Synchronization of patient data among health facilities through electronic medical records system: a case study of Kabgayi District Hospital

Background: The use of modern technology in healthcare system aims to increase the reliability, accessibility and productivity of delivered services. In most developing countries, particularly in sub-Saharan Africa, Electronic Medical Records (EMRs) has been dominated by paper-based system. In Rwanda, EMRs started in 2011 with a baseline of 8% and reached 50% in 2017 within 516 health facilities, but patient data synchronization among health facilities is still a problem. The aim of this research was to identify factors hindering EMRs implementation and propose applied solutions.Methods: A cross-sectional descriptive study design with qualitative and quantitative approach was used. A purposive method to select the research participants among the target population was also used.Results: It was found that, despite the improvement of hospitals’ management and healthcare efficiency via EMRs system, factors affecting synchronization of patients’ data among health facilities still persist. The study also revealed the need for the interoperability in the integration of EMRs system among health facilities.Conclusion: The OpenMRS EMR-based data synchronization can reduce gaps in HIV care. It avoids a duplication of patient identification number (PID) at the same health facility for more than one visit and missing data among health facilities. As part of implementable solutions for effective service delivery, cloud-based server and patient identification were suggested as solutions for much more success in Open MRS EMRs system.Keywords: Electronic Medical Record, Data synchronization, Cloud computing technolog

Assessment of formats and completeness of paper-based referral letters among urban hospitals in Rwanda: a retrospective baseline study

Abstract Background Patient referral is a process in which a healthcare provider decides to seek assistance due to the limitations of available skills, resources and services offered locally. Paper-based referrals predominantly used in low-income countries hardly follow any procedure. This causes a major gap in communication, coordination, and continuity of care between primary and specialized levels, leading to poor access, delay, duplication and unnecessary costs. The goal of this study is to assess the formats and completeness of existing paper-based referral letters in order to improve health information exchange, coordination, and continuity of care. Methods A retrospective exploratory research was conducted in eight public and three private healthcare facilities in the city of Kigali from May to October 2021. A purposive sampling method was used to select hospitals and referral letters from patients’ files. A data capture sheet was designed according to the contents of the referral letters and the resulting responses were analyzed descriptively. Results In public hospitals, five types of updated referral letters were available, in total agreement with World Health Organization (WHO) standards of which two (neonatal transfer form and patient monitoring transfer form) were not used. There was also one old format that was used by most hospitals and another format designed and used by a district hospital (DH) separately. Three formats were designed and used by private hospitals (PH) individually. A total of 2,304 referral letters were perused and the results show that “external transfer” forms were completed at 58.8%; “antenatal, delivery, and postnatal external transfer” forms at 47.5%; “internal transfer” forms at 46.6%; “Referral/counter referral” forms at 46.0%; district hospital referrals (DH2) at 73.4%. Referrals by private hospitals (PH1, PH2 and PH3) were completed at 97.7%, 70.7%, and 0.0% respectively. The major completeness deficit was observed in counter referral information for all hospitals. Conclusion We observed inconsistencies in the format of the available referral letters used by public hospitals, moreover some of them were incompatible with WHO standards. Additionally, there were deficits in the completeness of all types of paper-based referral letters in use. There is a need for standardization and to disseminate the national patient referral guideline in public hospitals with emphasis on referral feedback, referral registry, triage, archiving and a need for regular training in all organizations

Integrated Analysis of Cytokine Profiles in Malaria Patients Discloses Selective Upregulation of TGF-β1, β3, and IL-9 in Mild Clinical Presentation

The proper control of Plasmodium infection requires a finely balanced immune response. Here, we evaluated the implication of TGF-β1 and TGF-β3 in this process using novel monoclonal antibodies to measure their plasma concentrations in comparison with other cytokines and the expression of FOXP3 mRNA. Plasma cytokine levels were measured in 80 patients with severe anaemic malaria and 186 with a mild presentation using ELISA, and rtPCR was used to measure FOXP3 mRNA expression. While no mature TGF-β isoforms were detected in the plasma, the latent TGF-β1 and TGF-β3 were strongly upregulated in patients with mild malaria and nearly undetected in patients with severe disease. Similar selective upregulation in mild patients was observed for IL-9 and FOXP3 mRNA, while IL-7, IL-10, IL-17, and IL-27, although higher in mild cases, were also detected in severe disease. In contrast, a clearly skewed trend of severe cases towards higher pro-inflammatory (IL-6, IL-13, TNF-α) and Th1 (IFN-γ) responses was observed, which was associated with a higher level of parasitaemia as well as lower IgG and higher IgM responses. Together, these results suggest that the stimulation of regulatory T cells through TGF-β1/TGF-β3 and IL-9 is paramount to an effective and balanced protective immunity in natural human malaria infection