categories of STD clinics island wide. Doctors made up the largest group (37.6%), a broader representation than earlier Sri Lankan studies(5). Most staff had not used any electronic record platform other than EIMS (61.3%), and only 68.8% reported having received formal EIMS training, due to irregular training programs. Impacts of EIMS Most staff members felt that EIMS improved communication with patients, except for doctors, who reported that using computers during sensitive consultations could impede the doctor-patient rapport. This underscores the importance of balancing technology use with interpersonal communication skills. Most staff believed EIMS facilitated confidentiality (p < 0.001), but PHI/PHNS were less convinced (p = 0.012). While EIMS limits data access to authorized users, earlier reviews cautioned that no EHR system guarantees complete confidentiality(23). Staff reports improved data security with EHRs, though international reviews confirm patients stay more concerned than clinicians about confidentiality(12,24). Respondents reported that EIMS reduced clinical errors (p < 0.001). Literature supports that EHRs reduce missing data and enable more accurate health record-keeping(25), but may also introduce new errors, such as incorrect drug selection(4). EIMS was broadly seen as improving work efficiency (p < 0.001), a finding echoed in both Sri Lankan and global studies(3,12,24). However, initial implementation may temporarily reduce productivity. Barriers to Successful Maintenance of EIMS A large majority (95.9%) met technical issues (p < 0.001), especially slow connectivity. No significant differences between staff categories (p = 0.232), indicating technical difficulties affect all staff equally regardless of role. This is higher than reported at EIMS implementation(5) and is commonly cited in international literature as a barrier(12,24). Over half (52.9%) cited insufficient facilities (e.g., space, hardware, equipment), a figure much higher than earlier studies(5). No significant differences between staff categories (p = 0.340), showing this barrier is uniformly perceived across different healthcare roles. This issue is well-documented in both local and global literature as a primary challenge for EHR maintenance(2,8,26). Most staff felt computer literacy was adequate, though nursing officers lagged significantly behind (p = 0.006), consistent with findings that technical skills are crucial for EHR success(8). English literacy was adequate for most, but PHI/PHNS expressed concerns. English proficiency varies across different staff categories, affecting ease of training and system use since manuals are in English. Staff with limited English skills might be less confident or disengaged during training, reducing training effectiveness. Lack of Training: Two-thirds reported adequate training (p < 0.001), but nursing officers were again less likely to be adequately trained (p = 0.02). Training gaps were more pronounced than in 2019(5). Sustained and role-specific training programs are essential for successful EHR implementation, as shown in Sri Lanka and internationally(2,8). While 55.4% cited high workload and inadequate staff as barriers, this was not universally significant. Pharmacists, PHLT, PHI, and PHNS were less likely to view this as a barrier. Literature notes that inadequate staffing can be a critical barrier(8). Areas for Further Improvement The majority (76%) advocated for improved system speed. Participants also highlighted the need for better internet connectivity, backup power, and enhanced system content and format. Half of the respondents (50.6%) requested further training, with suggestions for longer, role-specific training and self-learning resources. Almost half wanted more user involvement in system development and recommended ongoing onsite and technical support. These findings align with both current and earlier implementation-phase studies in Sri Lanka and the global evidence on EHR improvement priorities(3,5). Limitations of the study Only staff with access to EIMS and a minimum of 2 weeks’ usage were included. Clinics not yet established with EIMS, or staff early in the onboarding process, were excluded, potentially omitting both critical implementation-phase challenges and the experiences of the least experienced users. While a finite population correction was applied to determine the sample size, the final study population was smaller than the initially calculated ideal sample, which can restrict the statistical power for subgroup analyses. Six respondents were excluded for incomplete questionnaires (answered less than 60% of items), reducing the final sample to 173. This can introduce bias if non-responders or partial responders differed systematically from those included. Stratified random sampling ensured broad staff representation, but pharmacists/dispensers and PHLT were underrepresented. Larger studies are needed to better assess these groups' perceptions. The scale used to assess positive and negative impacts of EIMS had an alpha coefficient of 0.583, showing less-than-ideal internal consistency. The low internal consistency can limit confidence in the interpretation of results from this section, as measurement error or item heterogeneity may bias or obscure associations. Caution is warranted when interpreting findings regarding the positive and negative impacts reported by healthcare workers, as the assessment might not be fully consistent or comprehensive. The study focused solely on healthcare providers' perspectives, not those of patients/clients. Findings are specific to the EIMS in STD clinics and may not apply to inpatient settings or other EHR systems indicating limited generalizability of the findings. Only staff with access to EIMS and a minimum of 2 weeks’ usage were included. Clinics not yet established with EIMS, or staff early in the onboarding process, were excluded—potentially omitting both critical implementation-phase challenges and the experiences of the least experienced users. Conclusions and recommendations There was a significant overlap in job roles due to staffing shortages, and most staff were new to electronic health record (EHR) systems. Most healthcare providers perceived that EIMS positively affects communication and confidentiality, reduces errors, and improves work efficiency. However, doctors felt EIMS hindered effective doctor-patient communication, and PHIs/PHNS felt it compromised patient data confidentiality. The main barrier to EIMS use was technical difficulties. Most staff reported adequate computer literacy, training, and English proficiency, but nursing officers are not satisfied with their computer skills and training, and PHIs/PHNS had concerns about their English literacy. The most requested improvements were faster system speed and more training. Steps need to be taken to enhance doctor-patient communication and computer proficiency through targeted training, especially for nursing officers and building trust through privacy protections for data confidentiality. Provide adequate infrastructure and ensure fast, reliable internet connection. It Is necessary to consider user feedback in future EIMS updates, offer continuous technical support, and have onsite technical aid available. Conduct further research on patient/client perceptions of EIMS use. It is crucial to conduct similar cross-sectional studies involving healthcare workers from a range of settings including inpatient wards, outpatient departments, primary care clinics, and specialized hospital units. This would capture the diversity of roles, workflows, and information needs outside STD clinics. Abbreviations EHR: Electronic Health Record EIMS: Electronic Information Management System STD: Sexually Transmitted Disease STI: Sexually Transmitted Infection HIV: Human Immunodeficiency Virus NSACP: National STDAIDS Control Programme PHI: Public Health Inspector PHN: