Perceptions of healthcare workers on the electronic health record system of sexually transmitted disease clinics in Sri Lanka: a descriptive cross-sectional study - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. 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Learn more: PMC Disclaimer | PMC Copyright Notice BMC Health Serv Res . 2026 Mar 10;26:532. doi: 10.1186/s12913-026-14246-2 Search in PMC Search in PubMed View in NLM Catalog Add to search Perceptions of healthcare workers on the electronic health record system of sexually transmitted disease clinics in Sri Lanka: a descriptive cross-sectional study Hewa Annakkalage Dilanka Prabharshinee Nimalrathna Hewa Annakkalage Dilanka Prabharshinee Nimalrathna 1 Present Address: National STD/AIDS Control Programme, Colombo, Sri Lanka Find articles by Hewa Annakkalage Dilanka Prabharshinee Nimalrathna 1, ✉ , Airyaratne Manathunge Airyaratne Manathunge 1 Present Address: National STD/AIDS Control Programme, Colombo, Sri Lanka Find articles by Airyaratne Manathunge 1 Author information Article notes Copyright and License information 1 Present Address: National STD/AIDS Control Programme, Colombo, Sri Lanka ✉ Corresponding author. Received 2025 Oct 25; Accepted 2026 Feb 18; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13085317 PMID: 41803786 Abstract Background Electronic health recording (EHR) is an essential advancement for healthcare systems in developing countries. The success of EHRs depends on timely modifications based on user feedback. This cross-sectional study assessed the impacts, barriers, and areas for improvement of the Electronic Information Management System (EIMS) across twenty-three sexually transmitted disease (STD) clinics in Sri Lanka. Methods This study used stratified sampling including doctors, nurses, public health laboratory technicians (PHLTs), medical laboratory technicians (MLTs), public health inspectors (PHIs), public health nurses (PHNs) and pharmacists working in STD clinics ( n = 173). Data was collected via an online self-administered questionnaire in 2022. Results The sample had a mean age of 40.9 years; 62.4% were female. Most participants had not used other electronic health systems (61%), but had received EIMS training (68.8%) and held IT qualifications (56%). EIMS was perceived to enhance communication (61.3%), data confidentiality (81.9%), work efficiency (66.5%), and error reduction (68%). However, 35% of doctors reported a negative impact on patient communication ( p < 0.001), while 25% of PHIs and PHNs had concerns about data confidentiality ( p = 0.012). The main reported barriers were technical issues (95%) and high workload (43%). Although most respondents were confident in their computer and English literacy, 35% and 50% of nursing officers lacked computer skills and EIMS training, respectively. Additionally, 10% of PHIs/PHNs reported low English confidence. The most requested improvement was faster system speed (76%). Conclusions EIMS improved efficiency but has technical, training, and communication challenges. Interventions are needed to improve doctor–patient communication during EIMS use and strengthen computer skills among nurses and English proficiency among PHIs/PHNs. Address technical issues, reducing workload will improve EIMS use. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-026-14246-2. Keywords: Electronic health record, User perception, Sri Lanka Background An Electronic Information Management System (EIMS) is a digital platform designed to store and manage various healthcare data, such as clinical notes, lab reports, and prescriptions, within a centralized database [ 1 – 3 ]. Globally, Electronic Health Record (EHR) systems have been widely adopted in high- and middle-income countries like the USA, UK, China, and Asian nations [ 4 ]. EHR systems have demonstrated benefits at both institutional and individual levels. International studies have highlighted improvements in the accuracy of records, reductions in duplicated tests, better patient workflow, time and cost efficiency, and overall enhancements in patient care [ 4 – 6 ]. Despite these advantages, the transition to EHR systems is not without challenges. Negative consequences reported include initial disruptions to doctor–patient interactions, increased workload, time-consuming documentation, and a decline in productivity during the early implementation stages. Additionally, data privacy and security remain major concerns [ 7 – 9 ]. Common barriers to effective EHR adoption include insufficient training, poor digital literacy among staff, resistance from senior healthcare professionals, high upfront costs, slow system performance, and weak infrastructure, especially in low-resource environments [ 7 , 8 , 10 – 13 ]. However, implementing EHR in low-income