Journal of Intelligent Computing and Health Informatics (JICHI)
Vol 6, No 2 (2025): September

The Digital Efficiency Paradox: Modeling the Trade-off Between Documentation Speed and Patient Interaction in Infrastructure-Limited EHR Ecosystems

Amanda Appiah Acheampong (University of Ghana)
Samuel Antwi (University of Ghana)
Josephine Arhin Gordon (University of Ghana)
Khadijatu Adiss Yusif (Ghana Health Service)
Maame Dankwah Tiboah Asare (University of Ghana)
Richard Peter Yalley (University of Ghana)
Zainabu Mamley Adams (University of Ghana)
Abdul-Mumin Musah Bingle (University of Ghana)
Ramatu Adamu (University of Ghana)
Muniratu Abdul Razak (University of Ghana)
Rosemary Abrefa Bermaa (University of Cape Coast)
Francisca Tsidih (Nurses’ Training College)



Article Info

Publish Date
20 Sep 2025

Abstract

The digitization of clinical workflows through Electronic Health Records (EHR) is a global imperative aimed at enhancing data accuracy and care coordination. However, in resource-constrained environments, the transition from paper-based systems to digital platforms often surpasses the readiness of existing infrastructure. While systems such as the Lightwave Health Information Management System (LHIMS) in Ghana offer the promise of increased efficiency, they also introduce critical dependencies on unstable power and internet connectivity. This situation creates a "Digital Efficiency Paradox," wherein the urgency to document data swiftly before a potential power outage inadvertently diminishes the quality of clinician-patient interactions. This study employs a qualitative-driven process modeling approach at Juaben Municipal Hospital (N=10). We utilize formal Business Process Model and Notation (BPMN 2.0) semantics to reconstruct clinical workflows and apply the Control-Flow Complexity (CFC) metric to quantify the cognitive load shift from manual ($W_{\text{pre}}$) to digital ($W_{\text{post}}$) systems. Computational analysis reveals that while LHIMS reduced patient retrieval latency by approximately 96%, it increased structural complexity (CFC) from 3.0 to 14.0, thereby imposing a higher cognitive burden. Crucially, we identified a phenomenon of "Infrastructure-Induced Process Deadlock," where power outages result in total system paralysis ($\mathcal{I}(\tau)=0$), compelling clinicians to resort to risky hybrid workarounds. Paradoxically, the anxiety of potential system failure drives staff to prioritize "screen time" over "care time," creating a tunnel vision effect. The study challenges the "always-online" paradigm in the Global South. We conclude that digital efficiency must be balanced with structural resilience, advocating for an "Offline-First" architecture that decouples clinical documentation from grid instability to preserve the human element of care.

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Journal Info

Abbrev

ICHI

Publisher

Subject

Computer Science & IT Dentistry Electrical & Electronics Engineering Medicine & Pharmacology Public Health

Description

Journal of Intelligent Computing & Health Informatics (JICHI) was printed in March 2020. JICHI is a scientific review journal publishing that focus on exchanging information relating to intelligent computing and health informatics applied in industry, hospitals, government, and universities. All ...