Public Health Nurse MLT: Medical Laboratory Technologist PHLT: Public Health Laboratory Technologist GCE AL: General Certificate of Education Advanced Level IT: Information Technology SIM: Strategic Information Management MOH: Medical Officer of Health Declarations Ethics approval and consent to participate - This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethics Review Committee of the Postgraduate Institute of Medicine, University of Colombo, Sri Lanka (Reference number: ERC/PGIM/2021/063). Institutional clearance was granted by the National STD/AIDS Control Programme. All participants provided informed consent electronically prior to data collection, and confidentiality was maintained by ensuring anonymized and password-protected data storage. Consent for publications - All participants provided informed written consent for the study before participating in the study. This study publication does not contain individual participant data, thus consent for publication is not applicable. Availability of data and materials - All data generated or analysed during this study are included in this published article [and its supplementary information files]. Competing interests - The authors declare that they have no competing interests. Funding - This study was self-funded and did not receive any funding. Authors' contributions - HADP Nimalrathna conceptualized and designed the study, collected and analyzed data, and drafted the manuscript. KAM Ariyaratne provided supervision and critical revision of the manuscript. All authors read and approved of the final manuscript. Acknowledgements - Not applicable Authors' information H.A.D.P. Nimalrathna, MBBS (Colombo), Diploma in Venereology (Sri Lanka), MD in venereology (Sri Lanka), Senior Registrar in the National STD AIDS Control Program, Colombo, Sri Lanka. K.A.M. Ariyaratne, MBBS (Colombo), MSc in community medicine (Sri Lanka), MD in venereology (Sri Lanka), Consultant venereologist, National STD AIDS Control Program, Colombo, Sri Lanka. References Al-Harbi A. Healthcare Providers’ Perceptions towards Health Information Applications at King Abdul-Aziz Medical City, Saudi Arabia. International Journal of Advanced Computer Science and Applications [Internet]. 2012 Jul 1 [cited 2025 Oct 18];2(10). Available from: https://thesai.org/Publications/ViewPaper?Volume=2&Issue=10&Code=IJACSA&SerialNo=3 Denham Pole. Electronic Patient Records in Sri Lankan Hospitals. Sri Lanka Journal of Bio-Medical Informatics [Internet]. 2010 Jan 1 [cited 2025 Oct 18];43–5. 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Department of Census and Statistics [Internet]. [cited 2025 Oct 18]. Available from: https://www.statistics.gov.lk/LabourForce/StaticalInformation/AnnualReports Welcome to the Department of Official Languages [Internet]. [cited 2025 Oct 18]. Available from: https://www.languagesdept.gov.lk/ Jeyakodi T, Herath D. Acceptance, and use of Electronic Medical Records in Sri Lanka. Scientific Research Journal (SCIRJ) [Internet]. 2016 [cited 2025 Oct 18]; Available from: www.scirj.org Nguyen L, Bellucci E, Nguyen LT. Electronic health records implementation: An evaluation of information system impact and contingency factors. Int J Med Inform [Internet]. 2014 Nov 1 [cited 2025 Oct 18];83(11):779–96. Available from: https://pubmed.ncbi.nlm.nih.gov/25085286/ A M, MM G, R D, HE S. Use of Hospital Information System to Improve the Quality of Health Care from Clinical Staff Perspective. Galen medical journal [Internet]. 2021 Feb 4 [cited 2025 Oct 18];10. Available from: https://pubmed.ncbi.nlm.nih.gov/35434158/. Al-Harbi A. Healthcare Providers’ Perceptions towards Health Information Applications at King Abdul-Aziz Medical City, Saudi Arabia. International Journal of Advanced Computer Science and Applications [Internet]. 2012 Jul 1 [cited 2025 Oct 19];2(10). Available from: https://thesai.org/Publications/ViewPaper?Volume=2&Issue=10&Code=IJACSA&SerialNo=3 Additional Declarations No competing interests reported. Supplementary Files supplimentaryfile1Quaestionnaire.docx supplimentasupplimentaryfile2Dataset.xlsx Cite Share Download PDF Status: Published Journal Publication published 10 Mar, 2026 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 30 Jan, 2026 Reviews received at journal 22 Jan, 2026 Reviewers agreed at journal 19 Jan, 2026 Reviews received at journal 16 Dec, 2025 Reviews received at journal 03 Dec, 2025 Reviewers agreed at journal 26 Nov, 2025 Reviewers agreed at journal 25 Nov, 2025 Reviewers invited by journal 23 Nov, 2025 Editor invited by journal 29 Oct, 2025 Editor assigned by journal 29 Oct, 2025 Submission checks completed at journal 28 Oct, 2025 First submitted to journal 28 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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HADP¹","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxUlEQVRIiWNgGAWjYDCCw8wNIEoORBx4QJwWRrAWY7CWBKK0HIBoSQSTRGnhO87Y+Llwj136/LDDD4G22MnpNhDQInmYsVl6xrPk3I230wyAWpKNzQ4Q0GIA9Is0zwHm3I2zE0BaDiRuI0JL82+eA/XphrPTPxCtpQ1oy+EEeekcIm0B+qXNesaB44YbpHMKDiQYEOEXvvOHD98uOFAtLz87ffOHDxV2cgS1gAAz2IVglQZEKIdrkW8gUvUoGAWjYBSMPAAA0klIvFLkFOUAAAAASUVORK5CYII=","orcid":"","institution":"National STD/AIDS Control Programme","correspondingAuthor":true,"prefix":"","firstName":"Nimalrathna","middleName":"","lastName":"HADP¹","suffix":""},{"id":550918416,"identity":"9de1ffc2-7285-448e-a739-663841fdc962","order_by":1,"name":"Manathunge AKA¹","email":"","orcid":"","institution":"National STD/AIDS Control Programme","correspondingAuthor":false,"prefix":"","firstName":"Manathunge","middleName":"","lastName":"AKA¹","suffix":""}],"badges":[],"createdAt":"2025-10-27 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16:12:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":954987,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7944155/v1/d2b2fc8e-109f-4411-9a44-f047c5387f38.pdf"},{"id":97007547,"identity":"b6908715-58c9-4a5e-84fa-261d90f50c21","added_by":"auto","created_at":"2025-11-28 14:54:39","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":21354,"visible":true,"origin":"","legend":"","description":"","filename":"supplimentaryfile1Quaestionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-7944155/v1/4cc83f9643da33d3f037e465.docx"},{"id":97007548,"identity":"bfea59b6-b765-4b37-931d-2cefeeef35ce","added_by":"auto","created_at":"2025-11-28 14:54:39","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":35337,"visible":true,"origin":"","legend":"","description":"","filename":"supplimentasupplimentaryfile2Dataset.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7944155/v1/b4428fcd3dc97bf3ff78a00b.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePerceptions of Healthcare Workers on the Electronic Health Record System of Sexually Transmitted Disease Clinics in Sri Lanka: A Descriptive Cross-sectional Study\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eAn Electronic Information Management System (EIMS) is a digital platform designed to store and manage various healthcare data, such as clinical notes, lab reports, and prescriptions, within a centralized database(\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Globally, Electronic Health Record (EHR) systems have been widely adopted in high- and middle-income countries like the USA, UK, China, and Asian nations (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEHR systems have demonstrated benefits at both institutional and individual levels. International studies have highlighted improvements in the accuracy of records, reductions in duplicated tests, better patient workflow, time and cost efficiency, and overall enhancements in patient care (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Despite these advantages, the transition to EHR systems is not without challenges. Negative consequences reported include initial disruptions to doctor\u0026ndash;patient interactions, increased workload, time-consuming