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BMC Res Notes. 2016 Mar 5;9:146. doi: 10.1186/s13104-016-1943-4.

Developing a point-of-care electronic medical record system for TB/HIV co-infected patients: experiences from Lighthouse Trust, Lilongwe, Malawi.

Author information

1
The International Union Against Tuberculosis and Lung Disease, Paris, France. h_tweya@lighthouse.org.mw.
2
Lighthouse Trust, Lilongwe, Malawi. h_tweya@lighthouse.org.mw.
3
Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland. h_tweya@lighthouse.org.mw.
4
Lighthouse Trust, Lilongwe, Malawi. cfeld@uw.edu.
5
International Training and Education Center for Health (I-TECH), University of Washington, 901 Boren Avenue, Suite 1100, Seattle, WA, 98104, USA. cfeld@uw.edu.
6
Baobab Health Trust, Lilongwe, Malawi. jintha@gmail.com.
7
Lighthouse Trust, Lilongwe, Malawi. w_ngambi@lighthouse.org.mw.
8
Baobab Health Trust, Lilongwe, Malawi. soyapim@gmail.com.
9
Department of Biomedical Informatics, Center for Health Informatics for the Underserved, University of Pittsburgh, Pittsburgh, PA, USA. soyapim@gmail.com.
10
Baobab Health Trust, Lilongwe, Malawi. dave.phiri@baobabhealth.org.
11
Baobab Health Trust, Lilongwe, Malawi. lmkamvazina@gmail.com.
12
Baobab Health Trust, Lilongwe, Malawi. shawo.mwakilama@baobabhealth.org.
13
Malawi National Tuberculosis Program, Lilongwe, Malawi. hkanyerere@yahoo.com.
14
Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland. okeiser@ispm.unibe.ch.
15
Lighthouse Trust, Lilongwe, Malawi. j_mwafilaso@lighthouse.org.mw.
16
Bwaila District Hospital, TB clinic, Lilongwe, Malawi. ckamba@lighthouse.org.mw.
17
Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland. egger@ispm.unibe.ch.
18
International Training and Education Center for Health (I-TECH), University of Washington, 901 Boren Avenue, Suite 1100, Seattle, WA, 98104, USA. drandreasjahn@gmail.com.
19
Central Monitoring and Evaluation Division/Department for HIV and AIDS, Ministry of Health, Lilongwe, Malawi. drandreasjahn@gmail.com.
20
Baobab Health Trust, Lilongwe, Malawi. b_simwaka@lighthouse.org.mw.
21
Lighthouse Trust, Lilongwe, Malawi. samphiri@lighthouse.org.mw.

Abstract

BACKGROUND:

Implementation of user-friendly, real-time, electronic medical records for patient management may lead to improved adherence to clinical guidelines and improved quality of patient care. We detail the systematic, iterative process that implementation partners, Lighthouse clinic and Baobab Health Trust, employed to develop and implement a point-of-care electronic medical records system in an integrated, public clinic in Malawi that serves HIV-infected and tuberculosis (TB) patients.

METHODS:

Baobab Health Trust, the system developers, conducted a series of technical and clinical meetings with Lighthouse and Ministry of Health to determine specifications. Multiple pre-testing sessions assessed patient flow, question clarity, information sequencing, and verified compliance to national guidelines. Final components of the TB/HIV electronic medical records system include: patient demographics; anthropometric measurements; laboratory samples and results; HIV testing; WHO clinical staging; TB diagnosis; family planning; clinical review; and drug dispensing.

RESULTS:

Our experience suggests that an electronic medical records system can improve patient management, enhance integration of TB/HIV services, and improve provider decision-making. However, despite sufficient funding and motivation, several challenges delayed system launch including: expansion of system components to include of HIV testing and counseling services; changes in the national antiretroviral treatment guidelines that required system revision; and low confidence to use the system among new healthcare workers. To ensure a more robust and agile system that met all stakeholder and user needs, our electronic medical records launch was delayed more than a year. Open communication with stakeholders, careful consideration of ongoing provider input, and a well-functioning, backup, paper-based TB registry helped ensure successful implementation and sustainability of the system. Additional, on-site, technical support provided reassurance and swift problem-solving during the extended launch period.

CONCLUSION:

Even when system users are closely involved in the design and development of an electronic medical record system, it is critical to allow sufficient time for software development, solicitation of detailed feedback from both users and stakeholders, and iterative system revisions to successfully transition from paper to point-of-care electronic medical records. For those in low-resource settings, electronic medical records for integrated care is a possible and positive innovation.

PMID:
26945749
PMCID:
PMC4779573
DOI:
10.1186/s13104-016-1943-4
[Indexed for MEDLINE]
Free PMC Article

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