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

项目摘要 这一应用程序解决了迫切需要更多和更好的证据， 选择、实施和使用电子保健系统，以支持 发展中国家的艾滋病患者。电子医疗系统，包括电子病历 （电子病历）是加强卫生系统、改善获得 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， 这些国家的卫生系统面临严重的财政、基础设施、技术和人力资源问题， 然而，由于各种限制因素，决策者仍面临一些关键问题：（1）电子保健如何促进扩大 在资源贫乏的环境中采取保健措施？(2)这样的系统如何才能更有效地 开发和实施，以确保临床和计划的高质量信息 使用？(3)在资源贫乏的环境中对电子保健的大量投资是否得到证明 临床影响，如改善艾滋病毒患者的结果？(4)什么是短期和长期 实施这些系统的长期成本以及如何提高其可持续性？ 虽然电子保健在资源贫乏的环境中迅速发展，但通常是由 包括总统艾滋病紧急救援计划在内的机构的大量投资，关于其实施的数据， 影响和成本都很低。像卢旺达和肯尼亚这样的国家，他们的电子健康计划要求 各国推出电子病历系统迫切需要来自严格和可推广的研究的证据。 本研究中要解决的核心问题是：使用电子健康系统的好处是什么？ 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？它建立在一个评估开源EMR系统的关键机会之上， 卢旺达卫生部的一个技术小组正在对OpenMRS进行调整， 几百个诊所。到目前为止，已经有11个站点实现了，这是执行 随机对照试验，50个或更多临床试验机构随机接受系统的早期或晚期治疗。 我们将解决三个相关的问题：如何优化系统并确保它们稳定， 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、实验室检查的排序等活动以及ART前随访的丢失率 患者研究结果将为许多国家制定艾滋病毒和其他疾病的政策和护理提供信息。 我们还将在卢旺达国立大学开设电子保健评估培训课程 公共卫生学院，培训评估人员在设计和开展研究方面发挥带头作用。

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.