Asian countries faces multiple barriers. Usual challenges include limited technological infrastructure (e.g., unreliable electricity and internet), shortages of skilled healthcare and IT personnel, lack of training, organizational and management difficulties, resistance from healthcare workers, and concerns about data privacy and security [ 14 ]. In Sri Lanka, specific issues such as unreliable internet connectivity, hardware shortages, software limitations, and inadequate user training have also been observed [ 3 , 11 , 12 ]. Recommendations for overcoming these challenges include regular and comprehensive training programs, improving system usability, involving end-users in system design, and developing low-cost, locally appropriate solutions [ 9 , 12 , 15 , 16 ]. Enhancing network infrastructure and addressing interface difficulties are also key to ensuring successful implementation and user satisfaction [ 7 , 8 , 10 , 12 , 17 ]. In Sri Lanka, while earlier EHR initiatives faced limited success, more recent projects such as the Health Information Management System (HHIMS) have led to partial computerization in selected hospitals [ 2 , 3 , 12 , 15 , 18 ]. Sri Lanka’s National STD/AIDS Control Program (NSACP), with support from the Global Fund, implemented EIMS in 2017 to enhance the management of sexually transmitted infections (STIs) and HIV [ 13 , 18 , 19 ]. Initially piloted clinics at Colombo, Kalutara, and Balapitiya, the system was expanded to 23 STD clinics by the end of 2020 [ 18 ]. EIMS now supports a comprehensive range of services from patient registration and diagnosis to treatment, contact tracing, and data reporting [ 5 ]. Various healthcare workers, including Public Health Inspectors (PHIs), nurses, Medical Laboratory Technologists (MLTs), pharmacists, and doctors, use the system in separate phases of patient care [ 5 ]. EIMS has improved clinical data management and enabled the generation of reliable national statistics through the Strategic Information Management (SIM) unit of NSACP [ 5 , 19 ]. As Sri Lanka moves further into digital healthcare, the perception of healthcare staff remains crucial to successful EIMS adoption [ 5 , 6 , 15 , 19 , 20 ]. While an initial study in 2019 explored user experiences at three pilot sites [ 5 ], the current study aims to gather broader insights following the island-wide expansion of EIMS. Still certain STD clinics in Sri Lanka finds it difficult to establish the EIMS and maintaining it due to distinct reasons such as lack of uninterrupted internet connection. Thus, it is important to know the user perception on this EHR system to make it more user friendly. This study evaluates how user perceptions have evolved in response to ongoing training initiatives, increased system familiarity, and enhancements made to EIMS based on early feedback. This study aimed to describe perceptions of health staff on positive and negative impacts, barriers to successful maintenance of EIMS, and areas for further improvement in EIMS in the STD clinics in Sri Lanka. Methods A descriptive cross-sectional study was conducted from October 2020 to March 2023 to examine user perceptions of the Electronic Information Management System (EIMS) across 23 STD clinics in Sri Lanka where the system was established by the end of 2020, including locations such as Colombo, Kalutara, Balapitiya, Avissawella, Matale, Ragama, Gampaha, Negombo, Kurunegala, Galle, Panadura, Hambantota, Jaffna, Mullaitivu, Kilinochchi, Mannar, Batticaloa, Rathnapura, Matara, Vavuniya, Kalubowila, Badulla, Ampara, and Monaragala. Data collection was carried out from April 2022 to July 2022 targeting medical officers, nursing staff, public health inspectors (PHI), Public Health Nursing Sisters (PHNS), medical laboratory technicians (MLT), Public health laboratory technicians (PHLT), and pharmacists/dispensers working in EIMS-established STD clinics who had access to the system. The inclusion criteria required staff to be working in STD clinics with established EIMS facility, while exclusion criteria eliminated healthcare staff without EIMS access or those who had not used the system for at least 2 weeks. Using the standard formula for cross-sectional studies with a 95% confidence interval and 0.05 margin of error, an initial sample size of 384 was calculated, but given the finite population of 271 eligible staff, this was corrected to 158, with a 20% non-response allowance added to reach a final sample size of 189. Stratified random sampling was employed using probability proportionate sampling, recruiting sixty-nine medical officers, forty-two nursing officers, 20 PHIs/PHNSs, 27 MLTs, 21 PHLTs, and nine pharmacists/dispensers from the updated STD clinic staff directory. A well-structured, validated, self-administered questionnaire was newly