Clinical Information Systems as Tools to Improve Quality of Care in Developing Countries: Examples from HIV and TB Treatment Programs
Dr. Hamish Fraser
Harvard Medical School and Partners In Health
The scale-up of HIV treatment in developing countries and the parallel
creation of large scale treatment programs for multi-drug resistant
tuberculosis (MDR-TB) require the creation of systems for chronic
disease management in places where short-term care, or no care at all,
is the tradition. Partners In Health (PIH), a health care non-profit
based in Boston, provides care to some of the poorest communities in
countries such as Haiti, Peru, Rwanda and Lesotho. PIH has pioneered
the treatment of HIV and MDR-TB by focusing both on building capacity
in local communities and bringing the best modern medications,
investigations and training to these impoverished environments.
One of the tools PIH has developed and deployed is a web-based
electronic medical record system to track the treatment of these
patients and their lab results and clinical progress. I will briefly
describe the PIH-EMR and discuss how we use it to reduce medical
errors, delays and oversights in treatment. I will also describe the
evaluations we have performed on the system in use, and discuss the
critical need for systems to reduce loss to follow-up in HIV treatment
programs in Africa.
Dr. Hamish Fraser an Assistant Professor of Medicine at Harvard
Medical School and Associate Physician at the Brigham and Women's
Hospital. As the Director of Informatics and Telemedicine at Partners
In Health he directs the development of web-based medical record
systems and data analysis tools to support the treatment of
drug-resistant tuberculosis and HIV in Peru, Haiti, Rwanda, Lesotho,
Malawi and the Philippines. The first system developed, the PIH-EMR,
currently supports the management and monitoring of over 6500 patients
in treatment for MDR-TB in Peru, and 1000 patients in the Philippines.
Dr Fraser has also led the development of the HIV-EMR, which is used
to support the treatment of HIV patients in rural Haiti. Both of
these systems include data analysis tools, as well as components that
track the current use of medication and predict future medication
needs. The EMR systems used by PIH have been recently designed as part
of an international collaboration to develop flexible, open source
medical record systems in developing countries. The first version of
this OpenMRS system, of which Dr Fraser is a co-founder, went live in
February 2006 in Kenya and in August 2006 in Rwanda. OpenMRS is now
also used to support the PIH projects in Lesotho, and will soon be
rolled out to the new project in Malawi.
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