Raut Anant, Yarbrough Chase, Singh Vivek, Gauchan Bikash, Citrin David, Verma Varun, Hawley Jessica, Schwarz Dan, Harsha Bangura Alex, Shrestha Biplav, Schwarz Ryan, Adhikari Mukesh, Maru Duncan
Possible.
ThoughtWorks India.
J Innov Health Inform. 2017 Jun 23;24(2):862. doi: 10.14236/jhi.v24i2.862.
Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal, and its subsequent expansion to an additional public sector facility.DevelopmentThe electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology, and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking; and 4) effectiveness for quality improvement initiatives.
For these purposes, we adapted Bahmni, a product built with open-source components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management, and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality, and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal.DiscussionOver the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty.
在全球范围内，电子病历是现代医疗系统基础设施的核心。然而，绝大多数电子病历是为资源丰富的环境设计的，在贫困地区并不可行。在此，我们描述了尼泊尔农村一家公共部门区级医院电子病历的设计与实施，以及随后将其扩展到另一家公共部门机构的情况。
开发
1）整合住院、手术、门诊、急诊、实验室、放射科和药房等各医疗点的系统；2）有效提取数据以进行影响评估和政府监管；3）优化长期护理服务和患者跟踪；4）有效推动质量改进举措。
应用
出于这些目的，我们采用了Bahmni，这是一款由开源组件构建的产品，用于患者跟踪、临床协议、药房、实验室、影像、财务管理和供应物流。我们与政府官员密切合作，于2015年2月部署了该系统，增加了额外功能，并在接下来的一年中对系统进行了迭代改进。这段经历使我们能够在不到四周的时间内在该国另一个地区的另一家区级医院部署该系统。我们讨论了实施过程中遇到的挑战以及为在尼泊尔农村地区为公共部门构建电子病历所采取的策略。
讨论
在18个月的时间里，我们成功开发、部署并迭代了电子病历，然后仅用四周时间就在另一家机构部署了优化后的产品。我们的经验表明，即使在农村贫困地区，为公共部门提供综合电子病历也是可行的。
