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

评估大规模电子医疗系统实施的性能、影响和成本

• 批准号: 9126874
• 负责人: JEANINE CONDO
• 金额: $ 49.5万
• 依托单位: NATIONAL UNIVERSITY OF RWANDA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2016-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9126874
• 关键词: Evaluating; Performance; Impact; Costs; Large

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.

项目概要 该申请解决了对更多更好证据的迫切需要 选择、实施和使用电子医疗 (eHealth) 系统来支持护理 发展中国家的艾滋病毒患者。电子医疗系统，包括电子病历 （电子病历）是加强卫生系统、改善获得医疗服务的潜在强大工具 和护理质量，并降低成本。虽然这些技术在各国展现出巨大的前景 其卫生系统面临严峻的财政、基础设施、技术和人力资源问题 由于存在制约因素，决策者仍面临以下关键问题：(1) 电子卫生保健如何促进扩大规模 资源匮乏环境中的健康举措？ (2)如何让这样的系统更加有效 开发和实施以确保临床和规划的高质量信息 使用？ (3) 在资源匮乏的环境下对电子卫生保健进行大量投资 临床影响，例如改善艾滋病毒患者的治疗结果？ (4)什么是短期和长期 实施此类系统的短期成本以及如何提高其可持续性？ 虽然电子医疗在资源匮乏的环境中不断普及，但通常用于艾滋病毒护理 来自包括总统防治艾滋病紧急救援计划（PEPFAR）在内的机构的大量投资、实施数据、临床 影响和成本非常少。卢旺达和肯尼亚等国家的电子医疗计划要求 全国范围内电子病历的推广迫切需要来自严格且可推广的研究的证据。 本研究要解决的核心问题是：使用电子医疗系统有什么好处？ 收集和管理通常位于人员有限的偏远地点的诊所的临床数据，以及 基础设施？它建立在评估开源 EMR 系统的关键机会之上， OpenMRS 正在由卢旺达卫生部的技术团队进行改编，并推出到 数百家诊所。迄今为止已实施了 11 个站点，现在是执行 随机对照试验，有 50 个或更多地点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， 可用和已使用，对临床过程和结果有什么影响，以及成本是多少 部署和维护此类系统？临床指标包括平均 CD4 计数和 病毒载量、安排实验室检测等活动以及 ART 前随访的损失率 患者。研究结果将为许多国家针对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卫生评估培训课程 公共卫生学院，培训评估人员带头设计和开展研究。