Open source challenges for hospital information system (HIS) in developing countries: a pilot project in Mali

<p>Abstract</p> <p>Background</p> <p>We are currently witnessing a significant increase in use of Open Source tools in the field of health. Our study aims to research the potential of these software packages for developing countries. Our experiment was conducted at the Centre Hospitalier Mere Enfant in Mali.</p> <p>Methods</p> <p>After reviewing several Open Source tools in the field of hospital information systems, Mediboard software was chosen for our study. To ensure the completeness of Mediboard in relation to the functionality required for a hospital information system, its features were compared to those of a well-defined comprehensive record management tool set up at the University Hospital "La Timone" of Marseilles in France. It was then installed on two Linux servers: a first server for testing and validation of different modules, and a second one for the deployed full implementation. After several months of use, we have evaluated the usability aspects of the system including feedback from end-users through a questionnaire.</p> <p>Results</p> <p>Initial results showed the potential of Open Source in the field of health IT for developing countries like Mali.</p> <p>Five main modules have been fully implemented: patient administrative and medical records management of hospital activities, tracking of practitioners' activities, infrastructure management and the billing system. This last component of the system has been fully developed by the local Mali team.</p> <p>The evaluation showed that the system is broadly accepted by all the users who participated in the study. 77% of the participants found the system useful; 85% found it easy; 100% of them believe the system increases the reliability of data. The same proportion encourages the continuation of the experiment and its expansion throughout the hospital.</p> <p>Conclusions</p> <p>In light of the results, we can conclude that the objective of our study was reached. However, it is important to take into account the recommendations and the challenges discussed here to avoid several potential pitfalls specific to the context of Africa.</p> <p>Our future work will target the full integration of the billing module in Mediboard and an expanded implementation throughout the hospital.</p

Long-term cellular immunity of vaccines for Zaire Ebola Virus Diseases

Recent Ebola outbreaks underscore the importance of continuous prevention and disease control efforts. Authorized vaccines include Merck’s Ervebo (rVSV-ZEBOV) and Johnson & Johnson’s two-dose combination (Ad26.ZEBOV/MVA-BN-Filo). Here, in a five-year follow-up of the PREVAC randomized trial (NCT02876328), we report the results of the immunology ancillary study of the trial. The primary endpoint is to evaluate long-term memory T-cell responses induced by three vaccine regimens: Ad26–MVA, rVSV, and rVSV–booster. Polyfunctional EBOV-specific CD4+ T-cell responses increase after Ad26 priming and are further boosted by MVA, whereas minimal responses are observed in the rVSV groups, declining after one year. In-vitro expansion for eight days show sustained EBOV-specific T-cell responses for up to 60 months post-prime vaccination with both Ad26-MVA and rVSV, with no decline. Cytokine production analysis identify shared biomarkers between the Ad26-MVA and rVSV groups. In secondary endpoint, we observed an elevation of pro-inflammatory cytokines at Day 7 in the rVSV group. Finally, we establish a correlation between EBOV-specific T-cell responses and anti-EBOV IgG responses. Our findings can guide booster vaccination recommendations and help identify populations likely to benefit from revaccination

Implementation of a hospital information system in french speaking Africa : cinz@n, design and validation of the model in Mali