documentation, and a decline in productivity during the early implementation stages. Additionally, data privacy and security remain major concerns(\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCommon barriers to effective EHR adoption include insufficient training, poor digital literacy among staff, resistance from senior healthcare professionals, high upfront costs, slow system performance, and weak infrastructure, especially in low-resource environments (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). However, implementing EHR in low-income Asian countries faces multiple barriers. Usual challenges include limited technological infrastructure (e.g., unreliable electricity and internet), shortages of skilled healthcare and IT personnel, lack of training, organizational and management difficulties, resistance from healthcare workers, and concerns about data privacy and security(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In Sri Lanka, specific issues such as unreliable internet connectivity, hardware shortages, software limitations, and inadequate user training have also been observed(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRecommendations for overcoming these challenges include regular and comprehensive training programs, improving system usability, involving end-users in system design, and developing low-cost, locally appropriate solutions(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Enhancing network infrastructure and addressing interface difficulties are also key to ensuring successful implementation and user satisfaction(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In Sri Lanka, while earlier EHR initiatives faced limited success, more recent projects such as the Health Information Management System (HHIMS) have led to partial computerization in selected hospitals(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSri Lanka\u0026rsquo;s National STD/AIDS Control Program (NSACP), with support from the Global Fund, implemented EIMS in 2017 to enhance the management of sexually transmitted infections (STIs) and HIV (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Initially piloted clinics at Colombo, Kalutara, and Balapitiya, the system was expanded to 23 STD clinics by the end of 2020(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). EIMS now supports a comprehensive range of services from patient registration and diagnosis to treatment, contact tracing, and data reporting(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Various healthcare workers, including Public Health Inspectors (PHIs), nurses, Medical Laboratory Technologists (MLTs), pharmacists, and doctors, use the system in separate phases of patient care(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). EIMS has improved clinical data management and enabled the generation of reliable national statistics through the Strategic Information Management (SIM) unit of NSACP(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAs Sri Lanka moves further into digital healthcare, the perception of healthcare staff remains crucial to successful EIMS adoption(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). While an initial study in 2019 explored user experiences at three pilot sites(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), the current study aims to gather broader insights following the island-wide expansion of EIMS. Still certain STD clinics in Sri Lanka finds it difficult to establish the EIMS and maintaining it due to distinct reasons such as lack of uninterrupted internet connection. Thus, it is important to know the user perception on this EHR system to make it more user friendly. This study evaluates how user perceptions have evolved in response to ongoing training initiatives, increased system familiarity, and enhancements made to EIMS based on early feedback. This study aimed to describe perceptions of health staff on positive and negative impacts, barriers to successful maintenance of EIMS, and areas for further improvement in EIMS in the STD clinics in Sri Lanka.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA descriptive cross-sectional study was conducted from October 2020 to March 2023 to examine user perceptions of the Electronic Information Management System (EIMS) across 23 STD clinics in Sri Lanka where the system was established by the end of 2020, including locations such as Colombo, Kalutara, Balapitiya, Avissawella, Matale, Ragama, Gampaha, Negombo, Kurunegala, Galle, Panadura, Hambantota, Jaffna, Mullaitivu, Kilinochchi, Mannar, Batticaloa, Rathnapura, Matara, Vavuniya, Kalubowila, Badulla, Ampara, and Monaragala. Data collection was carried out from April 2022 to July 2022 targeting medical officers, nursing staff, public health inspectors (PHI), Public Health Nursing Sisters (PHNS), medical laboratory technicians (MLT), Public health laboratory technicians (PHLT), and pharmacists/dispensers working in EIMS-established STD clinics who had access to the system.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria required staff to be working in STD clinics with established EIMS facility, while exclusion criteria eliminated healthcare staff without EIMS access or those who had not used the system for at least 2 weeks. Using the standard formula for cross-sectional studies with a 95% confidence interval and 0.05 margin of error, an initial sample size of 384 was calculated, but given the finite population of 271 eligible staff, this was corrected to 158, with a 20% non-response allowance added to reach a final sample size of 189. Stratified random sampling was employed using probability proportionate sampling, recruiting sixty-nine medical officers, forty-two nursing officers, 20 PHIs/PHNSs, 27 MLTs, 21 PHLTs, and nine pharmacists/dispensers from the updated STD clinic staff directory. A well-structured, validated, self-administered questionnaire was newly developed in English and translated into Sinhala and Tamil, with content validity obtained from expert panels including consultant venereologists and community medicine specialists, and face validity confirmed through pretesting. The questionnaire included sections on sociodemographic and occupational data, positive and negative impacts of EIMS on patient care, barriers to successful implementation, and areas needing improvement (supplementary file 1) . Data collection utilized Google Forms distributed via email, WhatsApp, or Viber based on participant preference, with facilitators identified at each clinic to enhance response rates while maintaining anonymity by not collecting personal identification details. The collected data were automatically summarized and downloaded as Microsoft Excel sheets, processed using Excel software, and then exported to SPSS version 27 for analysis, employing descriptive statistics, frequency tables, bar diagrams, chi-square tests, and Fisher\u0026apos;s exact test for subgroup comparisons. In this study, data cleaning involved removing incomplete responses, specifically excluding six participants who had answered less than 60% of the questionnaire.\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Ethical Review Committee of the Post Graduate Institute of Medicine, Colombo, with institutional clearance from the National STD/AIDS Control Program Director and permissions from individual clinic consultants, while informed consent was secured through information sheets, voluntary participation was ensured, and confidentiality was maintained through password-protected data storage\u003c/p\u003e\n\u003cp\u003eA total of 179 staff members responded out of 189 eligible clinic staff who were requested to participate in the study, with ten participants not responding despite three reminders, resulting in a response rate of 94.7%. However, six participants were removed from the study because they had not completed the questionnaire satisfactorily, having answered less than 60% of the questions, leaving 173 participants for the final analysis. Internal consistency analysis revealed that the subscale measuring positive and negative impacts of currently practicing EIMS in patient care consisted of four items with Cronbach\u0026apos;s alpha of 0.583, which was below the acceptable threshold of 0.6, showing unsatisfactory internal consistency. In contrast, the subscale assessing barriers to successful implementation of EIMS in the STD clinic setup consisted of four items with Cronbach\u0026apos;s alpha of 0.607, meeting the minimum threshold of 0.6 and demonstrating satisfactory internal consistency.