Personal digital assistants to collect tuberculosis bacteriology data in Peru reduce delays, errors, and workload, and are acceptable to users: cluster randomized controlled trial

SummaryObjectivesTo evaluate the effectiveness of a personal digital assistant (PDA)-based system for collecting tuberculosis test results and to compare this new system to the previous paper-based system. The PDA- and paper-based systems were evaluated based on processing times, frequency of errors, and number of work-hours expended by data collectors.MethodsWe conducted a cluster randomized controlled trial in 93 health establishments in Peru. Baseline data were collected for 19 months. Districts (n=4) were then randomly assigned to intervention (PDA) or control (paper) groups, and further data were collected for 6 months. Comparisons were made between intervention and control districts and within-districts before and after the introduction of the intervention.ResultsThe PDA-based system had a significant effect on processing times (p<0.001) and errors (p=0.005). In the between-districts comparison, the median processing time for cultures was reduced from 23 to 8 days and for smears was reduced from 25 to 12 days. In that comparison, the proportion of cultures with delays >90 days was reduced from 9.2% to 0.1% and the number of errors was decreased by 57.1%. The intervention reduced the work-hours necessary to process results by 70% and was preferred by all users.ConclusionsA well-designed PDA-based system to collect data from institutions over a large, resource-poor area can significantly reduce delays, errors, and person-hours spent processing data

Adaptation of a Web-Based, Open Source Electronic Medical Record System Platform to Support a Large Study of Tuberculosis Epidemiology

Background: In 2006, we were funded by the US National Institutes of Health to implement a study of tuberculosis epidemiology in Peru. The study required a secure information system to manage data from a target goal of 16,000 subjects who needed to be followed for at least one year. With previous experience in the development and deployment of web-based medical record systems for TB treatment in Peru, we chose to use the OpenMRS open source electronic medical record system platform to develop the study information system. Supported by a core technical and management team and a large and growing worldwide community, OpenMRS is now being used in more than 40 developing countries. We adapted the OpenMRS platform to better support foreign languages. We added a new module to support double data entry, linkage to an existing laboratory information system, automatic upload of GPS data from handheld devices, and better security and auditing of data changes. We added new reports for study managers, and developed data extraction tools for research staff and statisticians. Further adaptation to handle direct entry of laboratory data occurred after the study was launched. Results: Data collection in the OpenMRS system began in September 2009. By August 2011 a total of 9,256 participants had been enrolled, 102,274 forms and 13,829 laboratory results had been entered, and there were 208 users. The system is now entirely supported by the Peruvian study staff and programmers. Conclusions: The information system served the study objectives well despite requiring some significant adaptations mid-stream. OpenMRS has more tools and capabilities than it did in 2008, and requires less adaptations for future projects. OpenMRS can be an effective research data system in resource poor environments, especially for organizations using or considering it for clinical care as well as research

Training software developers for electronic medical records in Rwanda

Also published in Studies in health technology and informatics (2010), volume: 160, issue: pt 1, p. 585-589.This paper describes a training program in Rwanda that enables local computer science graduates to play a significant role in the country’s implementation of a national electronic medical record (EMR) system. This training program is unique in the region. The paper discusses the challenges inherent in such an undertaking which produces local software developers familiar with medical informatics. Successful and sustainable eHealth implementations in the developing world will rely on local talent

OpenMRS Implementers Network

The article reviews Open Medical Record System (OpenMRS), a collaborative open-source project for development of software that supports health care delivery in developing countries. The aim is to develop an open Implementers Network to provide regional support for the growing number of OpenMRS implementations and to include African developers in future growth of OpenMRS. The South African OpenMRS Implementer group successfully configured, installed and maintained an integrated HIV/TB OpenMRS application without significant programming support. Since then, this model has been replicated in other African sites. The OpenMRS Implementers NetworkWiki and listserv have proven to be effective in providing implementation support

OpenMRS Implementers Network

OpenMRS (www.openmrs.org) is a highly configurable open source electronic medical record system focused on developing countries. An international collaboration of individuals and institutions is contributing to developing and extending the core application and a network of implementers is configuring specific implementations of OpenMRS for treating and managing care for patients with HIV/AIDS and tuberculosis at sites in Eastern and Southern Africa. Support is critical for successful implementation and an OpenMRS implementers group has been formed driven by developers of OpenMRS with initial implementers from Kenya, Rwanda and South Africa and pilot implementers in Lesotho, Malawi, Tanzania, Uganda, and Zambia. The OpenMRS implementers group not only provides a first line of support to other implementers, but also performs functional testing and documentation. Support for local customizations is mainly provided through the OpenMRS Wiki, forum, and two e-mail mailing lists. The mailing lists are fairly active and responsive to issues arising during implementation, allowing a reasonably high level of support to be maintained for specific in country implementations, and are supplemented with regular implementer meetings. Three meetings were held during 2006, in Eldoret, Cape Town and Dar-Es-Salaam. The first meeting of 2007 will take place in Mali during the Helina 2007 conference

Comprehensive treatment of extensively drug-resistant tuberculosis

BACKGROUND: Extensively drug-resistant tuberculosis has been reported in 45 countries, including countries with limited resources and a high burden of tuberculosis. We describe the management of extensively drug-resistant tuberculosis and treatment outcomes among patients who were referred for individualized outpatient therapy in Peru. METHODS: A total of 810 patients were referred for free individualized therapy, including drug treatment, resective surgery, adverse-event management, and nutritional and psychosocial support. We tested isolates from 651 patients for extensively drug-resistant tuberculosis and developed regimens that included five or more drugs to which the infecting isolate was not resistant. RESULTS: Of the 651 patients tested, 48 (7.4%) had extensively drug-resistant tuberculosis; the remaining 603 patients had multidrug-resistant tuberculosis. The patients with extensively drug-resistant tuberculosis had undergone more treatment than the other patients (mean [+/-SD] number of regimens, 4.2+/-1.9 vs. 3.2+/-1.6; P\u3c0.001) and had isolates that were resistant to more drugs (number of drugs, 8.4+/-1.1 vs. 5.3+/-1.5; P\u3c0.001). None of the patients with extensively drug-resistant tuberculosis were coinfected with the human immunodeficiency virus (HIV). Patients with extensively drug-resistant tuberculosis received daily, supervised therapy with an average of 5.3+/-1.3 drugs, including cycloserine, an injectable drug, and a fluoroquinolone. Twenty-nine of these patients (60.4%) completed treatment or were cured, as compared with 400 patients (66.3%) with multidrug-resistant tuberculosis (P=0.36). CONCLUSIONS: Extensively drug-resistant tuberculosis can be cured in HIV-negative patients through outpatient treatment, even in those who have received multiple prior courses of therapy for tuberculosis