Multimedia Appendix 5 codebook - ULTRA

Healthcare Providers’ Experiences and Perspectives on the Use of Electronic Health Record System-ULTRA for Maternal and Perinatal Care in Kilimanjaro, Tanzania: A qualitative studyAbstractIntroductionSub-Saharan Africa faces challenges in collecting maternal and perinatal data because of poor documentation in paper-based systems and inadequate infrastructure for digital utilization. The electronic health record system-ULTRA (EHRS-ULTRA) was developed and piloted in the Kilimanjaro region from October 2022 to August 2024 to improve data management. This qualitative study aimed to explore healthcare providers’ perspectives and experiences of using EHRS-ULTRA in maternal and perinatal healthcare, including its perceived value, implementation challenges, and implications for future implementation and scale-up.MethodsThe study used a qualitative exploratory descriptive design to examine healthcare providers’ experiences using the EHRS-ULTRA in Kilimanjaro, Tanzania. Data were collected through key informant interviews and focus group discussions. Participants were purposively selected from two districts representing urban (Moshi Municipal) and rural (Moshi District) areas, including reproductive and child health coordinators; facility managers; and healthcare professionals from the antenatal care, labor and delivery, and postnatal care departments. A total of 35 participants took part, including 29 healthcare providers and 6 health managers. The data were analyzed through reflexive thematic analysis.Results:The EHRS-ULTRA was perceived by study participants to improve access to patients’ clinical information, continuity of care, quality of clinical decision-making, and quality of documentation for maternal and perinatal health services. Real-time notifications and referral tracking were reported to support timely clinical responses and leadership oversight. Key success factors for future adoption included leadership engagement, supportive supervision, and alignment of their existing “Mfumo wa Taarifa za Uendeshaji wa Huduma za Afya-MTUHA” paper-records system workflow. However, widespread challenges with unstable electricity, lack of reliable Internet service, limited number of digital devices, and variability in digital literacy skills were perceived as the primary barriers to successful implementation and scaling of the system.Conclusion
Based on users’ experiences with the EHRS-ULTRA, healthcare professionals perceived EHRS-ULTRA as complementing existing paper-based documentation systems by improving information access, continuity of care, referral tracking, and the timeliness of clinical decisions about maternal and perinatal health care. EHRS-ULTRA demonstrated considerable potential to strengthen maternal and perinatal care; however, broader implementation and scale-up will require improvements in infrastructure, workforce readiness, and overall health system preparedness.