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic, education and occupation related characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 173 participants averaged 40.94 years of age (SD = 8.90; range = 25\u0026ndash;62), with a median age of 40 years. Women predominated (62.4%), and nearly all respondents were married (90.2%). Sinhala was the native language for most (89.6%), followed by Tamil (9.8%) and English (0.6%). Educational attainment was high: 43.4% held a certificate, technical qualification, or diploma, 34.7% had completed a university degree, and 19.1% owned postgraduate credentials, while only 2.9% reported General Certificate of Education Advanced Level (GCE A/L) as their highest qualification. A little over half (56.6%) had formal information technology training, most commonly a certificate or diploma (42.2%), while 43.4% reported no IT qualification.\u003c/p\u003e\n\u003cp\u003eDoctors constituted the largest professional group (38%), followed by nursing officers (22%), medical laboratory technologists (14%), public-health inspectors or nursing sisters (12%), public-health laboratory technologists (10%), and pharmacists (5%). Participants had worked in STD clinics for an average of 5.1 years (SD = 4.98; range = 0.07\u0026ndash;23 years; median = 3.08 years). Roles within the Electronic Information Management System (EIMS) frequently overlapped: the most common functions were STD consultation (36%) and patient registration (30%), with substantial involvement in HIV consultation (27%), bleeding (21%), statistics generation (19%), laboratory MLT (15%), drug dispensing (13%) and laboratory microscopy (10%). Just over one-third (38.4%) had previously used other electronic platforms for a mean of 29 months (SD = 21.5; range = 1\u0026ndash;96), and two-thirds (68.8%) had received formal EIMS training, with pharmacists showing the lowest training coverage (50%). (Table 1)\u003c/p\u003e\n\u003cp\u003eTable 1:Healthcare Worker Demographics, Qualifications, and Roles with EIMS in STD Clinics\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory / Metric\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e40.94 (8.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eMedian (Range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e40 (25\u0026ndash;62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e37.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e62.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e90.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNever married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eMother language\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eSinhala\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e89.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eTamil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eEnglish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eEducational qualification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eGCE A/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eCertificate / Diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e43.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eDegree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e34.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eIT qualification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e43.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eGCE O/L (IT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eGCE A/L (IT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eCertificate / Diploma (IT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e42.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eDegree (IT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eDesignation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNursing officer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eMedical laboratory technologist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003ePHI / PHNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003ePublic-health laboratory technologist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003ePharmacist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eYears of service in STD clinic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e5.10 (4.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eMedian (Range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e3.08 (0.07\u0026ndash;23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eEIMS role participation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eSTD consultation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e35.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003ePatient registration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e30.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eHIV consultation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e27.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eBleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eStatistics generation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eLaboratory MLT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eDrug dispensing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eLaboratory microscopy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003ePrior use of other electronic platforms\u0026nbsp;(N = 172)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e38.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e61.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eMean months \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e29 \u0026plusmn; 21.5 (1\u0026ndash;96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eReceived EIMS training\u0026nbsp;(N = 168)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e68.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e32.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePositive and negative impacts of EIMS in the STD clinic.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study examined four key areas of EIMS\u0026apos;s impact on healthcare delivery in STD clinics.\u0026nbsp;Impact on effective communication\u0026nbsp;showed mixed results, with 61.3% of staff believing EIMS had a positive impact while 27% reported negative effects, and the rest neutral (\u0026chi;\u0026sup2; = 62.23, p \u0026lt; 0.001). Post hoc analysis revealed that doctors experienced significantly more negative impacts on patient communication compared to other staff categories.\u0026nbsp;Impact on maintaining confidentiality\u0026nbsp;was overwhelmingly positive, with 81.9% of respondents believing EIMS facilitated confidentiality maintenance, only 7% reporting negative impacts, and 11.1% neutral responses (\u0026chi;\u0026sup2; = 181.72, p \u0026lt; 0.001). However, PHI/PHNS staff showed significantly more concerns about confidentiality maintenance difficulties.\u0026nbsp;Impact on errors in patient care\u0026nbsp;demonstrated positive outcomes, with 68% of staff believing EIMS reduced errors, 8% reporting increased errors, and 24% neutral responses (\u0026chi;\u0026sup2; = 97.65, p \u0026lt; 0.001). No significant differences were found between staff categories for error reduction perceptions.