The MoH requires that ART sites that have adopted the EMR system also continue to run paper-based systems to serve as backup in the eventuality of EMR system failures. EMR data are fi rst backed up on the server at the health facility where the system is running and at an off-site central server on a daily basis. Case registration and information on ART outcomes generated through printouts of master card data in the form of adhesive labels from the EMR are manually transcribed by clinic staff into the paper-based register. The ART supervision team observed that there were differences in the data that were transferred and reported using the paper-based system as compared to the EMR. As national reporting and drug forecasting depends on the EMR, inaccuracies in the paper-based system in case of EMR failure could have important programmatic implications, such as incorrect drug forecasting.Our objective was to assess the extent of inaccuracies in the transcription of case registration and recorded deaths between the EMR and the paper-based data system. METHODS Design, study setting and populationWe conducted a retrospective audit of routine programme data at fi ve ART sites in the central and southern regions of Malawi. These ART sites included three district hospitals (Dedza, Ntcheu and Salima), one mission hospital (St Gabriel's Mission Hospital) and one central hospital (Queen Elizabeth Central Hospital [QECH]). The district hospitals each have two nurses, a clinician and two clerks. They typically attend to more than 200 patients on a clinic day, and their ART registers currently have more than 3000 patients each. QECH has four nurses, three clinical offi cers and two clerks, who attend to more than 400 patients per day; their ART register has more than 10 000 patients. St Gabriel's Mission Hospital has three nurses, two clinicians and one clerk, who see more than 100 patients a day; their ART register includes more than 200 patients. These sites were chosen as they were among the fi rst sites to start ART in Malawi, had high case loads and were among the fi rst to implement the EMR. All these fi ve sites also run paper-based register systems.All patients enrolled in the ART programme up to 31 December 2010 at these fi ve ART sites were included in the study. A review of the paper registers was conducted at all fi ve health facilities between January and February 2011. Interna onal Union Against Tuberculosis and Lung DiseaseHealth solu ons for the poor Setting: Antiretroviral treatment (ART) clinics at one central hospital, three district hospitals and one mission hospital in the central and southern regions of Malawi. Objective: To measure the extent of inaccuracies in the transcription of case registration and recorded deaths between electronic medical data (EMR) and paper registers. This was done to inform the Ministry of Health on the reliability of the paper-based system as backup in case of EMR failure. Design: Retrospective analysis of routine programme data.Results: A total of 31 763 registrations and 2...