developed in English and translated into Sinhala and Tamil, with content validity obtained from expert panels including consultant venereologists and community medicine specialists, and face validity confirmed through pretesting. The questionnaire included sections on sociodemographic and occupational data, positive and negative impacts of EIMS on patient care, barriers to successful implementation, and areas needing improvement (supplementary file 1 ). Data collection utilized Google Forms distributed via email, WhatsApp, or Viber based on participant preference, with facilitators identified at each clinic to enhance response rates while maintaining anonymity by not collecting personal identification details. The collected data were automatically summarized and downloaded as Microsoft Excel sheets, processed using Excel software, and then exported to SPSS version 27 for analysis, employing descriptive statistics, frequency tables, bar diagrams, chi-square tests, and Fisher’s exact test for subgroup comparisons. In this study, data cleaning involved removing incomplete responses, specifically excluding six participants who had answered less than 60% of the questionnaire. Ethical approval was obtained from the Ethical Review Committee of the Post Graduate Institute of Medicine, Colombo, with institutional clearance from the National STD/AIDS Control Program Director and permissions from individual clinic consultants, while informed consent was secured through information sheets, voluntary participation was ensured, and confidentiality was maintained through password-protected data storage. A total of 179 staff members responded out of 189 eligible clinic staff who were requested to participate in the study, with ten participants not responding despite three reminders, resulting in a response rate of 94.7%. However, six participants were removed from the study because they had not completed the questionnaire satisfactorily, having answered less than 60% of the questions, leaving 173 participants for the final analysis. Internal consistency analysis revealed that the subscale measuring positive and negative impacts of currently practicing EIMS in patient care consisted of four items with Cronbach’s alpha of 0.583, which was below the acceptable threshold of 0.6, showing unsatisfactory internal consistency. In contrast, the subscale assessing barriers to successful implementation of EIMS in the STD clinic setup consisted of four items with Cronbach’s alpha of 0.607, meeting the minimum threshold of 0.6 and demonstrating satisfactory internal consistency. Results Sociodemographic, education and occupation related characteristics The 173 participants averaged 40.94 years of age (SD = 8.90; range = 25–62), with a median age of 40 years. Women predominated (62.4%), and nearly all respondents were married (90.2%). Sinhala was the native language for most (89.6%), followed by Tamil (9.8%) and English (0.6%). Educational attainment was high: 43.4% held a certificate, technical qualification, or diploma, 34.7% had completed a university degree, and 19.1% owned postgraduate credentials, while only 2.9% reported General Certificate of Education Advanced Level (GCE A/L) as their highest qualification. A little over half (56.6%) had formal information technology training, most commonly a certificate or diploma (42.2%), while 43.4% reported no IT qualification. Doctors constituted the largest professional group (38%), followed by nursing officers (22%), medical laboratory technologists (14%), public-health inspectors or nursing sisters (12%), public-health laboratory technologists (10%), and pharmacists (5%). Participants had worked in STD clinics for an average of 5.1 years (SD = 4.98; range = 0.07–23 years; median = 3.08 years). Roles within the Electronic Information Management System (EIMS) frequently overlapped: the most common functions were STD consultation (36%) and patient registration (30%), with substantial involvement in HIV consultation (27%), bleeding (21%), statistics generation (19%), laboratory MLT (15%), drug dispensing (13%) and laboratory microscopy (10%). Just over one-third (38.4%) had previously used other electronic platforms for a mean of 29 months (SD = 21.5; range = 1–96), and two-thirds (68.8%) had received formal EIMS training, with pharmacists showing the lowest training coverage (50%). (Table 1 ) Table 1. Healthcare worker demographics, qualifications, and roles with EIMS in STD clinics Characteristic Category / Metric n % Age (years) Mean (SD) 40.94 (8.90) — Median (Range) 40 (25–62) — Sex Male 65 37.6 Female 108 62.4 Marital status Married 156 90.2 Never married 15 8.7 Other 2 1.2 Mother language Sinhala 155 89.6 Tamil 17 9.8 English 1 0.6 Educational qualification GCE A/L 5 2.9 Certificate / Diploma 75 43.4 Degree 60 