\u0026nbsp;Impact on work efficiency\u0026nbsp;showed positive results, with 66.5% reporting improved efficiency, 22.5% decreased efficiency, and 11% neutral responses (\u0026chi;\u0026sup2; = 88.97, p \u0026lt; 0.001). Staff categories showed no significant differences in work efficiency perceptions. (Table 2)\u003c/p\u003e\n\u003cp\u003eTable 2: Impact of EIMS on health care delivery\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImpact Domain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e{N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative Impact\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeutral Response\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive Impact\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChi-Square\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSignificant Staff Category Differences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eEffective Communication\u003c/p\u003e\n \u003cp\u003e(173)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e27.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e11.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e61.30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 62.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eDoctors perceived significantly more negative\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eMaintaining Confidentiality\u003c/p\u003e\n \u003cp\u003e(171)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e7.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e11.10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e81.90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 181.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003ePHI/PHNS perceived significantly more negative\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eErrors in Patient Care\u003c/p\u003e\n \u003cp\u003e(169)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e8.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e24.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e68.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 97.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eNo significant differences (p = 0.736)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eWork Efficiency\u003c/p\u003e\n \u003cp\u003e(173)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e22.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e11.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e66.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 88.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eNo significant differences (p = 0.130)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNote. All chi-square tests had degree of freedom (df) = 2. Fisher-Freeman-Halton Exact test was used for staff category comparisons.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers to the successful maintenance of EIMS in STD clinics.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis examined six key barriers to Electronic Information Management System (EIMS) usage among healthcare staff across five professional categories. Technical difficulties\u0026nbsp;appeared as the most prevalent barrier, with 96% of 171 respondents experiencing this issue. This stood for a statistically significant finding (p \u0026lt; 0.001), though no significant differences existed between staff categories. Inadequate facilities\u0026nbsp;affected 53% of 168 respondents, but this proportion was not statistically significant overall (p = 0.440), and no significant difference was found between staff categories. Computer literacy\u0026nbsp;was adequate, with 88% of 162 respondents reporting sufficient skills. However, Nursing Officers showed significantly lower perceived computer literacy compared to other staff categories (p = 0.006). Training adequacy\u0026nbsp;was reported by 66.5% of 164 respondents, with significant overall differences (p \u0026lt; 0.001). Nursing Officers again stood out as having significantly less adequate training compared to other categories (p = 0.02). English literacy\u0026nbsp;was high across all groups, with 97.6% of 169 respondents reporting adequate skills. However, PHI/PHNS perceived significantly lower English literacy levels compared to other categories (p = 0.034). Higher workload and inadequate staffing\u0026nbsp;affected 55.4% of 168 respondents, though this was not statistically significant overall (p = 0.165). However, significant differences existed between staff categories (p = 0.01), with Pharmacists, PHLT, PHI, and PHNS less likely to perceive this as a barrier compared to other staff groups. (Table 3)\u003c/p\u003e\n\u003cp\u003eTable 3: Barriers for using EIMS.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBarrier\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage experiencing barrier\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistical significance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSignificant differences between staff categories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe most affected staff category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eTechnical difficulties\u003c/p\u003e\n \u003cp\u003e(171)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e96%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003ep \u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eNo (p = 0.232)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNone (no significant difference)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eInadequate facilities\u003c/p\u003e\n \u003cp\u003e(168)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e53%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003ep = 0.440\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eNo (p = 0.340)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNone (no significant difference)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eInadequate computer literacy\u003c/p\u003e\n \u003cp\u003e(162)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003ep \u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eYes (p = 0.006)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eMore Nursing Officers perceived as a barrier\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eInadequate training\u003c/p\u003e\n \u003cp\u003e(164)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e33.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003ep \u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eYes (p = 0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eMore Nursing Officers perceived as a barrier\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eInadequate English literacy\u003c/p\u003e\n \u003cp\u003e(169)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e2.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003ep \u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eYes (p = 0.034)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eMore PHI/PHNS perceived as a barrier\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eHigher workload/Inadequate staff\u003c/p\u003e\n \u003cp\u003e(168)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e55.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003ep = 0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eYes (p = 0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eMore Doctors, MLT, Nursing Officers perceived as a barrier (compared to Pharmacists/PHLT/PHI/PHNS)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAreas for Further Improvement in EIMS for STD Clinics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA detailed analysis of staff feedback finds\u0026nbsp;key areas for improvement\u0026nbsp;in the Electronic Information Management System (EIMS) tailored for STD clinic settings in Sri Lanka.\u0026nbsp;The findings reflect both quantitative survey responses and qualitative suggestions from open-ended questions. (Table 4)\u003c/p\u003e\n\u003cp\u003eTable 4: Demanded improvements in EIMS.