346 Implementing an Emergency Medicine Health Information System in Baghdad, Iraq

Abstract

Prior to 2008, Iraq had a rudimentary and poorly functioning system of emergency medicine. Over the past 3 years, International Medical Corps (IMC), an international humanitarian aid organization, has implemented a development and capacity building project I-EMCD (Iraq Emergency Medical Care Development) via the generous support of AusAID (Australian Agency for International Development). In an effort to assist the Iraq Ministry of Health (MoH) in monitoring the newly instituted ambulance service and training of emergency department personnel (doctors, nurses, paramedics), the EM HIS was designed and introduced by IMC and expert medical consultants from the Harbor-UCLA Emergency Medicine Global Health Program for in-depth tracking of key clinical indicators. Additionally, a system-wide bed tracking system was created to help understand resource utilization and ED crowding for all hospitals in Baghdad. Data collection for the system began in February 2011 and is ongoing currently. To implement and measure the output of a novel Emergency Medicine Health Information System (EM HIS), an electronic data tracking system designed to meet the needs of the emergency care system in Baghdad, Iraq. The EM HIS system was created using a MySQL database with a Web-based user interface. JAVA and PHP were used to create interactive Web form versions of the charting documents to facilitate data entry into the system. Multiple authentication algorithms were used (including MD5 and SHA1 encryption) to reinforce security of the database. An Emergency Department Chart (EDC) and Ambulance Run Report (ARR) were created to track and store information which was subsequently uploaded to the electronic database. Paper versions of the EDC were distributed to all Baghdad emergency departments and paper versions of the ARR were distributed to all ambulance dispatch centers. By decree of the Iraqi MOH, the ED Chart (EDC) document has replaced a version of the chart formerly used for ED documentation, and the ARR is the first of its kind to document clinical information for ambulance transports in Iraq. For the EDC, 26,978 entries were collected in the first 8 weeks of the project. An average of 19 charts per day, per hospital have been uploaded to the database (range: 2-48 charts/day/hospital). During the initial collection period, completeness of the new chart has been an issue with essential variables such as chief complaint and discharge diagnosis being variably completed with %CC (avg =61%, range 0-99%) and %Diag (avg = 17%, range 1-70%). This study demonstrates that it is possible to launch a comprehensive EM HIS in a low to middle-income country that is emerging from conflict. Although there are numerous inherent difficulties working in Iraq given ongoing security concerns, political uncertainty, and institutional inertia, we were able to successfully achieve implementation of this novel EM HIS system. The impact of this system on improving emergency care in Baghdad is only beginning to be realized. A robust EM HIS will generate important information about key clinical indicators which will permit targeted interventions to improve the delivery of emergency care in Iraq.