EHR implementation in Malawi brings additional challenges

Implementing an electronic medical records system in Malawi included the usual challenges, such as having tech staff available, selling clinicians on its value and training them to use it. But there were additional challenges, including power outages, low computer literacy in some areas and co-existing with a paper-based system, according to a new study published in PLOS Medicine.

According to researchers, an open source records system--Surveillance Programme of IN-patients and Epidemiology or SPINE--was installed at a major referral hospital, Queen Elizabeth Central Hospital, in the African nation. With the high rate of HIV infection, readmission is common. Fifteen percent of those admitted died in the hospital.

While the Ministry of Health in Malawi had instituted a number of initiatives aimed at HIV, TB and malaria, lack of data meant the country had difficulty quantifying the burden of disease, planning and monitoring the effectiveness of its interventions and forecasting the need for medications.

The system used touchscreen terminals in the medical wards to record patient information. It also used the open source software Ruby, which allowed integration with different hospitals and from different initiatives at no added cost.

Upon discharge, a patient's HIV status, medications, diagnosis, and up to two secondary diagnoses based on ICD-10 were recorded. An adhesive label with that information also was printed out and put in the patient's health passport, a document that most patients carry to be seen at hospital or health centers. The electronic system co-exists with paper-based data-collection system for lab, clinical, and other information.

"SPINE is thought to be having a positive impact on patient care by prompting clinicians to remember HIV testing, facilitating clear management plans, and improving quality of prescribing by giving clear printed prescriptions and correctly spelt drug names with appropriate doses," the authors wrote. They found it a suitable tool for auditing, monitoring diagnosis and prescription patterns as well as for mapping outbreaks.

The availability of electronic health and mobile health services play a major role in improving global public health, according to researchers from Fordham University. In a study published last fall, they examined the impact of information and communication technologies on the adolescent fertility rate, child immunization coverage, detection of tuberculosis, life expectancy, and the adult mortality rate in five nations between 2000 and 2008.

Mobile health technologies also have proved invaluable for real-time monitoring of disease, including malaria in Botswana and dengue fever in Mexico, according to a report published in January from GBI Research.

A recently released book from the World Health Organization, World Intellectual Property Organization and World Trade Organization focuses on the challenges of supporting innovative health technologies and ensuring they reach the people who need them. The book, "Promoting Access to Medical Technologies and Innovation: Intersections between Public Health, Intellectual Property and Trade, "is expected to be of particular interest to developing countries that face increasing calls for action.

To learn more:
- find the research