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImprovement Area\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% of Participants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eSystem speed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e76.20%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eTraining\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e50.60%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eInvolving user ideas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e46.30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eContinuous technical support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e42.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eOnsite support availability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e42.10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eContent improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e29.90%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eClinic setup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e29.30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eFormat improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e28.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMost staff called for improvements in system speed, followed by requests for more training, greater incorporation of user feedback in system modifications, and more direct technical/onsite support.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic and Education-related Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSri Lanka\u0026apos;s economically active labor force is male (66.7%)(21); however, the sample had a female majority (62.4%), reflecting the gender distribution in nursing roles. Most participants were married (90.2%), a higher proportion than the general population(21), because teenagers and the retired were not included. The majority spoke Sinhala (89.6%), with Tamil (9.8%) and English speakers in the minority, consistent with national language policies(22). All participants had, at least, passed the GCE A/L examination. Over half (56.6%) reported IT qualification, a proportion aligned with national trends showing higher computer literacy among those with advanced education(17).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOccupation-related Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing proportional sampling, the study included representation from all major staff categories of STD clinics island wide. Doctors made up the largest group (37.6%), a broader representation than earlier Sri Lankan studies(5). Most staff had not used any electronic record platform other than EIMS (61.3%), and only 68.8% reported having received formal EIMS training, due to irregular training programs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImpacts of EIMS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost staff members felt that EIMS improved communication with patients, except for doctors, who reported that using computers during sensitive consultations could impede the doctor-patient rapport. This underscores the importance of balancing technology use with interpersonal communication skills. Most staff believed EIMS facilitated confidentiality (p \u0026lt; 0.001), but PHI/PHNS were less convinced (p = 0.012). While EIMS limits data access to authorized users, earlier reviews cautioned that no EHR system guarantees complete confidentiality(23). Staff reports improved data security with EHRs, though international reviews confirm patients stay more concerned than clinicians about confidentiality(12,24). Respondents reported that EIMS reduced clinical errors (p \u0026lt; 0.001). Literature supports that EHRs reduce missing data and enable more accurate health record-keeping(25), but may also introduce new errors, such as incorrect drug selection(4). EIMS was broadly seen as improving work efficiency (p \u0026lt; 0.001), a finding echoed in both Sri Lankan and global studies(3,12,24). However, initial implementation may temporarily reduce productivity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers to Successful Maintenance of EIMS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA large majority (95.9%) met technical issues (p \u0026lt; 0.001), especially slow connectivity. No significant differences between staff categories (p = 0.232), indicating technical difficulties affect all staff equally regardless of role. This is higher than reported at EIMS implementation(5) and is commonly cited in international literature as a barrier(12,24). Over half (52.9%) cited insufficient facilities (e.g., space, hardware, equipment), a figure much higher than earlier studies(5). No significant differences between staff categories (p = 0.340), showing this barrier is uniformly perceived across different healthcare roles.\u003c/p\u003e\n\u003cp\u003eThis issue is well-documented in both local and global literature as a primary challenge for EHR maintenance(2,8,26). Most staff felt computer literacy was adequate, though nursing officers lagged significantly behind (p = 0.006), consistent with findings that technical skills are crucial for EHR success(8). English literacy was adequate for most, but PHI/PHNS expressed concerns. English proficiency varies across different staff categories, affecting ease of training and system use since manuals are in English. Staff with limited English skills might be less confident or disengaged during training, reducing training effectiveness.\u0026nbsp;Lack of Training: Two-thirds reported adequate training (p \u0026lt; 0.001), but nursing officers were again less likely to be adequately trained (p = 0.02). Training gaps were more pronounced than in 2019(5). Sustained and role-specific training programs are essential for successful EHR implementation, as shown in Sri Lanka and internationally(2,8). While 55.4% cited high workload and inadequate staff as barriers, this was not universally significant. Pharmacists, PHLT, PHI, and PHNS were less likely to view this as a barrier. Literature notes that inadequate staffing can be a critical barrier(8).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAreas for Further Improvement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe majority (76%) advocated for improved system speed. Participants also highlighted the need for better internet connectivity, backup power, and enhanced system content and format. Half of the respondents (50.6%) requested further training, with suggestions for longer, role-specific training and self-learning resources. Almost half wanted more user involvement in system development and recommended ongoing onsite and technical support. These findings align with both current and earlier implementation-phase studies in Sri Lanka and the global evidence on EHR improvement priorities(3,5).\u003c/p\u003e\n\u003ch4\u003eLimitations of the study\u003c/h4\u003e\n\u003cp\u003eOnly staff with access to EIMS and a minimum of 2 weeks\u0026rsquo; usage were included. Clinics not yet established with EIMS, or staff early in the onboarding process, were excluded, potentially omitting both critical implementation-phase challenges and the experiences of the least experienced users.