Chaplin Beth, Meloni Seema, Eisen Geoffrey, Jolayemi Toyin, Banigbe Bolanle, Adeola Juliette, Wen Craig, Reyes Nieva Harry, Chang Charlotte, Okonkwo Prosper, Kanki Phyllis
Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA.
AIDS Prevention Initiative in Nigeria, Abuja, Nigeria.
Int J Med Inform. 2015 Jan;84(1):58-68. doi: 10.1016/j.ijmedinf.2014.09.006. Epub 2014 Sep 30.
The implementation of PEPFAR programs in resource-limited settings was accompanied by the need to document patient care on a scale unprecedented in environments where paper-based records were the norm. We describe the development of an electronic medical records system (EMRS) put in place at the beginning of a large HIV/AIDS care and treatment program in Nigeria.
Databases were created to record laboratory results, medications prescribed and dispensed, and clinical assessments, using a relational database program. A collection of stand-alone files recorded different elements of patient care, linked together by utilities that aggregated data on national standard indicators and assessed patient care for quality improvement, tracked patients requiring follow-up, generated counts of ART regimens dispensed, and provided 'snapshots' of a patient's response to treatment. A secure server was used to store patient files for backup and transfer.
By February 2012, when the program transitioned to local in-country management by APIN, the EMRS was used in 33 hospitals across the country, with 4,947,433 adult, pediatric and PMTCT records that had been created and continued to be available for use in patient care. Ongoing trainings for data managers, along with an iterative process of implementing changes to the databases and forms based on user feedback, were needed. As the program scaled up and the volume of laboratory tests increased, results were produced in a digital format, wherever possible, that could be automatically transferred to the EMRS. Many larger clinics began to link some or all of the databases to local area networks, making them available to a larger group of staff members, or providing the ability to enter information simultaneously where needed.
The EMRS improved patient care, enabled efficient reporting to the Government of Nigeria and to U.S. funding agencies, and allowed program managers and staff to conduct quality control audits.
在资源有限的环境中实施总统防治艾滋病紧急救援计划（PEPFAR）项目时，需要在以纸质记录为主的环境中以前所未有的规模记录患者护理情况。我们描述了在尼日利亚一项大型艾滋病毒/艾滋病护理和治疗项目启动之初建立的电子病历系统（EMRS）的开发情况。
使用关系数据库程序创建数据库，以记录实验室检查结果、所开和所发药物以及临床评估情况。一组独立文件记录了患者护理的不同要素，通过实用程序链接在一起，这些实用程序汇总国家标准指标的数据并评估患者护理以改进质量，跟踪需要随访的患者，生成所发抗逆转录病毒治疗方案的计数，并提供患者对治疗反应的“快照”。使用安全服务器存储患者文件以进行备份和传输。
到2012年2月该项目转由APIN进行国内本地管理时，全国33家医院使用了该电子病历系统，已创建4947433份成人、儿科和预防母婴传播记录，并继续用于患者护理。需要对数据管理人员进行持续培训，并根据用户反馈对数据库和表格进行迭代修改。随着项目扩大以及实验室检查数量增加，尽可能以数字格式生成结果，并可自动传输到电子病历系统。许多较大的诊所开始将部分或全部数据库与局域网连接，使更多工作人员能够访问，或在需要时提供同时输入信息的功能。
电子病历系统改善了患者护理，能够向尼日利亚政府和美国资助机构进行高效报告，并使项目经理和工作人员能够进行质量控制审计。
