Scale-up of networked HIV treatment in Nigeria: Creation of an integrated electronic medical records system
Scale-up of networked HIV treatment in Nigeria: Creation of an integrated electronic medical records system
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DOI：
10.1016/j.ijmedinf.2014.09.006
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发表时间：
2015-01-01
影响因子：
4.9
通讯作者：
Kanki, Phyllis
中科院分区：
文献类型：
--
作者：
Chaplin, Beth;Meloni, Seema;Kanki, Phyllis
目的：在资源有限的环境中实施PEPFAR计划的同时，还需要以前所未有的规模记录患者护理，而这种规模在纸质记录是常态的环境中是前所未有的。我们描述了一个电子病历系统（EMRS）的发展，在一个大型的艾滋病毒/艾滋病护理和治疗计划在尼日利亚开始到位。方法：创建数据库，记录实验室结果，药物处方和分发，临床评估，使用关系数据库程序。一系列独立的文件记录了患者护理的不同要素，通过实用程序链接在一起，这些实用程序汇总了国家标准指标的数据，评估了患者护理的质量改进，跟踪了需要随访的患者，生成了分配的ART方案的计数，并提供了患者对治疗的反应的“快照”。一个安全的服务器被用来存储病人的档案备份和transfer.Results：到2012年2月，当该计划过渡到当地的国家管理APIN，EMRS被用于全国33家医院，有4，947，433成人，儿科和PMTCT记录已被创建，并继续可用于病人护理。需要对数据管理人员进行持续培训，沿着根据用户反馈对数据库和表格进行反复修改。随着项目规模的扩大和实验室检测量的增加，只要有可能，结果都以数字格式产生，可以自动传输到电子病历系统。许多较大的诊所开始将部分或全部数据库连接到局域网，使其可供更多的工作人员使用，或提供同时输入信息的能力（如果需要）。结论：EMRS改善了患者护理，使有效的报告给尼日利亚政府和美国资助机构，并允许项目经理和工作人员进行质量控制审计。(C)2014爱思唯尔爱尔兰有限公司版权所有。
Objectives: The implementation of PEPFAR programs in resource-limited settings was accompanied by the need to document patient care on a scale unprecedented in environments where paper-based records were the norm. We describe the development of an electronic medical records system (EMRS) put in place at the beginning of a large HIV/AIDS care and treatment program in Nigeria.Methods: Databases were created to record laboratory results, medications prescribed and dispensed, and clinical assessments, using a relational database program. A collection of stand-alone files recorded different elements of patient care, linked together by utilities that aggregated data on national standard indicators and assessed patient care for quality improvement, tracked patients requiring follow-up, generated counts of ART regimens dispensed, and provided 'snapshots' of a patient's response to treatment. A secure server was used to store patient files for backup and transfer.Results: By February 2012, when the program transitioned to local in-country management by APIN, the EMRS was used in 33 hospitals across the country, with 4,947,433 adult, pediatric and PMTCT records that had been created and continued to be available for use in patient care. Ongoing trainings for data managers, along with an iterative process of implementing changes to the databases and forms based on user feedback, were needed. As the program scaled up and the volume of laboratory tests increased, results were produced in a digital format, wherever possible, that could be automatically transferred to the EMRS. Many larger clinics began to link some or all of the databases to local area networks, making them available to a larger group of staff members, or providing the ability to enter information simultaneously where needed.Conclusions: The EMRS improved patient care, enabled efficient reporting to the Government of Nigeria and to U.S. funding agencies, and allowed program managers and staff to conduct quality control audits. (C) 2014 Elsevier Ireland Ltd. All rights reserved.