Evaluating a scalable model for implementing electronic health records in resource-limited settings

Abstract

Current models for implementing electronic health records (EHRs) in resource-limited settings may not be scalable because they fail to address human-resource and cost constraints. This paper describes an implementation model which relies on shared responsibility between local sites and an external three-pronged support infrastructure consisting of: (1) a national technical expertise center, (2) an implementer's community, and (3) a developer's community. This model was used to implement an open-source EHR in three Ugandan HIV-clinics. Pre-post time-motion study at one site revealed that Primary Care Providers spent a third less time in direct and indirect care of patients (p<0.001) and 40% more time on personal activities (p=0.09) after EHRs implementation. Time spent by previously enrolled patients with non-clinician staff fell by half (p=0.004) and with pharmacy by 63% (p<0.001). Surveyed providers were highly satisfied with the EHRs and its support infrastructure. This model offers a viable approach for broadly implementing EHRs in resource-limited settings.

Implementation of a cloud-based electronic medical record for maternal and child health in rural Kenya

“…[8][9][10][11]] EMR system implementation is also particularly amenable to maternal and child health, in which the pregnant mother must follow a continuum of care, starting with routine antenatal visits until delivery and then through postnatal and neonatal follow-up, including provision of routine immunisation.…”

“…[13,14] Traditional models of EMR implementation have installed local systems infrastructure, such as a server and network in each clinic, which can be costly to implement and maintain [9], and which require specialised human resources.…”

“…[9] In this study, we describe the implementation of a novel cloud-based EMR system for maternal and child health in Western Kenya, its impact on completeness of the antenatal record and implications for shared maternity care in resource-constrained settings.…”

Practices to improve identification of adult antiretroviral therapy failure at the Lighthouse Trust clinic in Lilongwe, Malawi

“…Innovation in screening protocols and technological advances in EMR hold promise for improving care (Were et al 2010). The Lighthouse Trust EMR is versatile and can determine percentage adherence and missed pills, generate weight trends graphically as a component of the ART clinic visit, and create lists of patients who have missed treatment visits (Douglas et al 2010; Keiser et al 2010; Weigel et al 2010).…”

Development and Implementation of Stre@mline, a Locally Developed Electronic Health Platform in Uganda (Preprint)

“…High initial costs associated with computer purchase and infrastructure setup is a critical barrier [8]. However, this can at least be partially mitigated by the potential cost-saving from reductions in record keeping costs [9] and significantly improved staff efficiency [10]. Arguably the most critical challenge to to the success of existing EHR systems is the lack of involvement of local staff in the design and testing of systems to ensure they are designed according to local needs and workflows.…”