Keeping track of patients and drugs in rural Haiti: electronic system is practical

An internet-based medical record system is proving practical and reliable in one of the world’s poorest countries and should be considered as an essential part of treatment scale-up, according to researchers from Partners in Health and Harvard Medical School reporting in the November 13^th edition of the British Medical Journal.

The system, called HIV-EMR, has been implemented at six rural clinics in the central plateau of Haiti monitoring over 7,000 patients with HIV. The system was developed at a pilot site in Cange and rolled out to other clinics in late 2003.

Patient data are entered into the system on a computer using forms that closely resemble the paper form used in the clinic, and then uploaded to a central database by satellite internet link.

The system supports:

• Automated checking of drug doses and interactions when generating prescriptions for the pharmacy
• Automated checking for patients eligible for treatment. Each night laboratory results are fed into the database. Doctors receive an automatic warning email if any patient has experienced a change in laboratory markers that may require a change in regimen.
• Stock checking and supply forecasting for drugs
• Email consultation with senior colleagues

“HIV-EMR has proved itself in some of the most challenging field conditions in the world, similar to those found in much of sub-Saharan Africa,” write the authors.

The system costs around $6000 per site to install, but broadband internet costs in Haiti add an additional $1600 to the site cost each year. These costs must be balanced against the potential improvements in care and research that can be achieved, say the researchers.

The system is to be made available as open source software by the developers, who plan to work with other HIV treatment projects, including WHO and the US government, to standardise tools and data sets.

Other systems are being pioneered in Africa, some of them using technologies that are already widespread.

In Malawi a smart card system is being used for patient records in which patients take custody of the cards, and present them either at central hospitals or local facilities in order to obtain drugs. This helps to keep track of patient flows and drug supply. The cards can be read by credit card readers that can be run off a car battery or solar power, and data can be collected on a regular basis by a visiting data manager without the need for phone or internet connection.

In Uganda Satellife is using mobile phone modems to transmit data from a central server after it has been gathered on Palm Pilots.

The full text of the British Medical Journal article is available here. The article includes details of other systems in development and internet links to developer sites for further details.