Viewpoint: A Pragmatic Approach to Constructing a Minimum Data Set for Care of Patients with HIV in Developing Countries

Providing quality health care requires access to continuous patient data that developing countries often lack. A panel of medical informatics specialists, clinical human immunodeficiency virus (HIV) specialists, and program managers suggests a minimum data set for supporting the management and monitoring of patients with HIV and their care programs in developing countries. The proposed minimum data set consists of data for registration and scheduling, monitoring and improving practice management, and describing clinical encounters and clinical care. Data should be numeric or coded using standard definitions and minimal free text. To enhance accuracy, efficiency, and availability, data should be recorded electronically by those generating them. Data elements must be sufficiently detailed to support clinical algorithms/guidelines and aggregation into broader categories for consumption by higher level users (e.g., national and international health care agencies). The proposed minimum data set will evolve over time as funding increases, care protocols change, and additional tests and treatments become available for HIV-infected patients in developing countrie

Implementing electronic medical record systems in developing countries

The developing world faces a series of health crises including HIV/AIDS and tuberculosis that threaten the lives of millions of people. Lack of infrastructure and trained, experienced staff are considered important barriers to scaling up treatment for these diseases. In this paper we explain why information systems are important in many healthcare projects in the developing world. We discuss pilot projects demonstrating that such systems are possible and can expand to manage hundreds of thousands of patients. We also pass on the most important practical lessons in design and implementation from our experience in doing this work. Finally, we discuss the importance of collaboration between projects in the development of electronic medical record systems rather than reinventing systems in isolation, and the use of open standards and open source software

The Implementation of an Open Source Electronic Medical Record at a Faith-Based Community Clinic

Faith-based nursing and healthcare is increasingly gaining popularity as the industry looks to minimize costs and improve health outcomes. Historically, qualitative studies have not shown the extent to which individuals and communities are impacted by health initiatives initiated by faith institutions. Healthcare technology can help support the specialty by providing increased quantity and quality data to analyze. Traditional, proprietary EMRs are too costly; however, open source systems offer a low cost, and easily modifiable option to non-profit, or smaller organizations. The data collected by an open source system allows organizations to improve the care that patients receive, and helps guide screening and preventative health efforts, contributing to the quantitative research available to show the impact of faith-based healthcare on patients and communities

Improving Health Care in Low- and Middle-Income Countries

This open access book is a collection of 12 case studies capturing decades of experience improving health care and outcomes in low- and middle-income countries. Each case study is written by healthcare managers and providers who have implemented health improvement projects using quality improvement methodology, with analysis from global health experts on the practical application of improvement methods. The book shows how frontline providers in health and social services can identify gaps in care, propose changes to address those gaps, and test the effectiveness of their changes in order to improve health processes and outcomes. The chapters feature cases that provide real-life examples of the challenges, solutions, and benefits of improving healthcare quality and clearly demonstrate for readers what quality improvement looks like in practice: Addressing Behavior Change in Maternal, Neonatal, and Child Health with Quality Improvement and Collaborative Learning Methods in Guatemala Haiti’s National HIV Quality Management Program and the Implementation of an Electronic Medical Record to Drive Improvement in Patient Care Scaling Up a Quality Improvement Initiative: Lessons from Chamba District, India Promoting Rational Use of Antibiotics in the Kyrgyz Republic Strengthening Services for Most Vulnerable Children through Quality Improvement Approaches in a Community Setting: The Case of Bagamoyo District, Tanzania Improving HIV Counselling and Testing in Tuberculosis Service Delivery in Ukraine: Profile of a Pilot Quality Improvement Team and Its Scale‐Up Journey Improving Health Care in Low- and Middle-Income Countries: A Case Book will find an engaged audience among healthcare providers and administrators implementing and managing improvement projects at Ministries of Health in low- to middle-income countries. The book also aims to be a useful reference for government donor agencies, their implementing partners, and other high-level decision makers, and can be used as a course text in schools of public health, public policy, medicine, and development. ACKNOWLEDGMENT: This work was conducted under the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, USAID Award No. AID-OAA-A-12-00101, which is made possible by the generous support of the American people through the U.S. Agency for International Development (USAID). DISCLAIMER: The contents of this book are the sole responsibility of the Editor(s) and do not necessarily reflect the views of USAID or the United States Government. Presents real-life case studies, from all levels of the healthcare system and addressing a wide range of health topics, to teach readers about using quality improvement methodology to strengthen health care in lower- and middle-income countries Teaches readers about the process of designing improvement efforts, choosing priorities, carrying out activities, understanding results, building health worker capacity to improve care, engaging leadership, and applying lessons learned from improvement to spread and scale-up initiatives Provides rich detail on how improvement work is applied in practice rather than focusing on methodologies and theory Includes expert commentaries and analysis to guide the reader in understanding results on key issues and themes in designing, supporting, and scaling up improvement Open acces

Describing Documentation of Electronic Health Records (EHR) in Anti-Retroviral Therapy (ART) Clinics to Improve Data Quality for Healthcare Processes in Malawi

