Table 2.

Barriers to EMR usage at Komfo Anokye Teaching Hospital Emergency Centre.

Themes	Quotes
Existing barriers
Financial resources	“Our main challenge is funds and technicians. We have to hire programmers to customise various aspects of the open EMR. This is expensive. In the past, some programmers presented themselves as capable but after 3–4 months they are unable to deliver. It has been constraining finding a programmer to customise the open EMR. Initially logistics to really do EMR, resources were not enough – lack of adequate computers and scanners and external drive, lack of external drive to do backup” (interviewee 24)
Data entry errors	“Sometimes one person having different registration numbers. Data entries challenges - data entered incorrectly or incompletely. For instance, entry of date of birth and unknown details as brought in by some ‘good Samaritans” (interviewee 22)
Constraints of logistics	“The existing software application is not reliable in terms of data keeping, because we sometimes lose some important information. System has no backup” (interviewee 18)
Human resource constraints	“It’s a tedious job, pulling out and putting back folder together before and after scanning data. It gives extra work” (interviewee 3)
	“Staff attitude, since it’s a change process, naturally that people get stuck to old ways, especially records staff and clinical staff” (interviewee 21)
	“Before open EMR we used to use a book. It is easy to fill so they easily fill. So some of the data fields are not fields on the EMR. Some of the data of public health importance and policy health are not filled depending on those on duty” (interviewee 24)
Perceived barriers
Data security	“Privacy and confidentiality issues need to be considered because if you are going to do entries you can see everything online” (interviewee 1)
	“Legislature, now we are small so nobody cares. So if we start to network all of Kumasi that is when the law will require that we go to Parliament to seek for approval” (interviewee 23)
Logistical constraints	“If everything is connected to the electronic and at the mercy of electricity, huge data loss if the system crashes: it becomes a life and death issue for patients” (interviewee 12)