Syzdykova Assel, Malta André, Zolfo Maria, Diro Ermias, Oliveira José Luis
University of Aveiro, Department of Electronics, Telecommunications and Informatics (DETI) / Institute of Electronics and Informatics Engineering of Aveiro (IEETA), Aveiro, Portugal.
BMD Software, Aveiro, Portugal.
JMIR Med Inform. 2017 Nov 13;5(4):e44. doi: 10.2196/medinform.8131.
Despite the great impact of information and communication technologies on clinical practice and on the quality of health services, this trend has been almost exclusive to developed countries, whereas countries with poor resources suffer from many economic and social issues that have hindered the real benefits of electronic health (eHealth) tools. As a component of eHealth systems, electronic health records (EHRs) play a fundamental role in patient management and effective medical care services. Thus, the adoption of EHRs in regions with a lack of infrastructure, untrained staff, and ill-equipped health care providers is an important task. However, the main barrier to adopting EHR software in low- and middle-income countries is the cost of its purchase and maintenance, which highlights the open-source approach as a good solution for these underserved areas.
The aim of this study was to conduct a systematic review of open-source EHR systems based on the requirements and limitations of low-resource settings.
First, we reviewed existing literature on the comparison of available open-source solutions. In close collaboration with the University of Gondar Hospital, Ethiopia, we identified common limitations in poor resource environments and also the main requirements that EHRs should support. Then, we extensively evaluated the current open-source EHR solutions, discussing their strengths and weaknesses, and their appropriateness to fulfill a predefined set of features relevant for low-resource settings.
The evaluation methodology allowed assessment of several key aspects of available solutions that are as follows: (1) integrated applications, (2) configurable reports, (3) custom reports, (4) custom forms, (5) interoperability, (6) coding systems, (7) authentication methods, (8) patient portal, (9) access control model, (10) cryptographic features, (11) flexible data model, (12) offline support, (13) native client, (14) Web client,(15) other clients, (16) code-based language, (17) development activity, (18) modularity, (19) user interface, (20) community support, and (21) customization. The quality of each feature is discussed for each of the evaluated solutions and a final comparison is presented.
There is a clear demand for open-source, reliable, and flexible EHR systems in low-resource settings. In this study, we have evaluated and compared five open-source EHR systems following a multidimensional methodology that can provide informed recommendations to other implementers, developers, and health care professionals. We hope that the results of this comparison can guide decision making when needing to adopt, install, and maintain an open-source EHR solution in low-resource settings.
尽管信息通信技术对临床实践和卫生服务质量产生了巨大影响，但这种趋势几乎仅限于发达国家，而资源匮乏的国家面临许多经济和社会问题，这些问题阻碍了电子健康（eHealth）工具的实际效益。作为电子健康系统的一个组成部分，电子健康记录（EHR）在患者管理和有效的医疗服务中发挥着基础性作用。因此，在基础设施匮乏、工作人员未受过培训且医疗服务提供者设备简陋的地区采用电子健康记录是一项重要任务。然而，低收入和中等收入国家采用电子健康记录软件的主要障碍是其购买和维护成本，这凸显了开源方法是这些服务不足地区的一个良好解决方案。
本研究的目的是根据资源匮乏地区的要求和限制，对开源电子健康记录系统进行系统评价。
首先，我们回顾了关于现有开源解决方案比较的现有文献。我们与埃塞俄比亚贡德尔大学医院密切合作，确定了资源匮乏环境中的常见限制以及电子健康记录应支持的主要要求。然后，我们广泛评估了当前的开源电子健康记录解决方案，讨论了它们的优缺点，以及它们是否适合满足与资源匮乏地区相关的一组预定义功能。
该评估方法允许对现有解决方案的几个关键方面进行评估，如下所示：（1）集成应用程序；（2）可配置报告；（3）自定义报告；（4）自定义表单；（5）互操作性；（6）编码系统；（7）认证方法；（8）患者门户；（9）访问控制模型；（10）加密功能；（11）灵活的数据模型；（12）离线支持；（13）原生客户端；（14）Web客户端；（15）其他客户端；（16）基于代码的语言；（17）开发活动；（18）模块化；（19）用户界面；（20）社区支持；（21）定制。针对每个评估解决方案讨论了每个功能的质量，并进行了最终比较。
资源匮乏地区对开源、可靠且灵活的电子健康记录系统有明确需求。在本研究中，我们采用多维度方法对五个开源电子健康记录系统进行了评估和比较，可为其他实施者、开发者和医疗专业人员提供明智的建议。我们希望这种比较结果能够在需要在资源匮乏地区采用、安装和维护开源电子健康记录解决方案时指导决策。
