Int J Med Inform - Scale-up of networked HIV treatment in Nigeria: creation of an integrated electronic medical records system.

Tópicos

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Resumo

JECTIVES: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.

Resumo Limpo

jectiv implement pepfar program resourcelimit set accompani need document patient care scale unpreced environ paperbas record norm describ develop electron medic record system emr put place begin larg hivaid care treatment program nigeriamethod databas creat record laboratori result medic prescrib dispens clinic assess use relat databas program collect standalon file record differ element patient care link togeth util aggreg data nation standard indic assess patient care qualiti improv track patient requir followup generat count art regimen dispens provid snapshot patient respons treatment secur server use store patient file backup transferresult februari program transit local incountri manag apin emr use hospit across countri adult pediatr pmtct record creat continu avail use patient care ongo train data manag along iter process implement chang databas form base user feedback need program scale volum laboratori test increas result produc digit format wherev possibl automat transfer emr mani larger clinic began link databas local area network make avail larger group staff member provid abil enter inform simultan neededconclus emr improv patient care enabl effici report govern nigeria us fund agenc allow program manag staff conduct qualiti control audit

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