Information Technology Reference
In-Depth Information
EHRs in improving quality of care in developed
countries, have created a broad interest in the use
of such systems in the management of diseases
such as HIV and drug-resistant Tuberculosis (TB).
There are examples of successful implementations
of such systems, such as the AMPATH project
in Western Kenya, the PIH (Partners in Health)
projects in Peru, Haiti, and Rwanda, the Baobab
Health systems projects in Malawi, and the CI-
DRZ (Center for Infectious Disease Research in
Zambia) project (eHealth, 2008).
In many places, some kind of legacy, paper-
based EHR system will already be in place. But
throwing it out and replacing it with an electronic
system may not be so simple, or appropriate. It
can be difficult to shift the concerned parties in
lockstep from the paper-based system they know
to an electronic system you know. More likely, any
new system will have to be a hybrid of electronic
and paper-based tools. This adds to the difficulty
of designing a system because the records will
have to work in both a paper and an electronic
world. Simply scanning paper into electronic form
does not address the real issues, nor does it cor-
rect errors that may have been embedded earlier.
An accompanying problem is the lack, in many
developing countries, of a system for accurately
obtaining unique identification of every person for
whom a health record is created. Identifying each
and every individual accurately is not only a ma-
jor problem at healthcare facilities in developing
countries, but also a most difficult task. Obviously,
knowing who is who avoids potentially harmful,
even deadly, errors, and allows for continuity of
care and sound management of drug use. It also
helps eliminate unnecessary procedures and re-
duce fraud, thereby lowering costs and improving
a system's efficiency.
Accurate individual identification is also
necessary if a facility is to contribute to the epi-
demiological statistics gathered by the national
government. If you don't know whom you've
been treating, the prevalence of illness—such as
malaria, TB, or HIV/AIDS—cannot be counted
accurately. Measuring the baseline health of a
country, and any improvements in health, is dif-
ficult if not impossible.
Name confusion leading to mistaken identity
is a special problem in communities where most
people's names are not unique, as you may find in
a developing country. This is especially so within
smaller settings such as tribes and rural and remote
communities. In extreme cases, individuals may
have no useful identity to offer at all; their culture
or literacy may prevent them from accurately
reciting their identities with consistency. Tying
records to individuals without a stable means
of identification (name, address, etc.) can be a
great problem
3.1. Sub-Challenges
Individual ID
In many developing countries, there is no method
for accurately and uniquely identifying every
person who presents at a healthcare facility need-
ing or requesting care. Obviously, knowing “who
is who” helps avoid potentially harmful, even
deadly, errors and allows for continuity and sound
management of an individual's care. It can also
help eliminate unnecessary procedures and reduce
fraud, as well as contribute to the epidemiological
information for the region.
The Individual ID Challenge is to design a
system for healthcare facilities in developing
countries that correctly identifies individuals so
that accurate medical records (paper or electronic)
can be created, stored, and located the next time
that individual presents at the same or other
healthcare facility. Such a system should answer
the following questions:
•
Is this person who he/she claims to be?
•
Has this person accessed health services
previously here or elsewhere in the system?
•
What services has this person received?
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