We all see the signs that medical information is going digital. You’ve heard the hype about efficiency and accuracy and information at your fingertips but that was for clinics, health centers and operating rooms rooted in middle class America. Do IT tools really exist for those who practice medicine on hundreds of patients in two-week time intervals, in tents before the storm waters recede, or in cinder block clinics off dirt roads?
The answer is yes.
I’ve been deploying systems in developing countries and underserved areas since 2009 and I’ve seen my share of roadblocks. Our first customers were two rural health clinics in the Trans Mara district in Kenya. Together we worked through five iterations of hardware and software with myriad configurations of laptops – laptops as servers, routers, inverters, volt meters, solar controllers and finally, the CliniPAK all-in-one units. Today, we are expanding into all 44 clinics in Trans Mara to have the first all-digital, paperless data collection and reporting district in Kenya. We hope the investment in primary care at this foundational level will set the stage for better understanding of the local disease burden, better allocation of resources, better health service tracking and delivery, and in the end better health outcomes for the people of Trans Mara.
It has not come easy. Here are the barriers to electronic capture: (1) infrastructure, (2) local data sharing to patient record, (3) training/adoption, (4) lack of IT support. Now let’s explore the tools to overcome them.
First, evaluate the site in which you will be working. Is there power, what kind and is it consistent? The best strategy is multiple power options to fall back on and use the most passive first: solar, battery, AC and generator. Electronics can be tricky to convert the power to something useable for your devices, which is why I created the CliniPAK Node designed to be a “pop-up IT” platform. It’s a box that you plug in to a solar panel, 110/240V AC or even a car battery, then turn it on and forget about. This relieves local clinical staff of any burdens worrying about IT needs and consolidates the crazy mess of electronics into one easy on/off switch. There are other nifty packages such as We Care Solar and World Solar that make it easy to reliably negate power concerns without adding an electronics guru to your field team.
Second, consider your connectivity options, both locally between data capture devices (phones, tablets, laptops) and with the broader Internet. The Node emits a local Wi-Fi network that allows users on tablets, phones or laptops to connect and contribute to a patient record. It can also connect via USB modem to the Internet for data synchronization across locations. This is powerful if you are managing multiple sites or have remote team members who want to work with the data in (near) real time. There are also some great forms-based data capture applications that can be loaded directly onto tablets, such as CommCare. We’ve integrated these tools to contribute to our patient record for individuals out in the field. The limitation is that if there is no internet, the data is locked on the tablet until you can connect and synchronize with the cloud.
Which brings us to local data sharing. You’ve seen the problems of all the data being stored on one laptop in a bloated Excel file. Paper forms travel with patients from one station to the next and end up in a pile at the end of the day reducing your visibility on care demand and services provided. When clinicians’ tablets and laptops are connected to the Node, they can enter data to a single database of patient records that can then be accessed by anyone on the network. Suddenly, with the same amount of work, everyone is working together and patients flow smoothly from registration to screening to treatment and documented outcomes.
Finally, medical outreach teams have unique operational demands. With staff joining the team that morning from locations around the world, there is no time for training on a complicated EHR. Or perhaps local staff have minimal computer skills. This is where workflow based software and intuitive touchscreen interfaces lead users through clinical protocols and facilitate patient flow so that even the most reticent and uninitiated user can be won over. We have trained staff on our CliniPAK software within an hour and shadowed one work day to build confidence in point of care data capture. Other, more experienced computer and EHR users can continue on for training on more advanced features or to become super users and administrators on the system.
All this is to say that the barriers for electronic patient health data capture in even the wildest circumstances are coming down. Solutions are out there within a price range and skill level that global health and medical outreach programs can realize a positive return. Technology is advancing and creative groups are out there making sure the other 90 percent of the world can reap the benefits. Electronic patient records are the foundation of the health information infrastructure that we all contribute to whether we are on the ground for weeks, months or years.