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Challenge Limited technical capacity

By LORENZO DORR | 03 Dec, 2014

Technology related challenges encountered by health care delivery systems as well as health care providers in resource limited settings like ours are enormous. The country is experiencing brain drain. Computer literacy is limited. Computer training institutions are often inaccessible, particularly to rural dwellers. Only a negligible fraction of the rural population has acquired computer literacy/knowledge. Public institutions in rural setting still use type writers instead of computers for documentation. Moreover, training of staff is often not of top priority of public institutions including health and medical institutions and so it is not budgeted for. How do we address this challenge?

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A/Prof. Terry HANNAN Advisor Replied at 3:53 PM, 3 Dec 2014

Lorenzo the problems you outlined are what we faced in 1999-2000 in Kenya. Here are some references related to our early work. I hope they help.
1. Biondich PG, Mamlin B, Hannan TJ, Tierney WM. A call for collaboration: building an EMR for developing countries. AMIA Annu Symp Proc. 2005:894. Epub 2006/06/17.
2. Hannan TJ, Tierney WM, Rotich JK, Odero WW, Smith F, Mamlin JJ, et al. The MOSORIOT medical record system (MMRS) phase I to phase II implementation: an outpatient computer-based medical record system in rural Kenya. Stud Health Technol Inform. 2001;84(Pt 1):619-22. Epub 2001/10/18.
3. Rotich JK, Hannan TJ, Smith FE, Bii J, Odero WW, Vu N, et al. Installing and implementing a computer-based patient record system in sub-Saharan Africa: the Mosoriot Medical Record System. J Am Med Inform Assoc. 2003;10(4):295-303. Epub 2003/04/02.
4. Tierney WM., Kanter AS., Fraser HSF., C. B. A Toolkit For eHealth Partnerships in Low-Income Nations. Health Affairs. 2010;29(2):268-73.

Beatriz Manuel Chongo Replied at 8:54 AM, 4 Dec 2014

Dear Lorenzo,

Thank you very much for sharing your concerns which is also are ours. When we have Internet connection access and people who know how to use IT, the connection is poor or doesn't work.

A/Prof. Terry HANNAN Advisor Replied at 3:32 PM, 4 Dec 2014

Lorenzo and Beatriz, have a look at these short videos to see how you may manage you "intermittent web connectivity".
1. MDRTB Pakistan: http://www.youtube.com/watch?v=1N8236ReWnM
2. IRDResearch Data visualization using Google Earth: http://www.youtube.com/watch?v=v-3lqG3hSYM

Anne-Marie Audet Replied at 9:38 PM, 8 Dec 2014

Great topic - lots of other resonnance - how does an isolated 85 year old person with arthritis and poor vision get to benefit from HIT tools? We have lots of apps currently that cater to great number of people and make their lives easier- hence why they will use and benefit from it - think of your own life, has TripAdvisor made a difference in your selection of hotels, Eventbrite to know what's going on in your community and connect? So what would be needed for that 85 year old person - so she is connected, she can feel her that she is more secure about her health and life? How do we bring the person to the innovator, so we match the big problem with the right solutions, as opposed to having solutions and ideas and then searching for the problem (which is more often than not what we seen these days)? Can anyone give examples of successful ways to crowdsource the big societal problems and match those to teams that develop solutions?

And the second question is that of ability to pay. Many of the tools that will have the greatest impact on costs of care and outcomes at a societal level will have to target the needs of the most vulnerable, those who will not be able to pay for those - the single mother with asthma, on the bring of loosing her apartment, with 2 jobs and 2 kids, one with asthma and the other with depression. Have any of you come across or have ideas about how we can foster innovations when there is not an evident consumer market?

Kathlenn Healey Replied at 10:19 PM, 8 Dec 2014

These very disabled individuals have numerous problems and multidisciplinary team is needed. The problem is generally communication between all the providers. We are thinking about patient care conferences with the patient and home healthcare nurse assisting with the Tele visit in the patient's home. Our major focus is preventing complications of immobility including pressure ulcers, infections specifically urinary and respiratory. Preventing Falls and injuries and and controlling pain. Most of our patients are Medicare /Medicaid and you're right financing is an issue but we believe keeping individuals at home as long as possible is in the end cost-effective versus a long-term care facility.

Documenting the necessary information to bill and submit to Medicare for care plan oversight and reviews are extremely challenging it requires more time in documentation and billing maneuvers then the time we spend in care planning with the patient.

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