Electronic Medical Record in developing country (1)
Introduction
The developing world currently faces a series of health crises that threaten the lives of millions of people. Many of the worst-affected developing countries lack resources and robust healthcare infrastructures.
Recent statistics suggest that treating the rising tide of human immunodeficiency virus (HIV) in developing countries requires that large-scale interventions are immediately put into place, and ambitious worldwide initiatives such as the Global Fund and the World Health Organization (WHO) 3 by 5 Initiative have begun to mobilise resources and manpower in response.
Early lessons from treatment programmer indicate that new systems of care are required to allow these efforts to scale rapidly to thousands or even hundreds of thousands of patients. Programmer must also support healthcare providers, many of whom have limited training. To achieve these ends requires the ability to manage large and often complex projects, including the initiation of new treatments, the followup and monitoring of chronic diseases, medication procurement, and reporting to governments and funders. Research must also occur concurrently with these efforts, as the pathophysiology of these diseases is not fully understood in these environments, and continues to change in response to our interventions.
Many of these goals require excellent information management in order to be successful. Concerns have been expressed that the lack of infrastructure and skills in developing countries will prevent large-scale treatment of such diseases as HIV and multi-drug-resistant tuberculosis (MDR-TB). While HIV, TB and malaria are the best known, other important problems must be addressed, including maternal and infant mortality, other infectious diseases, trauma, and rising levels of hypertension, diabetes and cardiovascular disease in developing countries.
Growing use of electronic medical record (EMR) systems in Europe and the United States (US) has been driven by the belief that these systems can help to improve the quality of health care. Decision support systems, particularly for drug order entry, are becoming important tools in reducing medical errors. Email is important and widely used in healthcare systems, and access to medical data including online journals is expanding.
Even in resource-rich nations, the development of electronic medical record (EMR) systems is still an uncertain and challenging task, calling for a sensitive matching of local needs to available technologies and resources. Experience with creating electronic medical record (EMR) systems for the developing world is much more scarce; requirements, priorities and local constraints are less well understood and probably more heterogeneous.
Some settings in the developing world are similar to a European or US healthcare environment and can use similar software; other environments have very limited resources. It is impossible, therefore, to suggest a single electronic medical record (EMR) systems architecture and implementation that will fit all environments and needs. In this paper we focus on systems that can support health care in the very challenging impoverished environments where the vast majority of the world’s population live. A handful of projects in developing countries have now met the test of actual implementation in such settings and are in day-to-day use.
We first discuss the potential benefits of electronic medical record (EMR) systems in developing countries and then present short descriptions of several systems with which we are familiar that are in regular use.We then provide a taxonomy of system architectures and technology choices and comment on their applicability in particular kinds of environments, drawing on our practical experiences and the examples of deployed systems.We also present a number of challenging issues including reliable patient identification, data quality management, and data confidentiality and security. Finally, we conclude with mostly non-technical lessons learned from experience in successfully deploying systems.
This is intended as a practical guide for deploying and using electronic medical record (EMR) systems in developing countries rather than a review of all existing projects. Unfortunately few systems have been described in the literature and fewer evaluated, but a systematic review of such systems was published in 2002. (continue..)
HSF Fraser, P Biondich, D Moodley et al
The developing world currently faces a series of health crises that threaten the lives of millions of people. Many of the worst-affected developing countries lack resources and robust healthcare infrastructures.
Recent statistics suggest that treating the rising tide of human immunodeficiency virus (HIV) in developing countries requires that large-scale interventions are immediately put into place, and ambitious worldwide initiatives such as the Global Fund and the World Health Organization (WHO) 3 by 5 Initiative have begun to mobilise resources and manpower in response.
Early lessons from treatment programmer indicate that new systems of care are required to allow these efforts to scale rapidly to thousands or even hundreds of thousands of patients. Programmer must also support healthcare providers, many of whom have limited training. To achieve these ends requires the ability to manage large and often complex projects, including the initiation of new treatments, the followup and monitoring of chronic diseases, medication procurement, and reporting to governments and funders. Research must also occur concurrently with these efforts, as the pathophysiology of these diseases is not fully understood in these environments, and continues to change in response to our interventions.
Many of these goals require excellent information management in order to be successful. Concerns have been expressed that the lack of infrastructure and skills in developing countries will prevent large-scale treatment of such diseases as HIV and multi-drug-resistant tuberculosis (MDR-TB). While HIV, TB and malaria are the best known, other important problems must be addressed, including maternal and infant mortality, other infectious diseases, trauma, and rising levels of hypertension, diabetes and cardiovascular disease in developing countries.
Growing use of electronic medical record (EMR) systems in Europe and the United States (US) has been driven by the belief that these systems can help to improve the quality of health care. Decision support systems, particularly for drug order entry, are becoming important tools in reducing medical errors. Email is important and widely used in healthcare systems, and access to medical data including online journals is expanding.
Even in resource-rich nations, the development of electronic medical record (EMR) systems is still an uncertain and challenging task, calling for a sensitive matching of local needs to available technologies and resources. Experience with creating electronic medical record (EMR) systems for the developing world is much more scarce; requirements, priorities and local constraints are less well understood and probably more heterogeneous.
Some settings in the developing world are similar to a European or US healthcare environment and can use similar software; other environments have very limited resources. It is impossible, therefore, to suggest a single electronic medical record (EMR) systems architecture and implementation that will fit all environments and needs. In this paper we focus on systems that can support health care in the very challenging impoverished environments where the vast majority of the world’s population live. A handful of projects in developing countries have now met the test of actual implementation in such settings and are in day-to-day use.
We first discuss the potential benefits of electronic medical record (EMR) systems in developing countries and then present short descriptions of several systems with which we are familiar that are in regular use.We then provide a taxonomy of system architectures and technology choices and comment on their applicability in particular kinds of environments, drawing on our practical experiences and the examples of deployed systems.We also present a number of challenging issues including reliable patient identification, data quality management, and data confidentiality and security. Finally, we conclude with mostly non-technical lessons learned from experience in successfully deploying systems.
This is intended as a practical guide for deploying and using electronic medical record (EMR) systems in developing countries rather than a review of all existing projects. Unfortunately few systems have been described in the literature and fewer evaluated, but a systematic review of such systems was published in 2002. (continue..)
HSF Fraser, P Biondich, D Moodley et al
