Electronic medical record-generated data use for decision-making and associated factors among healthcare managers in Somali public health facilities: a multicenter cross-sectional study

Abstract

Background: Electronic medical record (EMR) systems have been introduced in public health facilities across Somalia to strengthen routine health information systems and support data-informed decision-making. However, evidence on the extent to which EMR-generated data are used for managerial and clinical decision-making remains limited. This study assessed EMR-generated data utilization and associated factors among healthcare managers in public health facilities in Somalia. Methods: A facility-based cross-sectional study was conducted from November to December 2025 across 45 public health facilities. A total of 405 healthcare managers were selected using a multistage cluster sampling technique. Data were collected using self-administered questionnaires and observational checklists developed based on the PRISM framework. The tool assessed organizational, technical, and behavioral factors influencing EMR data use. Data were entered and cleaned in Excel and analyzed using SPSS version 27. Descriptive statistics were used, and bivariable and multivariable binary logistic regression analyses identified factors associated with EMR-generated data utilization. Results: Overall, 145 healthcare managers (35.8%) reported adequate use of EMR-generated data for decision-making. EMR data were most commonly used to assess clinical guideline adherence (29.9%) and provider performance (28.4%), but least used for quality improvement (15.1%). Diploma-level qualification (AOR = 0.49; 95% CI: 0.25-0.95) and ≤1 year of administrative experience (AOR = 0.57; 95% CI: 0.36-0.90) were associated with lower EMR data use. Laboratory professionals were more likely to use EMR data than general practitioners (AOR = 2.96; 95% CI: 1.07-8.16). Creating performance dashboards (AOR = 2.25; 95% CI: 1.19-4.24), identifying patient care gaps (AOR = 5.02; 95% CI: 2.42-10.44), and access to technical support (AOR = 1.71; 95% CI: 1.02-2.89) were positively associated with EMR data use, while perceived system difficulty was negatively associated with utilization (AOR = 0.39; 95% CI: 0.22-0.70). Conclusion: EMR-generated data use for decision-making remains limited in Somalia's public health facilities. Strengthening user capacity, improving system usability, and ensuring technical support are essential to promote routine data-driven decision-making.