Prospects and problems of migrating from physical case note to electronic record systems in the spine clinic at national Orthopaedic Hospital Kano, Nigeria: A Retrospective Comparative Study of Two Eras (2018–2022 vs 2023–2026)

Background: Electronic Medical Record (EMR) systems offer significant advantages over paper-based documentation, yet adoption in Nigerian healthcare facilities remains low. This study compared the prospects and problems of EMR migration by analyzing clinical documentation outcomes during two distinct eras: the pre-EMR era (2018–2022) using physical case notes and the early EMR implementation era (2023–2026) at the Spine Clinic of National Orthopaedic Hospital Kano (NOHK), Nigeria.
Methods: A retrospective comparative study was conducted reviewing clinical documentation data from the NOHK Spine Clinic. Data from the paper-based era (January 2018–December 2022) were extracted from physical case note audits, while data from the EMR era (January 2023–March 2026) were obtained from the clinic's digital records system. Outcomes assessed included record retrieval time, documentation errors, missing records rate, patient waiting time, and staff satisfaction. Data were analysed using SPSS version 26 with descriptive statistics and independent t-tests.
Results: A total of 1,850 clinical encounters were analysed (1,200 from paper era, 650 from EMR era). EMR implementation resulted in significant improvements: mean record retrieval time decreased from 12.4 ± 4.6 minutes to 1.8 ± 0.8 minutes (p<0.001); documentation errors reduced from 15.2% to 4.6% (p<0.001); missing records rate dropped from 8.4% to 1.2% (p<0.001); and patient waiting time reduced from 68.4 ± 22.6 minutes to 42.8 ± 18.4 minutes (p<0.001). Staff satisfaction scores improved from 58.2% to 84.6% (p<0.001). However, persistent challenges in the EMR era included: intermittent power outages (42.6% of clinic days), system downtime (mean 3.2 ± 1.8 hours/week), inadequate computer terminals (68 staff sharing 12 terminals), and incomplete data migration from paper records (18.4% of legacy cases not fully digitized).
Conclusion: Migration from physical case notes to EMR at the NOHK Spine Clinic has yielded substantial improvements in clinical efficiency, data integrity, and patient experience. However, infrastructural challenges—including unreliable power supply, inadequate hardware, and incomplete legacy data migration—continue to limit the full potential of digital transformation. Strategic investments in infrastructure, staff training, and phased migration planning are essential for sustainable EMR implementation.