TY - JOUR
T1 - Developing and deploying a community healthcare worker-driven, digitally- enabled integrated care system for municipalities in rural Nepal
AU - Citrin, David
AU - Thapa, Poshan
AU - Nirola, Isha
AU - Pandey, Sachit
AU - Kunwar, Lal Bahadur
AU - Tenpa, Jasmine
AU - Acharya, Bibhav
AU - Rayamazi, Hari
AU - Thapa, Aradhana
AU - Maru, Sheela
AU - Raut, Anant
AU - Poudel, Sanjaya
AU - Timilsina, Diwash
AU - Dhungana, Santosh Kumar
AU - Adhikari, Mukesh
AU - Khanal, Mukti Nath
AU - Pratap KC, Naresh
AU - Acharya, Bhim
AU - Karki, Khem Bahadur
AU - Singh, Dipendra Raman
AU - Bangura, Alex Harsha
AU - Wacksman, Jeremy
AU - Storisteanu, Daniel
AU - Halliday, Scott
AU - Schwarz, Ryan
AU - Schwarz, Dan
AU - Choudhury, Nandini
AU - Kumar, Anirudh
AU - Wu, Wan Ju
AU - Kalaunee, S. P.
AU - Chaudhari, Pushpa
AU - Maru, Duncan
N1 - Funding Information:
DC, PT, IN, SPandey, LBK, JT, HR, AT, AR, SPoudel, DT, SKD, SH, NC, and SPK are employed by and Bibhav Acharya, SM, RS, Dschwarz, AK, WJW, and DM work in partnership with a nonprofit healthcare company (Possible) that delivers free healthcare in rural Nepal using funds from the Government of Nepal and other public, philanthropic, and private foundation sources. DC is a faculty member at a public university (University of Washington) and, DC and SH are employed part-time there. Bibhav Acharya is a faculty member at a public university (University of California, San Francisco). SM is employed at an academic medical center (Boston Medical Center) that receives public sector research funding, as well as revenue through private sector fee-for-service medical transactions and private foundation grants. SM is a faculty member at a private university (Boston University School of Medicine). SM and WJW are academic fellows at and RSchwarz, DSchwarz, and DM are employed at an academic medical center (Brigham and Women's Hospital) that receives public sector research funding, as well as revenue through private sector fee-for-service medical transactions and private foundation grants. MA, MNK, NPKC, Bhim Acharya, DRS, and PC are employed by the Government of Nepal. KBK is a faculty member at a public university (Tribhuvan University, Institute of Medicine). AHB is a medical resident at a public hospital (Contra Costa Regional Medical Center). JW is employed by a social enterprise and for-profit benefit corporation (Dimagi) that receives revenue from philanthropic, research, multilateral as well as contractual arrangements for developing and implementing information and communications technology for development projects. DStoristeanu is employed by a nonprofit technology company (Simprints) that develops and implements biometrics technology for development projects using funds from philanthropic and private foundation sources. RSchwarz is employed at an academic medical center (Massachusetts General Hospital) that receives public sector research funding, as well as revenue through private sector fee-for-service medical transactions and private foundation grants. RSchwarz, DSchwarz, and DM are faculty members at a private University (Harvard Medical School). DSchwarz is employed at an academic medical center (Beth Israel Deaconess Medical Center) that receives public sector research funding, as well as revenue through private sector fee-for-service medical transactions and private foundation grants. AK is a medical student at a private university (Icahn School of Medicine at Mount Sinai). SPK is a student at a private university (Eastern University). DM is employed at an academic medical center (Boston Children's Hospital) that receives public sector research funding, as well as revenue through private sector fee-for-service medical transactions and private foundation grants. DM is a non-voting member on Possible 's board of directors, but receives no compensation. All authors have read and understood Healthcare: Journal of Delivery Science and Innovation's policy on declaration of interests, and declare that we have no competing financial interests. The authors do, however, believe strongly that healthcare is a public good, not a private commodity. Appendix A
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/9
Y1 - 2018/9
N2 - Integrating care at the home and facility level is a critical yet neglected function of healthcare delivery systems. There are few examples in practice or in the academic literature of affordable, digitally-enabled integrated care approaches embedded within healthcare delivery systems in low- and middle-income countries. Simultaneous advances in affordable digital technologies and community healthcare workers offer an opportunity to address this challenge. We describe the development of an integrated care system involving community healthcare worker networks that utilize a home-to-facility electronic health record platform for rural municipalities in Nepal. Key aspects of our approach of relevance to a global audience include: community healthcare workers continuously engaging with populations through household visits every three months; community healthcare workers using digital tools during the routine course of clinical care; individual and population-level data generated routinely being utilized for program improvement; and being responsive to privacy, security, and human rights concerns. We discuss implementation, lessons learned, challenges, and opportunities for future directions in integrated care delivery systems.
AB - Integrating care at the home and facility level is a critical yet neglected function of healthcare delivery systems. There are few examples in practice or in the academic literature of affordable, digitally-enabled integrated care approaches embedded within healthcare delivery systems in low- and middle-income countries. Simultaneous advances in affordable digital technologies and community healthcare workers offer an opportunity to address this challenge. We describe the development of an integrated care system involving community healthcare worker networks that utilize a home-to-facility electronic health record platform for rural municipalities in Nepal. Key aspects of our approach of relevance to a global audience include: community healthcare workers continuously engaging with populations through household visits every three months; community healthcare workers using digital tools during the routine course of clinical care; individual and population-level data generated routinely being utilized for program improvement; and being responsive to privacy, security, and human rights concerns. We discuss implementation, lessons learned, challenges, and opportunities for future directions in integrated care delivery systems.
KW - Biometric identification
KW - Community health workers
KW - Delivery of healthcare, integrated
KW - Electronic health records
KW - Health information systems
KW - Nepal
UR - http://www.scopus.com/inward/record.url?scp=85048557713&partnerID=8YFLogxK
U2 - 10.1016/j.hjdsi.2018.05.002
DO - 10.1016/j.hjdsi.2018.05.002
M3 - Article
C2 - 29880283
AN - SCOPUS:85048557713
VL - 6
SP - 197
EP - 204
JO - Healthcare
JF - Healthcare
SN - 2213-0764
IS - 3
ER -