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

电子病历改善患者护理

• 批准号: 7497981
• 负责人: WILLIAM M. TIERNEY
• 金额: $ 44.95万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-29 至 2010-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7497981
• 关键词: Electronic; Medical; Records; Improve; Patient

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.

描述（由申请人提供）： 医疗保健是一个信息密集型的复杂过程。在提供者和站点之间整合护理需要整合医疗保健信息。发展中国家的医疗保健一直没有得到电子病历系统（EMR）的充分支持，处于数字鸿沟的另一边。 因此，没有数据来提高护理的质量和效率。来自印第安纳州大学、Regenstrief研究所的开发人员和他们在肯尼亚莫伊大学的合作者创建了撒哈拉以南非洲的第一个流动电子病历系统，该系统为肯尼亚西部的一个农村卫生中心服务（现在仍然服务）。该系统随后诞生了在整个撒哈拉以南非洲的艾滋病毒/艾滋病诊所中使用最广泛的综合电子病历系统：OpenMRS。虽然在肯尼亚西部，大多数艾滋病毒/艾滋病诊所都设在公共卫生设施内，这些公共卫生设施也设有初级保健诊所，但艾滋病毒/艾滋病信息系统不包含这些初级保健诊所的数据，因此初级保健和艾滋病毒/艾滋病护理是分开进行的，没有整合。然而，这些保健中心的初级保健诊所和艾滋病毒/艾滋病诊所都在照顾同样的病人，在发展中国家，获得保健服务总是具有挑战性，每次就诊都是提供以病人为中心的初级和专科保健的机会。 该项目将合并Mosoriot医疗记录系统，OpenMRS最初是从该系统创建的，回到OpenMRS。它将表明，一个单一的综合EMR可以支持初级和艾滋病毒/艾滋病护理，并成为一个有效的工具，在这两种类型的诊所护理。一旦整合，开发人员将证明，简单的决策支持工具，如计算机提醒，将增加遵守初级保健和艾滋病毒/艾滋病护理准则，如（a）防止艾滋病毒从孕妇传染给婴儿（具体而言，增加对妇女及其婴儿进行适当艾滋病毒检查的人数），（B）确保感染艾滋病毒的儿童得到适当的预防性护理（c）协调对同时感染艾滋病毒和结核病的成人和儿童的护理（具体而言，增加完成适当治疗和随访的同时感染患者的人数）。合并的主要/艾滋病毒/艾滋病EMR对提供者的生产力和时间管理的影响也将被衡量。 在发展中国家资助艾滋病毒/艾滋病护理的机构已经认识到，支付护理费用需要支付收集和管理高质量电子数据的费用。该项目将确定这种电子病历是否也可以用于以最低的额外成本支持初级保健（如果能够在更大规模上证明莫索里奥特的卫生保健提供者的生产力提高的初步证据，也许可以节省成本）。如果是这样的话，那么只要艾滋病毒/艾滋病护理得到资助，这种电子病历就可以持续下去，并且可以继续使用电子病历来管理和改善艾滋病毒/艾滋病和初级保健。