La mise en place de systèmes d’information hospitaliers centrés sur les processus de soins est porteuse de qualité des soins, de gestion éclairée des ressources et de productivité. C’est une nécessité qui s’impose à tous les pays quelque soit leur niveau de développement. Une question se pose toutefois : Étant données les différences de contextes financiers, technologiques et humains, faut-il, en Afrique, conduire une stratégie différenciée pour atteindre cet objectif partagé? Le but de notre travail était de mettre en place un modèle adapté au contexte culturel et économique des pays en développement. Notre méthodologie a été basée sur l’adaptation et l’implémentation d’un Open Source. Ces travaux ont permis la réalisation et la validation d’un modèle au Mali que nous avons baptisé Cinz@n. Il a été implémenté et testé à l’hôpital mère enfant de Bamako. Au delà de l’implémentation logicielle, l’accompagnement du changement et la formation, des personnes a été l’objet d’une attention particulière. Les résultats de l’évaluation de la couverture fonctionnelle, de l’ergonomique du système et de satisfaction des utilisateurs sont satisfaisants. 84% des utilisateurs pensent que le système a permis d’améliorer la qualité du travail, 100% des utilisateurs se sont dit prêts à continuer l’expérience. Cette même proportion a recommandé l’extension du système à tous les services de l’hôpital. L’analyse qualitative de la base des données a démontré un suivi rigoureux des consignes d’identification. Nous pouvons conclure que Cinz@n, ayant coûté que près de dix milles euros d’investissement et largement accepté par les utilisateurs peut servir de modèle pour l’Afrique Francophone.The implementation of hospital information systems focused on care processes has been shown to improve the quality of care, the management of resources, and the productivity. These benefits are necessary in all countries, regardless of their level of development. However, a question does arise: “Given the differences in financial, technological and human contexts, should we, in Africa, undertake a differentiated strategy to achieve these shared goals?”. The aim of our study was to develop a model adapted to the cultural and economical contexts of developing countries. Our methodology was based on the adaptation and implementation of an Open Source software. This work led to the development and validation of a model in Mali named Cinz@n. It has been implemented and tested at the Mother-Child hospital in Bamako. Beyond the software implementation, change management and the training of stakeholders have been the subject of special attention. The results of the evaluation of the functional coverage, the ergonomics of the system and user satisfaction are satisfactory. 84% of users consider that the system has improved the quality of their work, and 100% of users are willing to continue the experiment, also recommending the extension of the system to all hospital departments. The qualitative analysis of the database showed strict usage of the patient identification procedures. We conclude that Cinz@n, with an investment cost of about ten thousand euros, and a wide acceptance by users can be a model for other implementations in French Speaking Africa

Telemedicine as a tool for digital medical education: a 15-year journey inside the RAFT network

This paper presents the evolution and growth of continuous medical education through the Réseau en Afrique Francophone pour la Télémédecine (RAFT) network. RAFT is a telemedicine network present on four continents and built through years of experience, with the goal of supporting isolated healthcare professionals by providing them with the right expertise at the right time using affordable, low‐bandwidth technologies. Much more than a platform to share and exchange knowledge, RAFT has put in place a solid local infrastructure to ensure the sustainability and maintenance of the network. From experience gained with South–South collaboration to top‐down and bottom‐up approaches and various certification models, much know‐how has been acquired and different perspectives for improvement have been proposed. The results we have collected from these 15 years of practice are presented in this paper through lessons learned and key takeaways. Perspectives for future development supported by concrete examples conclude the paper. This paper presents the evolution and the growth of continuous medical education through the Réseau en Afrique Francophone pour la Télémédecine (RAFT) network. RAFT is a telemedicine network present on four continents and built upon years of experience, with the goal of supporting isolated healthcare professionals by providing them with the right expertise at the right time using affordable, low‐bandwidth technologies. The results we have collected from these 15 years of practice are presented in this paper through lessons learned and key takeaways

Reverse innovation experiences from the RAFT e-learning and telemedicine network

Available infrastructure, resources, and provided services in low-and middle-income countries differ significantly from high-income countries. In healthcare for example, the uneven distribution of health professionals and lack of human resources are real barriers to equitable access to quality health care and services in most developing countries and particularly in Sub-Saharan Africa. As available resources are lower and infrastructure is les developed many services and tools that have been developed for a high-income context cannot be used or are not sustainably affordable in a low-income environment, which led to the development of tools and services that are affordable and appropriate for this context. This ranges from concepts of blended learning, over tools for distance education and diagnostic to hardware like affordable and robust ultrasound machines and services like mobile payment. Many of these solutions and tools also have a great potential to be utilized in a different context and some of them have been deployed in high-income countries

First Principle Calculation of Accurate Electronic and Related Properties of Zinc Blende Indium Arsenide (zb-InAs)

We carried out a density functional theory (DFT) study of the electronic and related properties of zinc blende indium arsenide (zb-InAs). These related properties include the total and partial densities of states and electron and hole effective masses. We utilized the local density approximation (LDA) potential of Ceperley and Alder. Instead of the conventional practice of performing self-consistent calculations with a single basis set, albeit judiciously selected, we do several self-consistent calculations with successively augmented basis sets to search for and reach the ground state of the material. As such, our calculations strictly adhere to the conditions of validity of DFT and the results are fully supported by the theory, which explains the agreement between our findings and corresponding, experimental results. Indeed, unlike some 21 previous ab initio DFT calculations that reported zb-InAs band gaps that are negative or zero, we found the room temperature measured value of 0.360 eV. It is a clear achievement to reproduce not only the locations of the peaks in the valence band density of states, but also the measured values of the electron and hole effective masses. This agreement with experimental results underscores not only the correct description of the band gap, but also of the overall structure of the bands, including their curvatures in the vicinities of the conduction band minimum (CBM) and of the valence band maximum (VBM)