TY - JOUR
T1 - Design and implementation of an affordable, public sector electronic medical record in rural Nepal
AU - Raut, Anant
AU - Gauchan, Bikash
AU - Yarbrough, Chase
AU - Schwarz, Dan
AU - Citrin, David
AU - Singh, Vivek
AU - Verma, Varun
AU - Hawley, Jessica
AU - Bangura, Alex Harsha
AU - Shrestha, Biplav
AU - Schwarz, Ryan
AU - Adhikari, Mukesh
AU - Maru, Duncan
N1 - Publisher Copyright:
Copyright © 2017 The Author(s). Published by BCS, The Chartered Institute for IT under Creative Commons license.
PY - 2017
Y1 - 2017
N2 - Introduction Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet, the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here, we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal and its subsequent expansion to an additional public sector facility. Development The electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking and 4) effectiveness for quality improvement initiatives. Application For these purposes, we adapted Bahmni, a product built with opensource components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal. Discussion Over the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty.
AB - Introduction Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet, the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here, we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal and its subsequent expansion to an additional public sector facility. Development The electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking and 4) effectiveness for quality improvement initiatives. Application For these purposes, we adapted Bahmni, a product built with opensource components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal. Discussion Over the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty.
KW - Electronic medical records
KW - Global health
KW - Health systems strengthening
KW - Implementation research
KW - Nepal
KW - Open source technologies
UR - http://www.scopus.com/inward/record.url?scp=85021745515&partnerID=8YFLogxK
U2 - 10.14236/jhi.v24i2.862
DO - 10.14236/jhi.v24i2.862
M3 - Article
C2 - 28749321
AN - SCOPUS:85021745515
SN - 2058-4555
VL - 24
SP - 186
EP - 195
JO - Journal of innovation in health informatics
JF - Journal of innovation in health informatics
IS - 2
ER -