Health IT
A global approach to the management of EMR (Electronic Medical Records) of patients with HIV/AIDS in Sub-Saharan Africa: the experience of DREAM Software
This newly published study examines the DREAM software which was developed for the management of patients’ EMR within the DREAM health centres (http://dream.santegidio.org/x__homep.asp?Curlang=EN) in several countries in sub-Saharan Africa.
Some of the core aspects for the development of this software as explained in this study are:
1) The software needs to operate within the framework of the national health systems of the countries where it is implemented, and in several languages: Guinea Bissau; Republic of Guinea; Nigeria; Cameroon; Democratic Republic of Congo; Angola; Tanzania; Kenya; Malawi; Mozambique;
2) Consultation with DREAM centers' personnel to take into account local challenges before, during, after roll-out for continued improvements
3) Take into account the fact that “the treatment of AIDS [...] will last the whole of the patient’s life.
The diagnostic is organized in four levels in the software: progression of the disease and the patient’s clinical condition; patient's immune status (mainly expressed in terms of his CD4 cell count); the “quality” of the viral infection (viral load and resistance mutations); surveillance for any adverse events and toxicity related to the pharmacological treatment.
4) DREAM is only available at DREAM centers for security reasons: not only to prevent malicious uses or errors in the database but also to simplify the configuration of the computer used (Figure 4 illustrates the configuration of a DREAM center)
5) All DREAM centers have a computer linked to a server and other computers through LAN so that health providers can follow a patient throughout the center without paper trail/record.
6) Centers are interconnected via Internet through satellite in places where cable network connection is not available.
Several challenges to implementation were identified: power surges, disruptions in network connections, both LAN and Internet and low bandwidth. But the most pressing one is power. Solutions identified: using a UPS (Uninterruptible Power Supply); using a system of (rechargeable) batteries and inverters; using solar panels and batteries (allows continued use - no recharging time). Another suggestion in this article: identifying a back-up center. Authors also note that it is important to make careful inquiries to Internet Service Providers before signing up for service – which they did. If they felt a good Internet connection was not possible, they went with satellite.
7) Creating a dictionary of terms used for the management of the database. Encoding and clean data are vital to EMR systems. ICD X and ATC codifications in particular were used. The transcoding dictionaries compile 2,700 items for pathologies in the following languages: English, French,
Portuguese and Italian. And the registration of test results comes directly from laboratories and is automated (which have specific software for the administration of tests).
One of the main benefits shown with the usage of the software was the efficient management of the drugs as it improves adherence to the therapy by monitoring the patients’ use of the medicines; and helps avoid waste in using the drugs.
8) The software was also developed with “replication and interoperability” in mind. The DREAM software is in its 4th version today, and is used in 31 centers across10 countries in sub-Saharan Africa, with 20 technicians trained for computer assistance at centers and developers staffed in Europe.
The authors of this study notably conclude that it is possible to have homogeneous data from different countries.
Attached resource:
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A global approach to the management of EMR (Electronic Medical Records) of patients with HIV/AIDS in Sub-Saharan Africa: the experience of DREAM Software (external URL) Link leads to: http://www.biomedcentral.com/content/pdf/1472-6947-9-42.pdf
Summary: This newly published study examines the DREAM software which was developed for the management of patients’ EMR within the DREAM health centres (http://dream.santegidio.org/x__homep.asp?Curlang=EN) in several countries in sub-Saharan Africa.
Some of the core aspects for the development of this software as explained in this study are:
1) The software needs to operate within the framework of the national health systems of the countries where it is implemented, and in several languages: Guinea Bissau; Republic of Guinea; Nigeria; Cameroon; Democratic Republic of Congo; Angola; Tanzania; Kenya; Malawi; Mozambique;
2) Consultation with DREAM centers' personnel to take into account local challenges before, during, after roll-out for continued improvements
3) Take into account the fact that “the treatment of AIDS [...] will last the whole of the patient’s life.
The diagnostic is organized in four levels in the software: progression of the disease and the patient’s clinical condition; patient's immune status (mainly expressed in terms of his CD4 cell count); the “quality” of the viral infection (viral load and resistance mutations); surveillance for any adverse events and toxicity related to the pharmacological treatment.
4) DREAM is only available at DREAM centers for security reasons: not only to prevent malicious uses or errors in the database but also to simplify the configuration of the computer used (Figure 4 illustrates the configuration of a DREAM center)
5) All DREAM centers have a computer linked to a server and other computers through LAN so that health providers can follow a patient throughout the center without paper trail/record.
6) Centers are interconnected via Internet through satellite in places where cable network connection is not available.
Several challenges to implementation were identified: power surges, disruptions in network connections, both LAN and Internet and low bandwidth. But the most pressing one is power. Solutions identified: using a UPS (Uninterruptible Power Supply); using a system of (rechargeable) batteries and inverters; using solar panels and batteries (allows continued use - no recharging time). Another suggestion in this article: identifying a back-up center. Authors also note that it is important to make careful inquiries to Internet Service Providers before signing up for service – which they did. If they felt a good Internet connection was not possible, they went with satellite.
7) Creating a dictionary of terms used for the management of the database. Encoding and clean data are vital to EMR systems. ICD X and ATC codifications in particular were used. The transcoding dictionaries compile 2,700 items for pathologies in the following languages: English, French,
Portuguese and Italian. And the registration of test results comes directly from laboratories and is automated (which have specific software for the administration of tests).
One of the main benefits shown with the usage of the software was the efficient management of the drugs as it improves adherence to the therapy by monitoring the patients’ use of the medicines; and helps avoid waste in using the drugs.
8) The software was also developed with “replication and interoperability” in mind. The DREAM software is in its 4th version today, and is used in 31 centers across10 countries in sub-Saharan Africa, with 20 technicians trained for computer assistance at centers and developers staffed in Europe.
The authors of this study notably conclude that it is possible to have homogeneous data from different countries.Source: BMC Medical Informatics and Decision Making
Publication Date: September 11, 2009
Language: English
Keywords: electronic medical records, Software
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