34.7 Postgraduate 33 19.1 IT qualification None 75 43.4 GCE O/L (IT) 7 4 GCE A/L (IT) 7 4 Certificate / Diploma (IT) 73 42.2 Degree (IT) 2 1.2 Other 9 5.2 Designation Doctor 65 38 Nursing officer 38 22 Medical laboratory technologist 24 13.9 PHI / PHNS 20 11.6 Public-health laboratory technologist 17 9.8 Pharmacist 9 5.2 Years of service in STD clinic Mean (SD) 5.10 (4.98) — Median (Range) 3.08 (0.07–23) — EIMS role participation STD consultation 62 35.8 Patient registration 52 30.1 HIV consultation 47 27.2 Bleeding 37 21.4 Statistics generation 33 19.1 Laboratory MLT 26 15 Drug dispensing 22 12.7 Laboratory microscopy 18 10.4 Other 4 2.3 Prior use of other electronic platforms ( N = 172) Yes 66 38.4 No 106 61.6 Mean months ± SD (range) 29 ± 21.5 (1–96) — Received EIMS training ( N = 168) Yes 119 68.8 No 49 32.2 Open in a new tab Positive and negative impacts of EIMS in the STD clinic The study examined four key areas of EIMS’s impact on healthcare delivery in STD clinics. Impact on effective communication showed mixed results, with 61.3% of staff believing EIMS had a positive impact while 27% reported negative effects, and the rest neutral (χ² = 62.23, p < 0.001). Fishers exact test revealed that doctors experienced significantly more negative impacts on patient communication compared to other staff categories. Impact on maintaining confidentiality was overwhelmingly positive, with 81.9% of respondents believing EIMS facilitated confidentiality maintenance, only 7% reporting negative impacts, and 11.1% neutral responses (χ² = 181.72, p < 0.001). However, PHI/PHNS staff showed significantly more concerns about confidentiality maintenance difficulties according to the Fisher’s exact test. Impact on errors in patient care demonstrated positive outcomes, with 68% of staff believing EIMS reduced errors, 8% reporting increased errors, and 24% neutral responses (χ² = 97.65, p < 0.001). No significant differences were found between staff categories for error reduction during separate Fishers exact test analysis between staff categories. Impact on work efficiency showed positive results, with 66.5% reporting improved efficiency, 22.5% decreased efficiency, and 11% neutral responses (χ² = 88.97, p < 0.001). Staff categories showed no significant differences in work efficiency perceptions during separate Fishers exact test analysis between staff categories (Table 2 ). Table 2. Impact of EIMS on health care delivery Impact Domain { N ) Negative Impact Neutral Response Positive Impact Chi-Square p -value Significant Staff Category Differences Effective Communication (173) 27.00% 11.70% 61.30% χ² = 62.23 < 0.001 Doctors perceived significantly more negatively. ( P < 0.001) Maintaining Confidentiality (171) 7.00% 11.10% 81.90% χ² = 181.72 < 0.001 PHI/PHNS perceived significantly more negative. ( P < 0.001) Errors in Patient Care (169) 8.00% 24.00% 68.00% χ² = 97.65 < 0.001 No significant differences ( p = 0.736) Work Efficiency (173) 22.50% 11.00% 66.50% χ² = 88.97 < 0.001 No significant differences ( p = 0.130) Open in a new tab Note. All chi-square tests had degree of freedom (df) = 2. Fisher-Freeman-Halton Exact test was used for staff category comparisons Barriers to the successful maintenance of EIMS in STD clinics The analysis examined six key barriers to Electronic Information Management System (EIMS) usage among healthcare staff across five professional categories. Technical difficulties appeared as the most prevalent barrier, with 96% of 171 respondents experiencing this issue. This stood for a statistically significant finding ( p < 0.001), though no significant differences existed between staff categories. Inadequate facilities affected 53% of 168 respondents, but this proportion was not statistically significant overall ( p = 0.440), and no significant difference was found between staff categories. Computer literacy was adequate, with 88% of 162 respondents reporting sufficient skills. However, Nursing Officers showed significantly lower perceived computer literacy compared to other staff categories ( p = 0.006). Training adequacy was reported by 66.5% of 164 respondents, with significant overall differences ( p < 0.001). Nursing Officers again stood out as having significantly less adequate training compared to other categories ( p = 0.02). English literacy was high across all groups, with 97.6% of 169 respondents reporting adequate skills. However, PHI/PHNS perceived significantly lower English literacy levels compared to other categories ( p = 0.034). Higher workload and inadequate staffing affected 55.4% of 168 respondents, though this was not statistically significant overall ( p = 0.165). However, significant differences existed between staff categories ( p = 0.01), with Pharmacists, PHLT, PHI, and PHNS less likely to perceive this