Information Technology Reference
In-Depth Information
your area, and how your community could
benefit.
that adapts to the local culture and language(s).
It will be of great help if you consider systems
that have already been successfully deployed in
challenging environments, especially if you can
find systems with ample evaluation data. A sum-
mary of recent efforts to create EHR systems in
developing countries is found in (Fraser et al.,
2005). This paper discusses projects in Kenya,
Peru, Haiti, Uganda, Malawi and Brazil. It de-
scribes system and network requirements, as well
as organizational, user and security concerns. It
includes basic cost estimates for various kinds of
systems, along with an extensive bibliography.
Open source systems and initiatives already under
way such as OpenMRS or CHITS (Seebregts et
al., 2007; Marcelo, 2009) could lead to reliable
technology at reduced costs.
Any technology platform you deploy must
be practical for the intended environment and its
end-users. It must integrate hardware, software,
instrumentation and communications efficiently
and cost-effectively. Such a platform must also
complement and integrate with existing or future
hospital, laboratory, healthcare and clinical sys-
tems, making adherence to recognized standards
important. Several technologies may be deployed
in a single environment; some may be available
commercially (Alvin Systems, 2005) or from
nonprofits (OLPC Health Project, 2010), while
others could be based on proposed new approaches
(Zhang et al., 2007).
Availability and cost effectiveness are the two
key issues to be considered at this stage, along
with standards and the country's culture. An ex-
ample of a low-cost computer-based approach is
the One Laptop per Child (OLPC Health Project,
2010) non-profit project (OLPC, 2009), and its
target $100 laptop (this particular project may
not be applicable to our needs). At the same time,
wireless technologies such as cellular communica-
tions and smart phones are becoming more widely
available, and there is at least one initiative using
them for remote diagnoses and data collection
(Vital Wave Consulting, 2009). This technology
4. APPLICABLE TECHNOLOGIES
A number of technologies are applicable to an
individual ID system, as well as to storing and re-
trieving EHRs. Possibilities include a combination
of biometrics and human-readable alphanumeric
characters such as a name and a number, barcodes,
RFID tags. Biometric techniques can be chosen
from among fingerprint systems and facial, voice,
and iris recognition. A generic biometrics system
captures, usually in real-time, the characteristics
of an individual, then processes and stores the
record in a database. Another possibility is making
use of the SIM cards many individuals have in
their cell phones to use a phone as a platform for
validating the person's identity (although shared
use of cell phones may compromise this approach
due to confidentiality issues).
One example of an architecture already in place
for verifying an individual's ID is a system in Crete
(Lees et al., 2000). The Lees paper describes a
set of middleware services that facilitate access
to the island's telecommunications infrastructure
and integrates electronic records from multiple
systems. The middleware provides three kinds
of services. One is a directory that identifies in-
dividuals based on commonly used information,
and includes such information as the addresses of
facilities in the system. The system also provides
security for certification of users and encryption
of the records and a glossary of terms that can be
helpful for translating among different standards.
Unfortunately, the approach to correlating indi-
vidual ID relies on information such as name and
address, which is unsatisfactory for this challenge.
But the system's architecture could be used with
other techniques such as biometrics.
Above all else, an EHR system for a remote
area should be simple (Maryland Health care
Commission, 2007) and have a user interface
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