Abstract
BackgroundElectronic medical record (EMR) systems are increasingly being adopted to support the delivery of health care in developing countries and their implementation can help to strengthen pathways of care and close gaps in the HIV treatment cascade by improving access to and use of data to inform clinical and public health decision-making.MethodsThis study implemented a novel cloud-based electronic medical record system in an HIV outpatient setting in Western Kenya and evaluated its impact on reducing gaps in the HIV treatment continuum including missing data and patient eligibility for ART. The impact of the system was assessed using a two-sample test of proportions pre- and post-implementation of EMR-based data verification and clinical decision support.ResultsSignificant improvements in data quality and provision of clinical care were recorded through implementation of the EMR system, helping to ensure patients who are eligible for HIV treatment receive it early. A total of 2,169 and 764 patient records had missing data pre-implementation and post-implementation of EMR-based data verification and clinical decision support respectively. A total of 1,346 patients were eligible for ART, but not yet started on ART, pre-implementation compared to 270 patients pre-implementation.ConclusionEMR-based data verification and clinical decision support can reduce gaps in HIV care, including missing data and eligibility for ART. A cloud-based model of EMR implementation removes the need for local clinic infrastructure and has the potential to enhance data sharing at different levels of health care to inform clinical and public health decision-making. A number of issues, including data management and patient confidentiality, must be considered but significant improvements in data quality and provision of clinical care are recorded through implementation of this EMR model.
Highlights
Electronic Medical record (EMR) systems are increasingly being adopted to support the delivery of health care in resource-constrained settings and their implementation is amenable to chronic diseases, including HIV. [1,2,3,4] The ultimate goal of an HIV program is to achieve sustained viral suppression and improved quality of life, for which an individual must be diagnosed as early as possible after infection, linked to care, remain engaged in care and receive antiretroviral therapy (ART) where medically indicated. [5]Accessing HIV treatment is only part of the HIV care and treatment continuum, which is a long-term process that moves individuals through a set of stages beginning with HIV diagnosis and aiming to achieve durable viral suppression
Significant improvements in data quality and provision of clinical care were recorded through implementation of the Electronic medical record (EMR) system, helping to ensure patients who are eligible for HIV treatment receive it early
A cloud-based model of EMR implementation removes the need for local clinic infrastructure and has the potential to enhance data
Summary
Electronic medical record (EMR) systems are increasingly being adopted to support the delivery of health care in developing countries and their implementation can help to strengthen pathways of care and close gaps in the HIV treatment cascade by improving access to and use of data to inform clinical and public health decision-making
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