Evaluating the Performance, Impact and Costs of a Large Scale eHealth System Impl

项目总结 这一应用程序满足了对更多和更好的适当证据的迫切需求 选择、实施和使用电子保健(EHealth)系统，以支持护理 发展中国家的艾滋病毒患者。电子健康系统，包括电子病历 (EMR)是加强卫生系统、改善获得卫生服务机会的潜在有力工具 和护理质量，并降低成本。虽然这些技术在各国显示出巨大的前景 其卫生系统面临严峻的财政、基础设施、技术和人力资源 限制，决策者仍然面临的关键问题：(1)eHealth如何促进 资源匮乏环境中的卫生倡议？(2)这种系统如何才能更有效 开发和实施以确保为临床和规划提供高质量的信息 使用？(3)展示了在资源匮乏的环境中对电子健康的大量投资 临床影响，如改善艾滋病毒患者的预后？(4)短期和长期是什么？ 实施这类系统的长期成本，以及如何提高其可持续性？ 虽然电子健康在资源匮乏的环境中激增，但通常用于由 来自包括PEPFAR在内的机构的大量投资，其实施数据，临床 影响和成本非常稀少。像卢旺达和肯尼亚这样的国家，其电子健康计划要求 EMR在全国范围内的推广迫切需要来自严谨和可推广的研究的证据。 这项研究的核心问题是：使用电子健康系统来 收集和管理诊所的临床数据，这些诊所通常位于人员有限的偏远地点，以及 基础设施？它建立在评估开源电子病历系统的关键机会上， OpenMRS，这是由卢旺达卫生部的一个技术团队改编的，并推广到 数百家诊所。到目前为止，已经实现了11个站点，现在是执行 随机对照试验，50个或更多的站点被随机提前或延迟接受该系统。 我们将解决三个相关问题：如何优化系统并确保其稳定， 可用和使用，对临床过程和结果有什么影响，成本是多少 部署和维持这样的系统？临床指标将包括平均CD4计数和 病毒载量，诸如订购实验室检测的活动，以及抗逆转录病毒治疗前的随访失败率 病人。这一结果应该为许多国家针对艾滋病毒和其他疾病的政策和护理提供参考。 我们还将在卢旺达国立大学开设电子健康评估培训课程 公共卫生学院，培训评估员带头设计和开展研究。

Project summary This application addresses the urgent need for more and better evidence on the appropriate selection, implementation and use of electronic health (eHealth) systems to support the care of HIV patients in developing countries. eHealth system including electronic medical records (EMRs) are potentially powerful instruments to strengthen health systems, to improve access to and quality of care, and reduce costs. While these technologies show great promise in countries whose health systems face severe financial, infrastructural, technical and human resource constraints, key questions remain for decision makers: (1) How can eHealth facilitate scale up of health initiatives in resource poor environments? (2) How can such systems be more effectively developed, and implemented to ensure high quality information for clinical and programmatic use? (3) Have the large investments in eHealth in resource-poor environments demonstrated clinical impacts such as improving HIV patient outcomes? (4) What are the short term and long term costs of implementing such systems and how can their sustainability be improved? While eHealth is proliferating in resource poor environments, often for HIV care supported by large investments from agencies including PEPFAR, data on their implementation, clinical impact and costs is very sparse. Countries like Rwanda and Kenya whose eHealth plans call for national rollouts of EMRs critically need evidence from rigorous, and generalizable studies. The core issue being addressed in this study is: What is the benefit of using an eHealth system to collect and manage clinical data at clinics that are often in remote sites with limited staff, and infrastructure? It builds on a critical opportunity to assess an open source EMR system, OpenMRS, that is being adapted by a technical team from the Rwandan MOH, and rolled out to several hundred clinics. With 11 sites implemented to date, this is the ideal time to perform a randomized controlled trial with 50 or more sites randomized to receive the system early or late. We will address three related questions: how to optimize systems and ensure they are stable, usable and used, what are the impacts on clinical processes and outcomes, and what are the costs of deploying and sustaining such systems? Clinical indicators will include mean CD4 count and viral load, activities such as ordering of laboratory tests, and rate of loss to follow up of pre-ART patients. The results should inform policy and care in many countries for HIV and other diseases. We will also create a training course in eHealth evaluation at the National University of Rwanda School of Public Health, training evaluators to take a lead in designing and carrying out studies.