Electronic Medical Record in developing country (2)
Potential benefits of Electronic Medical Records systems in developing countries
Although Electronic Medical Records systems have been shown to be feasible in developing countries, the problem of limited resources begs several questions. Do Electronic Medical Records systems contribute important benefits to healthcare projects? Is this use of information technology (IT) practical beyond a few well-funded pilot sites? Does it have a beneficial impact on patient care or the management of such healthcare organisations? What lessons can we pass on to other healthcare organisations to help them identify the most effective and sustainable technologies for Electronic Medical Records systems in these environments?
Rapid developments in IT have greatly reduced the costs of setting up information systems. Plans have recently been announced to develop a laptop PC for $100.16 Internet access is now relatively widely available in many developing countries (Peru, Ghana, etc.) and there exists a broad range of robust and flexible devices to manage data, including personal digital assistants (PDAs) and mobile phones.
In developing countries, healthcare information systems have been driven mainly by the need to report aggregate statistics for government or funding agencies.
Such data collection can be performed with simple paper forms at the clinic level, with all electronic data entry done centrally, but that approach tends to be difficult and time-consuming and may provide little or no feedback to the staff collecting data. Individual patient data that are collected and accessible at the point of care can support clinical management.
Clinicians can easily access previous records, and simple tools can be incorporated to warn of potential problems such as incompatible drugs. Physicians or nurses can check on the outcomes of individuals or groups of patients and perform research studies. Many of these functions will work well on paper or with simple spreadsheets for up to 100 patients but become very time-consuming and potentially unreliable with more than 1000 records, and virtually impossible with 10 000 or more.
Networked Electronic Medical Records systems allow laboratory data to be entered from distant sites, assisting prompt and effective patient management. Access to email or web communications allows staff to seek specialist advice from remote physicians. Assessing resource requirements and preventing drug stock shortages, while not normally a consideration for medical staff in developed countries, can be a critical issue in the developing world. It requires an accurate knowledge of numbers of patients with particular regimens or types of disease and knowledge of drug stocks and supply. Electronic Medical Records systems can also be used to track patient outcomes, compliance with therapy and to record surgical procedures. Finally, point-of-care data can be used to rapidly generate aggregate reports, which should be more complete and accurate because users will more likely recognise errors regarding their own patients. Incorporating multiple functions into the same information system allows reuse of data and should help to justify the basic costs of set-up and technical support. For example, in sites with no modern communications, a satellite internet connection might be justified purely to allow regular communication by email and possibly internet telephony. The benefits of web access for data management and medical education are additional.
summarises the benefits of Electronic Medical Records systems.
HSF Fraser, P Biondich, D Moodley et al
Although Electronic Medical Records systems have been shown to be feasible in developing countries, the problem of limited resources begs several questions. Do Electronic Medical Records systems contribute important benefits to healthcare projects? Is this use of information technology (IT) practical beyond a few well-funded pilot sites? Does it have a beneficial impact on patient care or the management of such healthcare organisations? What lessons can we pass on to other healthcare organisations to help them identify the most effective and sustainable technologies for Electronic Medical Records systems in these environments?
Rapid developments in IT have greatly reduced the costs of setting up information systems. Plans have recently been announced to develop a laptop PC for $100.16 Internet access is now relatively widely available in many developing countries (Peru, Ghana, etc.) and there exists a broad range of robust and flexible devices to manage data, including personal digital assistants (PDAs) and mobile phones.
In developing countries, healthcare information systems have been driven mainly by the need to report aggregate statistics for government or funding agencies.
Such data collection can be performed with simple paper forms at the clinic level, with all electronic data entry done centrally, but that approach tends to be difficult and time-consuming and may provide little or no feedback to the staff collecting data. Individual patient data that are collected and accessible at the point of care can support clinical management.
Clinicians can easily access previous records, and simple tools can be incorporated to warn of potential problems such as incompatible drugs. Physicians or nurses can check on the outcomes of individuals or groups of patients and perform research studies. Many of these functions will work well on paper or with simple spreadsheets for up to 100 patients but become very time-consuming and potentially unreliable with more than 1000 records, and virtually impossible with 10 000 or more.
Networked Electronic Medical Records systems allow laboratory data to be entered from distant sites, assisting prompt and effective patient management. Access to email or web communications allows staff to seek specialist advice from remote physicians. Assessing resource requirements and preventing drug stock shortages, while not normally a consideration for medical staff in developed countries, can be a critical issue in the developing world. It requires an accurate knowledge of numbers of patients with particular regimens or types of disease and knowledge of drug stocks and supply. Electronic Medical Records systems can also be used to track patient outcomes, compliance with therapy and to record surgical procedures. Finally, point-of-care data can be used to rapidly generate aggregate reports, which should be more complete and accurate because users will more likely recognise errors regarding their own patients. Incorporating multiple functions into the same information system allows reuse of data and should help to justify the basic costs of set-up and technical support. For example, in sites with no modern communications, a satellite internet connection might be justified purely to allow regular communication by email and possibly internet telephony. The benefits of web access for data management and medical education are additional.
summarises the benefits of Electronic Medical Records systems.
- Improvement in legibility of clinical notes
- Decision support for drug ordering, including allergy warnings and drug incompatibilities
- Reminders to prescribe drugs and administer vaccines
- Warnings for abnormal laboratory results
- Support for programme monitoring, including reporting outcomes, budgets and supplies
- Support for clinical research
- Management of chronic diseases such as diabetes,hypertension and heart failure
HSF Fraser, P Biondich, D Moodley et al
