Health IT

Dear Joaquin,

Apologies for not responding sooner, I was in the field visiting new sites in the South of Malawi, then in transit to the States, then a week of catching up after the month away.

With regard to expansion of the ART EMR, the Ministry of Health (MoH) is focusing on installing the system at high-burden sites first, as these sites have the greatest challenge in producing quarterly reports. In the paper (submitted in February) we mentioned that our target by end of 2010 was 50,000 patients managed with the system, but we have passed that point already, and additional sites are now coming on-line. The goal is to have most if not all of the sites with more than 2,000 patients on ART running the ART EMR by end of 2012, funding permitting. MoH has just identified the next seven sites to receive the EMR, with a combined number of patients under treatment of roughly 31,500, and funding is already secured for those sites.

Regarding support, clearly its important to be building systems that are both scalable, and sustainable over time, not just demonstration systems with no plans for support beyond the life of donor ...

Dear Joaquin,

Apologies for not responding sooner, I was in the field visiting new sites in the South of Malawi, then in transit to the States, then a week of catching up after the month away.

With regard to expansion of the ART EMR, the Ministry of Health (MoH) is focusing on installing the system at high-burden sites first, as these sites have the greatest challenge in producing quarterly reports. In the paper (submitted in February) we mentioned that our target by end of 2010 was 50,000 patients managed with the system, but we have passed that point already, and additional sites are now coming on-line. The goal is to have most if not all of the sites with more than 2,000 patients on ART running the ART EMR by end of 2012, funding permitting. MoH has just identified the next seven sites to receive the EMR, with a combined number of patients under treatment of roughly 31,500, and funding is already secured for those sites.

Regarding support, clearly its important to be building systems that are both scalable, and sustainable over time, not just demonstration systems with no plans for support beyond the life of donor funding. Our strategy for sustainability is based on creating local ownership and adding value at all levels. Baobab Health Trust (BHT) itself strives to be an organization “of the people, by the people, and for the people”. BHT is a Malawian organization comprising 46 employees, of whom 43 are Malawian, including 7 software developers. Additionally, the Trust is accountable to a predominantly Malawian (5/6) board of trustees. The Baobab ART EMR was commissioned by MoH, and is installed at MoH sites at their request. To address the issue of paying for consumables, MoH requires that sites incorporate consumable and support costs into their budgets rather than MoH head-office budgets, consistent with Malawi's model of decentralization.

In addition to adding value for the user, as described in the paper, we are currently trying to creating a body of evidence that the value of EMR systems in low-resource settings is just as much about reducing/containing healthcare delivery cost as it is about improving patient outcomes. We believe that it is cheaper to deliver healthcare with “an appropriate” EMR than without. This is not necessarily intuitive, but through a process of modeling we are able to show a return on investment with a break-even within a few years at both central hospital and district hospital type of facilities. Our model is conservative, and considers all costs including initial deployment, consumables and maintenance/support (working on a draft paper on this now). We anticipate that by demonstrating a financial value proposition MoH will continue to support system put into place. Over time, as more modules come on-line at existing sites, economies of scale will kick-in, further reducing costs.

Many thanks for the opportunity to respond to questions.

Regards,
Gerry.

Is the Baobab ART EMR based on OpenMRS?

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John Wesonga

Hi John,

The current version of the ART EMR is built on an early version (V1.10) of the OpenMRS data model, but is not API compliant. A description of the complete software stack is shown in Text S3 of the PLoS Medicine paper, and can be viewed at ...

http://www.plosmedicine.org/article/fetchSingleRepresentation.action?uri=info...

In collaboration with Partners in Health - Malawi, we are in the process of merging the ART functionality of our EMR with primary care functionality they developed that is in use at their site in Neno, Malawi. This merged version uses a current version of the OpenMRS data model with the goal of being able to operate side-by-side with other OpenMRS modules as with the Neno installation, and allowing us to use OpenMRS tools, for reporting, etc.

Regards,
Gerry.