\u003c/p\u003e\n\u003cp\u003eWhile a finite population correction was applied to determine the sample size, the final study population was smaller than the initially calculated ideal sample, which can restrict the statistical power for subgroup analyses. Six respondents were excluded for incomplete questionnaires (answered less than 60% of items), reducing the final sample to 173. This can introduce bias if non-responders or partial responders differed systematically from those included. Stratified random sampling ensured broad staff representation, but pharmacists/dispensers and PHLT were underrepresented. Larger studies are needed to better assess these groups\u0026apos; perceptions. The scale used to assess positive and negative impacts of EIMS had an alpha coefficient of 0.583, showing less-than-ideal internal consistency. The low internal consistency can limit confidence in the interpretation of results from this section, as measurement error or item heterogeneity may bias or obscure associations. Caution is warranted when interpreting findings regarding the positive and negative impacts reported by healthcare workers, as the assessment might not be fully consistent or comprehensive. The study focused solely on healthcare providers\u0026apos; perspectives, not those of patients/clients. Findings are specific to the EIMS in STD clinics and may not apply to inpatient settings or other EHR systems indicating limited generalizability of the findings. Only staff with access to EIMS and a minimum of 2 weeks\u0026rsquo; usage were included. Clinics not yet established with EIMS, or staff early in the onboarding process, were excluded\u0026mdash;potentially omitting both critical implementation-phase challenges and the experiences of the least experienced users.\u003c/p\u003e"},{"header":"Conclusions and recommendations","content":"\u003cp\u003eThere was a significant overlap in job roles due to staffing shortages, and most staff were new to electronic health record (EHR) systems. Most healthcare providers perceived that EIMS positively affects communication and confidentiality, reduces errors, and improves work efficiency. However, doctors felt EIMS hindered effective doctor-patient communication, and PHIs/PHNS felt it compromised patient data confidentiality. The main barrier to EIMS use was technical difficulties. Most staff reported adequate computer literacy, training, and English proficiency, but nursing officers are not satisfied with their computer skills and training, and PHIs/PHNS had concerns about their English literacy. The most requested improvements were faster system speed and more training.\u003c/p\u003e\n\u003cp\u003eSteps need to be taken to enhance doctor-patient communication and computer proficiency through targeted training, especially for nursing officers and building trust through privacy protections for data confidentiality. Provide adequate infrastructure and ensure fast, reliable internet connection.\u003c/p\u003e\n\u003cp\u003eIt Is necessary to consider user feedback in future EIMS updates, offer continuous technical support, and have onsite technical aid available. Conduct further research on patient/client perceptions of EIMS use. It is crucial to conduct similar cross-sectional studies involving healthcare workers from a range of settings including inpatient wards, outpatient departments, primary care clinics, and specialized hospital units. This would capture the diversity of roles, workflows, and information needs outside STD clinics.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003eEHR: Electronic Health Record\u003c/li\u003e\n \u003cli\u003eEIMS: Electronic Information Management System\u003c/li\u003e\n \u003cli\u003eSTD: Sexually Transmitted Disease\u003c/li\u003e\n \u003cli\u003eSTI: Sexually Transmitted Infection\u003c/li\u003e\n \u003cli\u003eHIV: Human Immunodeficiency Virus\u003c/li\u003e\n \u003cli\u003eNSACP: National STDAIDS Control Programme\u003c/li\u003e\n \u003cli\u003ePHI: Public Health Inspector\u003c/li\u003e\n \u003cli\u003ePHN: Public Health Nurse\u003c/li\u003e\n \u003cli\u003eMLT: Medical Laboratory Technologist\u003c/li\u003e\n \u003cli\u003ePHLT: Public Health Laboratory Technologist\u003c/li\u003e\n \u003cli\u003eGCE AL: General Certificate of Education Advanced Level\u003c/li\u003e\n \u003cli\u003eIT: Information Technology\u003c/li\u003e\n \u003cli\u003eSIM: Strategic Information Management\u003c/li\u003e\n \u003cli\u003eMOH: Medical Officer of Health\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e - This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethics Review Committee of the Postgraduate Institute of Medicine, University of Colombo, Sri Lanka (Reference number: ERC/PGIM/2021/063). Institutional clearance was granted by the National STD/AIDS Control Programme. All participants provided informed consent electronically prior to data collection, and confidentiality was maintained by ensuring anonymized and password-protected data storage.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publications\u003c/strong\u003e - All participants provided informed written consent for the study before participating in the study. This study publication does not contain individual participant data, thus consent for publication is not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e - All data generated or analysed during this study are included in this published article [and its supplementary information files].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e- The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e - This study was self-funded and did not receive any funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e - HADP Nimalrathna conceptualized and designed the study, collected and analyzed data, and drafted the manuscript. KAM Ariyaratne provided supervision and critical revision of the manuscript. All authors read and approved of the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e - Not applicable\u003c/p\u003e\n\u003ch4\u003eAuthors\u0026apos; information\u003c/h4\u003e\n\u003cp\u003e\u0026nbsp;H.A.D.P. Nimalrathna, MBBS (Colombo), Diploma in Venereology (Sri Lanka), MD in venereology (Sri Lanka), Senior Registrar in the National STD AIDS Control Program, Colombo, Sri Lanka.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eK.A.M. Ariyaratne, MBBS (Colombo), MSc in community medicine (Sri Lanka), MD in venereology (Sri Lanka), Consultant venereologist, National STD AIDS Control Program, Colombo, Sri Lanka.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAl-Harbi A. Healthcare Providers\u0026rsquo; Perceptions towards Health Information Applications at King Abdul-Aziz Medical City, Saudi Arabia. International Journal of Advanced Computer Science and Applications [Internet]. 2012 Jul 1 [cited 2025 Oct 18];2(10). Available from: https://thesai.org/Publications/ViewPaper?Volume=2\u0026amp;Issue=10\u0026amp;Code=IJACSA\u0026amp;SerialNo=3\u003c/li\u003e\n\u003cli\u003eDenham Pole. Electronic Patient Records in Sri Lankan Hospitals. Sri Lanka Journal of Bio-Medical Informatics [Internet]. 2010 Jan 1 [cited 2025 Oct 18];43\u0026ndash;5. Available from: http://www.mdssrilanka.com\u003c/li\u003e\n\u003cli\u003eRathnayake SHR. Impact of electronic health records in Sri Lanka: case study of four government hospitals. 2019 Sep 30 [cited 2025 Oct 18]; Available from: https://www.researchgate.net/publication/336132444_\u003c/li\u003e\n\u003cli\u003eCresswell KM, Worth A, Sheikh A. Integration of a nationally procured electronic health record system into user work practices. BMC Med Inform Decis Mak [Internet]. 2012 [cited 2025 Oct 18];12(1). Available from: https://pubmed.ncbi.nlm.nih.gov/22400978/\u003c/li\u003e\n\u003cli\u003eKarunaratne H, Rajakaruna L, Muraliharan S, Peiris D, Dileka W, Manathunge A. User experience on the newly implemented Electronic Information Management System of the National STD/AIDS Control Programme. Sri Lanka Journal of Sexual Health and HIV Medicine. 2019 Dec 30;5(0):30. \u003c/li\u003e\n\u003cli\u003eNational eHealth Guidelines and Standards [ NeGS ] 1.0. 2016; \u003c/li\u003e\n\u003cli\u003eCresswell KM, Sheikh A. Health information technology in hospitals: current issues and future trends. Future Hosp J [Internet]. 2015 Feb [cited 2025 Oct 18];2(1):50\u0026ndash;6. Available from: https://pubmed.ncbi.nlm.nih.gov/31098079/\u003c/li\u003e\n\u003cli\u003eGesulga JM, Berjame A, Moquiala KS, Galido A. Barriers to Electronic Health Record System Implementation and Information Systems Resources: A Structured Review. Procedia Comput Sci [Internet]. 