as a barrier compared to other staff groups (Table 3 ). Table 3. Barriers to the successful maintenance of EIMS in STD clinics Barrier ( N ) Percentage experiencing as a barrier Chi square Statistical significance Significant differences between staff categories Technical difficulties (171) 96% χ² = 144.15 p < 0.001 (Chi square test) No ( p = 0.232) (Fisher-Freeman-Halton Exact) Inadequate facilities (168) 53% χ² = 0.59 p = 0.440 (Chi square test) No ( p = 0.340) (Chi square test) Inadequate computer literacy (162) 12% χ² = 91.88 p < 0.001 (Chi square test) Yes ( p = 0.006) (Fisher-Freeman-Halton Exact) More Nursing Officers perceived as a barrier Inadequate training (164) 33.50% χ² = 17.78 p < 0.001 (Chi square test) Yes ( p = 0.02) (Fisher-Freeman-Halton Exact) More Nursing Officers perceived as a barrier Inadequate English literacy (169) 2.40% χ² = 153.388 p < 0.001 (Chi square test) Yes ( p = 0.034) (Fisher-Freeman-Halton Exact) More PHI/PHNS perceived as a barrier Higher workload/Inadequate staff (168) 55.40% χ² = 1.929 p = 0.165 (Chi square test) Yes ( p = 0.01) More Doctors, MLT, Nursing Officers perceived as a barrier (compared to Pharmacists/PHLT/PHI/PHNS) Open in a new tab Note. All chi-square tests had degree of freedom (df) = 1. Fisher-Freeman-Halton Exact test was used for staff category comparisons when the chi square test could not be applied Areas for further improvement in EIMS for STD clinics A detailed analysis of staff feedback finds key areas for improvement in the Electronic Information Management System (EIMS) tailored for STD clinic settings in Sri Lanka. The findings reflect both quantitative survey responses and qualitative suggestions from open-ended questions (Table 4 ). Table 4. Demanded improvements in EIMS Improvement Area N % of Participants System speed 125 76.20% Training 83 50.60% Involving user ideas 76 46.30% Continuous technical support 70 42.70% Onsite support availability 69 42.10% Content improvement 49 29.90% Clinic setup 48 29.30% Format improvement 47 28.70% Open in a new tab Most staff called for improvements in system speed, followed by requests for more training, greater incorporation of user feedback in system modifications, and more direct technical/onsite support Discussion Sociodemographic and education-related characteristics Sri Lanka’s economically active labor force is male (66.7%) [ 21 ]; however, the sample had a female majority (62.4%), reflecting the gender distribution in nursing roles. Most participants were married (90.2%), a higher proportion than the general population [ 21 ], because teenagers and the retired were not included. The majority spoke Sinhala (89.6%), with Tamil (9.8%) and English speakers in the minority, consistent with national language policies [ 22 ]. All participants had, at least, passed the GCE A/L examination. Over half (56.6%) reported IT qualification, a proportion aligned with national trends showing higher computer literacy among those with advanced education [ 17 ]. Occupation-related characteristics Using proportional sampling, the study included representation from all major staff categories of STD clinics island wide. The proportion of doctors within the National STD/AIDS Control Programme in Sri Lanka was higher than that of other staff categories, primarily due to the inclusion of a larger number of postgraduate trainee doctors in the system. Consequently, doctors constituted the largest group in the sample (37.6%), representing a broader proportion compared to previous Sri Lankan studies [ 5 ]. Most staff had not used any electronic record platform other than EIMS (61.3%), and only 68.8% reported having received formal EIMS training, due to irregular training programs. Impacts of EIMS Most staff members felt that EIMS improved communication with patients, except for doctors, who reported that using computers during sensitive consultations could impede the doctor-patient rapport. This underscores the importance of balancing technology use with interpersonal communication skills. Most staff believed EIMS facilitated confidentiality ( p < 0.001), but PHI/PHNS were less convinced ( p = 0.012). While EIMS limits data access to authorized users, earlier reviews cautioned that no EHR system guarantees complete confidentiality [ 23 ]. Staff reports improved data security with EHRs, though international reviews confirm patients stay more concerned than clinicians about confidentiality [ 12 , 24 ]. Respondents reported that EIMS reduced clinical errors ( p < 0.001). Literature supports that EHRs reduce missing data and enable more accurate health record-keeping [ 25 ], but may also introduce new errors, such as incorrect drug selection [ 4 ]. EIMS was broadly seen as improving work efficiency ( p < 0.001), a finding echoed in both Sri Lankan and global