Electronic Medical Records to Improve Patient Care & Public Health in Rural Kenya

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DESCRIPTION (provided by applicant): Health care is an information-intensive, complex set of processes. Integrating care between providers and sites requires integrating health care information. Health care in developing countries has been inadequately sup- ported with electronic medical record systems (EMRs), being on the far side of the digital divide. As a result, data are not available to enhance the quality and efficiency of care. Developers from Indiana University, the Regenstrief Institute, and their collaborators at Moi University in Kenya created sub-Saharan Africa's first ambulatory electronic medical record system that served (and still serves) a rural health centre in western Kenya. This system then gave birth to what has become the most widely implemented, comprehensive electronic medical record system used in HIV/AIDS clinics throughout sub-Saharan Africa: OpenMRS. Although in western Kenya most of the HIV/AIDS clinics are in public health facilities that also contain primary care clinics, the HIV/AIDS information system does not contain data from these primary care clinics, and therefore primary care and HIV/AIDS care happens separately, without integration. Yet both primary care and HIV/AIDS clinics in these health centres are caring for the same patients, and each visit in developing countries where access to care is always challenging is an opportunity to provide patient-focused primary and specialty care. This project will merge the Mosoriot Medical Record System, from which OpenMRS was originally created, back into OpenMRS. It will demonstrate that a single integrated EMR can support both primary and HIV/AIDS care and become an effective tool for care in both types of clinics. Once integrated, the developers will demonstrate that simple decision-support tools such as computer reminders will increase adherence to both primary care and HIV/AIDS care guidelines, such as (a) preventing transmission of HIV from pregnant mothers to their infants (specifically, increasing the number of women and their infants appropriately screened for HIV), (b) ensuring that HIV-infected children receive appropriate preventive care (specifically, receiving appropriate immunizations), and (c) coordinating care for adults and children co-infected with HIV and tuberculosis (specifically, increasing the number of co-infected patients completing appropriate treatment and follow-up). The effect of the merged primary/HIV/AIDS EMR on provider productivity and time management will also be measured. The agencies funding HIV/AIDS care in developing countries have realized that paying for care requires paying for the collection and management of high-quality electronic data. This project will discern whether such EMRs can also be used to support primary care at minimal additional cost (and perhaps be cost-saving if preliminary evidence of increased productivity of Mosoriot's health care providers can be demonstrated on a larger scale). If so, then such EMRs will be sustainable as long as HIV/AIDS care is funded, and the use of EMRs to manage and improve HIV/AIDS and primary care can be maintained.