2017 Jan 1 [cited 2025 Oct 18];124:544\u0026ndash;51. Available from: https://www.sciencedirect.com/science/article/pii/S1877050917329563\u003c/li\u003e\n\u003cli\u003eMiller RH, Sim I. Physicians\u0026rsquo; use of electronic medical records: barriers and solutions. Health Aff (Millwood) [Internet]. 2004 [cited 2025 Oct 18];23(2):116\u0026ndash;26. Available from: https://pubmed.ncbi.nlm.nih.gov/15046136/\u003c/li\u003e\n\u003cli\u003eGoswami A, Dutta S. Gender Differences in Technology Usage\u0026mdash;A Literature Review. Open Journal of Business and Management. 2016;04(01):51\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eJayawardena AS. A systematic literature review of Security, Privacy and Confidentiality of patient information in Electronic Health Information Systems. Sri Lanka Journal of Bio-Medical Informatics. 2013 Dec 5;4(2):25. \u003c/li\u003e\n\u003cli\u003eMogli G Das. Challenges of Electronic Health Records Implementation. Sri Lanka Journal of Bio-Medical Informatics. 2012 Mar 13;2(2):67. \u003c/li\u003e\n\u003cli\u003eSri Lanka Annual Report 2019 | HIV/AIDS Data Hub for the Asia-Pacific Region [Internet]. [cited 2025 Oct 18]. Available from: https://new.aidsdatahub.org/resource/sri-lanka-annual-report-2019\u003c/li\u003e\n\u003cli\u003eDornan L, Pinyopornpanish K, Jiraporncharoen W, Hashmi A, Dejkriengkraikul N, Angkurawaranon C. Utilisation of Electronic Health Records for Public Health in Asia: A Review of Success Factors and Potential Challenges. Biomed Res Int [Internet]. 2019 [cited 2025 Oct 18];2019. Available from: https://pubmed.ncbi.nlm.nih.gov/31360723/\u003c/li\u003e\n\u003cli\u003eJeyakodi T, Herath D. Acceptance and Use of Electronic Medical Records in Sri Lanka. Scientific Research Journal (SCIRJ) [Internet]. 2016 Jan [cited 2025 Oct 18]; Volume IV (Issue I). Available from: www.scirj.org\u003c/li\u003e\n\u003cli\u003eSecginli S, Erdogan S, Monsen KA. Attitudes of health professionals towards electronic health records in primary health care settings: a questionnaire survey. Inform Health Soc Care [Internet]. 2014 Jan [cited 2025 Oct 18];39(1):15\u0026ndash;32. Available from: https://pubmed.ncbi.nlm.nih.gov/24131449/\u003c/li\u003e\n\u003cli\u003eSri Lanka - Computer Literacy Survey - 2006 [Internet]. [cited 2025 Oct 18]. Available from: https://nada.statistics.gov.lk/index.php/catalog/247\u003c/li\u003e\n\u003cli\u003eSri Lanka Annual Report 2020 | HIV/AIDS Data Hub for the Asia-Pacific Region [Internet]. [cited 2025 Oct 18]. Available from: https://www.aidsdatahub.org/resource/sri-lanka-annual-report-2020\u003c/li\u003e\n\u003cli\u003eNational HIV/STI Strategic Plan Sri Lanka 2018-2022: Towards Ending AIDS | HIV/AIDS Data Hub for the Asia-Pacific Region [Internet]. [cited 2025 Oct 18]. 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Electronic health records implementation: An evaluation of information system impact and contingency factors. Int J Med Inform [Internet]. 2014 Nov 1 [cited 2025 Oct 18];83(11):779\u0026ndash;96. Available from: https://pubmed.ncbi.nlm.nih.gov/25085286/\u003c/li\u003e\n\u003cli\u003eA M, MM G, R D, HE S. Use of Hospital Information System to Improve the Quality of Health Care from Clinical Staff Perspective. Galen medical journal [Internet]. 2021 Feb 4 [cited 2025 Oct 18];10. Available from: https://pubmed.ncbi.nlm.nih.gov/35434158/.\u003c/li\u003e\n\u003cli\u003eAl-Harbi A. Healthcare Providers\u0026rsquo; Perceptions towards Health Information Applications at King Abdul-Aziz Medical City, Saudi Arabia. International Journal of Advanced Computer Science and Applications [Internet]. 2012 Jul 1 [cited 2025 Oct 19];2(10). Available from: https://thesai.org/Publications/ViewPaper?Volume=2\u0026amp;Issue=10\u0026amp;Code=IJACSA\u0026amp;SerialNo=3\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"electronic health record, user perception, Sri Lanka","lastPublishedDoi":"10.21203/rs.3.rs-7944155/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7944155/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eElectronic health recording (EHR) is an essential advancement for healthcare systems in developing countries. The success of EHRs depends on timely modifications based on user feedback. This cross-sectional study assessed the impacts, barriers, and areas for improvement of the Electronic Information Management System (EIMS) across twenty-three sexually transmitted disease (STD) clinics in Sri Lanka.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study used stratified sampling. Data were collected via an online self-administered questionnaire from key clinic staff (n\u0026thinsp;=\u0026thinsp;173) in 2022.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe sample had a mean age of 40.9 years; 62.4% were female. Most participants had not used other electronic health systems (61%) but had received EIMS training (68.8%) and held IT qualifications (56%). EIMS was perceived to enhance communication (61.3%), data confidentiality (81.9%), work efficiency (66.5%), and error reduction (68%). However, 35% of doctors reported a negative impact on patient communication (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while 25% of public health inspectors (PHIs) and public health nurses (PHNs) had concerns about data confidentiality (p\u0026thinsp;=\u0026thinsp;0.012). The main reported barriers were technical issues (95%) and high workload (43%). Although most respondents were confident in their computer and English literacy, 35% and 50% of nursing officers lacked computer skills and EIMS training, respectively. Additionally, 10% of PHIs/PHNs reported low English confidence. The most requested improvement was faster system speed (76%).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eEIMS improved efficiency but has technical, training, and communication challenges. Interventions are needed to improve doctor\u0026ndash;patient communication during EIMS use and strengthen computer skills among nurses and English proficiency among PHIs/PHNs. Address technical issues, reducing workload will improve EIMS use.\u003c/p\u003e","manuscriptTitle":"Perceptions of Healthcare Workers on the Electronic Health Record System of Sexually Transmitted Disease Clinics in Sri Lanka: A Descriptive Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-28 14:54:34","doi":"10.21203/rs.3.rs-7944155/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-30T09:07:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-22T09:26:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"290482625251940072775666532214262521072","date":"2026-01-20T04:31:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-16T08:02:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-04T01:33:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"313904517582646818784608464522921659404","date":"2025-11-26T05:09:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"281704592092473999549276682434361725535","date":"2025-11-26T00:13:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-23T23:53:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-29T06:28:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-29T06:26:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-28T17:35:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-10-28T17:32:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"45177e05-0a61-47b9-9d21-41e5b608bb53","owner":[],"postedDate":"November 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-16T16:08:06+00:00","versionOfRecord":{"articleIdentity":"rs-7944155","link":"https://doi.org/10.1186/s12913-026-14246-2","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2026-03-10 15:58:59","publishedOnDateReadable":"March 10th, 2026"},"versionCreatedAt":"2025-11-28 14:54:34","video":"","vorDoi":"10.1186/s12913-026-14246-2","vorDoiUrl":"https://doi.org/10.1186/s12913-026-14246-2","workflowStages":[]},"version":"v1","identity":"rs-7944155","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7944155","identity":"rs-7944155","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}