studies [ 3 , 12 , 24 ]. However, initial implementation may temporarily reduce productivity. Barriers to successful maintenance of EIMS A large majority (95.9%) met technical issues ( p < 0.001), especially slow connectivity. No significant differences between staff categories ( p = 0.232), indicating technical difficulties affect all staff equally regardless of role. This is higher than reported at EIMS implementation [ 5 ] and is commonly cited in international literature as a barrier [ 12 , 24 ]. Over half (52.9%) cited insufficient facilities (e.g., space, hardware, equipment), a figure much higher than earlier studies [ 5 ]. No significant differences between staff categories ( p = 0.340), showing this barrier is uniformly perceived across different healthcare roles. This issue is well-documented in both local and global literature as a primary challenge for EHR maintenance [ 2 , 8 , 26 ]. Most staff felt computer literacy was adequate, though nursing officers lagged significantly behind ( p = 0.006), consistent with findings that technical skills are crucial for EHR success [ 8 ]. English literacy was adequate for most, but PHI/PHNS expressed concerns. English proficiency varies across different staff categories, affecting ease of training and system use since manuals are in English. Staff with limited English skills might be less confident or disengaged during training, reducing training effectiveness. Lack of Training: Two-thirds reported adequate training ( p < 0.001), but nursing officers were again less likely to be adequately trained ( p = 0.02). Training gaps were more pronounced than in 2019 [ 5 ]. Sustained and role-specific training programs are essential for successful EHR implementation, as shown in Sri Lanka and internationally [ 2 , 8 ]. While 55.4% cited high workload and inadequate staff as barriers, this was not universally significant. Pharmacists, PHLT, PHI, and PHNS were less likely to view this as a barrier. Literature notes that inadequate staffing can be a critical barrier [ 8 ]. Areas for further improvement The majority (76%) advocated for improved system speed. Participants also highlighted the need for better internet connectivity, backup power, and enhanced system content and format. Half of the respondents (50.6%) requested further training, with suggestions for longer, role-specific training and self-learning resources. Almost half wanted more user involvement in system development and recommended ongoing onsite and technical support. These findings align with both current and earlier implementation-phase studies in Sri Lanka and the global evidence on EHR improvement priorities [ 3 , 5 ]. Limitations of the study Only staff with access to EIMS and a minimum of 2 weeks’ usage were included. Clinics not yet established with EIMS, or staff early in the onboarding process, were excluded, potentially omitting both critical implementation-phase challenges and the experiences of the least experienced users. While a finite population correction was applied to determine the sample size, the final study population was smaller than the initially calculated ideal sample, which can restrict the statistical power for subgroup analyses. Six respondents were excluded for incomplete questionnaires (answered less than 60% of items), reducing the final sample to 173. This can introduce bias if non-responders or partial responders differed systematically from those included. Stratified random sampling ensured broad staff representation, but pharmacists/dispensers and PHLT were underrepresented. Larger studies are needed to better assess these groups’ perceptions. The scale used to assess positive and negative impacts of EIMS had an alpha coefficient of 0.583, showing less-than-ideal internal consistency. The low internal consistency can limit confidence in the interpretation of results from this section, as measurement error or item heterogeneity may bias or obscure associations. Caution is warranted when interpreting findings regarding the positive and negative impacts reported by healthcare workers, as the assessment might not be fully consistent or comprehensive. Though the literature survey revealed the senior health care professionals are reluctant to use electronic health record systems, this study did not study the seniority level as a barrier. The study focused solely on healthcare providers’ perspectives, not those of patients/clients. Findings are specific to the EIMS in STD clinics and may not apply to inpatient settings or other EHR systems indicating limited generalizability of the findings. Only staff with access to EIMS and a minimum of 2 weeks’ usage were included. Clinics not yet established with EIMS, or staff early in the onboarding process, were excluded—potentially omitting both critical