Marseille 2007
Marseille 2007
Abstract book
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Abstract #411  -  Can an Electronic Medical Record System Improve Health Care in Lusaka, Zambia?
  20.5: New tools, new toys (Parallel) on Monday @ 14.00-16.00 in PR Chaired by John De Wit, Seth Kalichman
  Presenting Author:   Mr Gordon Cressman - RTI International, United States
  Additional Authors:   
In 2002 the World Health Organization (WHO) and UNICEF estimated that a Zambian womans risk of dying in pregnancy was around 940/100,000. Studies conducted in Lusaka found that nearly one-third of pregnant women were infected with HIV. If untreated almost half of these women would transmit the fatal infection to their infants. Nearly all western-style health care for the roughly two million citizens in Lusaka was delivered through a network of 24 clinics and one hospital. This paper examines the experience and results of efforts to develop a networked electronic medical record system for public health facilities in Lusaka to improve health care and provide valuable data for health surveillance and research.
Method / Issue:
A mixture of technologies was used to interconnect 24 public health clinics and the main hospital in Lusaka. Three or more Industry standard personal computers and at least one printer were installed on mobile carts in each clinic. Equipment was installed to provide voice communications among facilities over the network. A centralized data center was developed within a separate non-governmental organization. Web-based electronic patient records and referral systems were developed using open source software and in close collaboration with Zambian and American clinicians and physicians. Local personnel were recruited and trained to support the system. More than 800 medical personnel were trained in the use of the computers and the software. Senior medical advisors and researchers are using the data to monitor adherence to treatment protocols, to coach clinical teams, and to monitor health and treatment trends.
Results / Comments:
All medical facilities used the electronic patient referral system successfully for two years prior to the introduction of an integrated patient record and referral system. Acceptance by clinicians was rapid and positive. Training by peers was an important factor in acceptance. Fifteen clinics currently use the system to provide health care to more than 23,000 patients. Results from a small survey in selected pilot clinics early in the program indicated that most clinicians believed the electronic system was at least as easy and fast to use as the previous paper system. Overall availability of the data and voice communications network has been as high as 98 percent for extended periods, but lightening, extended power failures, and contention for technical support personnel have reduced this at times to the mid 80 percent range. Early results indicate that use of the data for coaching of clinical teams has resulted in improvements in patient care.
Networked medical record systems interconnect facilities, enabling facilities to share access to patient records, and providing a centralized patient records database surveillance and research. Such systems have high technical support and operating costs compared to disconnected facility level systems. It is unlikely such a system can scale to include rural health care facilities. Pilot testing suggests such a system can be modified for use in rural facilities and to report aggregate data via existing public telecommunications networks.
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