In healthcare, documentation deals with recording of significant patient encounters within a healthcare information system. Documentation has evolved from paper-based tools to electronic means such as Electronic Health Record (EHR) systems. The EHR may optimize healthcare processes by facilitating communication, offering decision support, and allocating and distributing resources to health facilities for patient care. Faced with the Human Immunodeficiency Viruses that leads to the Acquired ImmunoDeficiency Syndrome (HIV/AIDS) pandemic, Malawi has embraced an EHR for its Anti-Retroviral Therapy (ART) clinics since 2006. The 90-90-90 HIV/AIDS eradication strategy which Malawi adopted with the leadership of the World Health Organization (WHO) United Nations against AIDS (UNAIDS) may benefit from this EHR. In this initiative, identification and enrollment of HIV positive clients into ART clinics is essential for viral load suppression. The EHR benefits rely on good data quality, which has been lacking in Low-Income Countries (LICs) including Malawi. Although data quality has many definitions, a widely accepted concept is “data quality is fit for purpose.” This concept has not been used in many data quality assessments, particularly in LICs. I asked the following research question: How can the varying purposes of EHR data use for different stakeholders inform interventions for EHR data quality improvement? I had the following research aims: • To understand the importance of data quality characteristics in the context of EHR stakeholders’ purposes of data use • To conduct a data quality assessment and understand the drivers of the observed data quality I conducted this research at primary, secondary and tertiary level ART clinics that manage over 200 patients a day in Malawi. My study used an observational study design with mixed methods. I conducted semi-structured interviews with 34 stakeholders comprised of nurses and clinicians as well as public health officials and donors who support the EHR. Additionally, I assessed 160,647 patient records that had 549,826 visits across 10 different health facilities, extracted from existing EHR data. My work established that stakeholders have clinical facing purposes or administrative purposes of data use. Stakeholders with clinical facing purposes of data use expected their data to be plausible. On the other hand, stakeholders with administrative purposes of data use expected completeness first. I found variation in the observed proportions of the data quality characteristics of completeness and plausibility. Completeness ranged from 5% to 99% while plausibility ranged from 40% to 99% across variables essential to the 90-90-90 initiative. After integrating my qualitative and quantitative results, some results indicated agreement or convergence between different sources of information about data quality. Data quality was high for the preferred characteristic of plausibility for patient health tracking. Conversely, there were divergent results between findings in my first and second aims for data management and use. For this purpose of data use, I found that plausibility was highly prioritized by participants, but in the data assessment, I found that only 40% of the records were plausible. The recommendations that follow from my work regarding interventions to improve data quality include: • Consider priorities based on importance of specific data quality characteristics for different stakeholder purposes of data use. • Assess observed data quality proportions after conducting a quantitative data quality assessment to identify where interventions should first be implemented in relation with expected stakeholder data characteristics and purposes of data use.PHDHlth Infrastr & Lrng Systs PhDUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/168001/1/ojgadabu_1.pd

Engineering an EMR System in the Developing WorldNecessity is the Mother of Invention

While Electronic Medical Record (EMR) systems continue to improve the efficacy of healthcare delivery in the West, they have yet to be widely deployed in the developing world, where more than 90% of the global disease burden exists. The benefits afforded by an EMR notwithstanding, there is some skepticism regarding the feasibility of operationalizing an EMR system in a low-resource setting. This dissertation challenges these preconceptions and advances the understanding of the problems faced when implementing EMR systems to support healthcare delivery in a developing-world setting.Our methodology relies primarily on eight years of in-field experimentation and study. To facilitate a better understanding of the needs and challenges, we created a pilot system in a large government central hospital in Malawi, Africa. Learning from the pilot we developed and operationalized a point-of-care EMR system for managing the care and treatment of patients receiving antiretroviral therapy, which we put forth as a demonstration of feasibility in a developing-world setting.The pilot identified many unique challenges of healthcare delivery in the developing world, and reinforced the need to engineer solutions from scratch rather than blindly transplant systems developed in and for the West. Three novel technologies were developed over the course of our study, the most significant of which is the touchscreen clinical workstation appliance. Each of the novel technologies and their contribution towards successful implementation are described in the context of both an engineering and a risk management framework. A small comparative study to address data quality concerns associated with a point-of-care approach concluded that there was no significant difference in the accuracy of data collected through the use of a prototype point-of-care system compared to that of data entered retrospectively from paper records. We conclude by noting that while feasibility has been demonstrated the greatest challenge to sustainability is the lack of financial resources to monitor and support EMR systems once in place

Evaluation of IDRC-supported eHealth projects : final report

This report provides an in-depth account of the evaluation findings and recommendations for the next five years of IDRC’s eHealth programming. The quantitative and qualitative assessment covered 25 projects representing activities in 25 countries in Africa, Asia, and Latin America and the Caribbean (LAC) of which approximately 50% have been completed and 50% remain on-going ranging in scope from $30,000 -$2,422,652. The total dollar value of the projects included in this evaluation is approximately $17 million CAD. To complement the evaluation a targeted literature review of eHealth, a series of Lessons Learned Workshops with grantees and IDRC staff, and key informant interviews with internal and external stakeholders were conducted..