Implementation of a Cloud-Based Electronic Medical Record to Reduce Gaps in the HIV Treatment Continuum in Rural Kenya
Implementation of a Cloud-Based Electronic Medical Record to Reduce Gaps in the HIV Treatment Continuum in Rural Kenya
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DOI：
10.1371/journal.pone.0135361
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发表时间：
2015-08-07
期刊：
影响因子：
3.7
通讯作者：
Sharif, Shahnaaz
中科院分区：
文献类型：
--
作者：
Haskew, John;Ro, Gunnar;Sharif, Shahnaaz
背景电子病历（EMR）系统越来越多地被采用来支持发展中国家的医疗保健服务，其实施可以通过改善数据的获取和使用来为临床和公共卫生决策提供信息，从而有助于加强护理途径并缩小艾滋病毒治疗级联中的差距。基于电子病历系统在肯尼亚西部的艾滋病毒门诊设置，并评估其对减少艾滋病毒治疗连续性的差距，包括缺失的数据和患者接受抗逆转录病毒治疗的资格的影响。和实施后的EMR为基础的数据验证和临床决策support.ResultsSignificant改善数据质量和提供临床护理记录通过实施的EMR系统，有助于确保患者谁有资格获得艾滋病毒治疗早期。在基于EMR的数据验证和临床决策支持实施前和实施后，分别有2，169和764例患者记录缺失数据。共有1,346名患者有资格接受抗逆转录病毒治疗，但尚未开始接受抗逆转录病毒治疗，与实施前的270名患者相比。包括缺失的数据和ART的资格。云-基于模型的EMR实施消除了对当地诊所基础设施的需求，并有可能在不同级别的医疗保健中加强数据共享为临床和公共卫生决策提供信息。一些问题，包括数据管理和患者的保密性，必须考虑，但在数据质量和提供临床护理的显着改善记录通过实施此EMR模型。
BackgroundElectronic medical record (EMR) systems are increasingly being adopted to support the delivery of health care in developing countries and their implementation can help to strengthen pathways of care and close gaps in the HIV treatment cascade by improving access to and use of data to inform clinical and public health decision-making.MethodsThis study implemented a novel cloud-based electronic medical record system in an HIV outpatient setting in Western Kenya and evaluated its impact on reducing gaps in the HIV treatment continuum including missing data and patient eligibility for ART. The impact of the system was assessed using a two-sample test of proportions pre-and post-implementation of EMR-based data verification and clinical decision support.ResultsSignificant improvements in data quality and provision of clinical care were recorded through implementation of the EMR system, helping to ensure patients who are eligible for HIV treatment receive it early. A total of 2,169 and 764 patient records had missing data pre-implementation and post-implementation of EMR-based data verification and clinical decision support respectively. A total of 1,346 patients were eligible for ART, but not yet started on ART, pre-implementation compared to 270 patients pre-implementation.ConclusionEMR-based data verification and clinical decision support can reduce gaps in HIV care, including missing data and eligibility for ART. A cloud-based model of EMR implementation removes the need for local clinic infrastructure and has the potential to enhance data sharing at different levels of health care to inform clinical and public health decision-making. A number of issues, including data management and patient confidentiality, must be considered but significant improvements in data quality and provision of clinical care are recorded through implementation of this EMR model.