Cloud-based Electronic Health Records (Ehr) Adoption Rate in Nigeria: Barriers and Performance Bottlenecks

Background: Cloud-Based Electronic Health Records (EHRs) are critical to the enhancement of the quality of healthcare, healthcare continuity, and the efficiency of the system. Adoption of them is still low and uneven in Nigeria and other low and middle-income countries (LMICs). There is limited empirical data on the level of adoption, system performance, and the bottlenecks in the implementation process of the systems within the facilities of the healthcare sector in Nigeria. Methods: Primary and secondary data were used in carrying out an exploratory mixed-methods study. The primary data were gathered through an online survey of 26 healthcare facilities operating in 11 states of Nigeria in the period between January and March 2025. A collection of secondary institutional data from 130 facilities comprised records of vendor deployment, government and regulatory reports, hospital web pages, and the peer-reviewed literature, were also used. Quantitative data were undertaken through descriptive statistics and chi-square tests, whereas qualitative responses were undertaken thematically. Pareto analysis, radar charts, box plots, and Ishikawa diagrams were systems-engineering tools that were used to determine significant bottlenecks in performance. Results: The primary survey found that only 23% of the facilities were fully electronic EHR systems, 42% were hybrid systems, and 35% could only use paper-based records. The reported digital implementation (75%), as shown through secondary data, had more reported implementation, but operational maturity was not in line with the institutional claims of implementation. The uptake of the EHR also grew beyond 2019, especially in tertiary and specialist institutions. Approximately 90% of performance bottlenecks that were reported included power instability (76.9%), high implementation costs (69.2%), and poor IT infrastructure (65.4%). The infrastructure reliability score of power (2.3/10) and internet connectivity (3.5/10) was low. System reliability was polarized, with 53.8 percent saying they had rare or no failures and 15.4 percent saying they had daily failures. Staff overall satisfaction was high (57.7%), which was low due to infrastructural constraints. Conclusions: The use of cloud-based EHR in Nigeria is still in the process of transition and its implementation is limited by insufficient underlying infrastructure and not by the resistance of users.