implementation-phase challenges and the experiences of the least experienced users. Conclusions and recommendations There was a significant overlap in job roles due to staffing shortages, and most staff were new to electronic health record (EHR) systems. Most healthcare providers perceived that EIMS positively affects communication and confidentiality, reduces errors, and improves work efficiency. However, doctors felt EIMS hindered effective doctor-patient communication, and PHIs/PHNS felt it compromised patient data confidentiality. The main barrier to EIMS use was technical difficulties. Most staff reported adequate computer literacy, training, and English proficiency, but nursing officers are not satisfied with their computer skills and training, and PHIs/PHNS had concerns about their English literacy. The most requested improvements were faster system speed and more training. Steps need to be taken to enhance doctor-patient communication while using the computer. Computer proficiency needs to be improved through targeted training, especially for nursing officers. Building trust through privacy protections for data is necessary to improve confidentiality concerns among PHIs. Providing adequate infrastructure and ensuring fast, reliable internet connection is strongly recommended to overcome technical barriers to use EIMS. It Is necessary to consider user feedback in future EIMS updates, offer continuous technical support, and have onsite technical aid available. Conduct further research on patient/client perceptions of EIMS use. It is crucial to conduct similar cross-sectional studies involving healthcare workers from a range of settings including inpatient wards, outpatient departments, primary care clinics, and specialized hospital units. This would capture the diversity of roles, workflows, and information needs outside STD clinics. Supplementary Information Below is the link to the electronic supplementary material. Supplementary Material 1 (20.9KB, docx) Supplementary Material 2 (34.5KB, xlsx) Acknowledgements Not applicable. Abbreviations EHR Electronic health record EIMS Electronic information management system STD Sexually transmitted disease STI Sexually transmitted infection HIV Human immunodeficiency virus NSACP National STDAIDS control programme PHI Public health inspector PHN Public health nurse MLT Medical laboratory technologist PHLT Public health laboratory technologist GCE AL General certificate of education advanced level IT Information technology SIM Strategic information management MOH Medical officer of health Biographies Hewa Annakkalage Dilanka Prabharshinee Nimalrathna is a Senior Registrar in Sexual Health and HIV Medicine at the National STD/AIDS Control Programme, Sri Lanka. With over six years of clinical experience, she specializes in HIV treatment, STI management and HIV/STI prevention. Airyaratne Manathunge is a Consultant Venereologist at the National STD/AIDS Control Programme, Sri Lanka. With extensive clinical experience, he specializes in HIV treatment, STI management, and HIV/STI prevention. Author contributions HADP Nimalrathna conceptualized and designed the study, collected and analyzed data, and drafted the manuscript. KAM Ariyaratne provided supervision and critical revision of the manuscript. All authors read and approved of the final manuscript. Funding This study was self-funded and did not receive any funding. Data availability All data generated or analysed during this study are included in this published article [and its supplementary information files]. Declarations Ethics approval and consent to participate This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethics Review Committee of the Postgraduate Institute of Medicine, University of Colombo, Sri Lanka (Reference number: ERC/PGIM/2021/063). Institutional clearance was granted by the National STD/AIDS Control Programme. All participants provided informed consent electronically prior to data collection, and confidentiality was maintained by ensuring anonymized and password-protected data storage. Consent for publications All participants provided informed written consent for the study before participating in the study. This study publication does not contain individual participant data, thus consent for publication is not applicable. Authors' information H.A.D.P. Nimalrathna, MBBS (Colombo), Diploma in Venereology (Sri Lanka), MD in venereology (Sri Lanka), Senior Registrar in the National STD AIDS Control Program, Colombo, Sri Lanka. K.A.M. Ariyaratne, MBBS (Colombo), MSc in community medicine (Sri Lanka), MD in venereology (Sri Lanka), Consultant venereologist, National STD AIDS Control Program, Colombo, Sri Lanka. Competing interests The authors declare no competing interests. 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