Speech Title

Internet based medical information systems to support healthcare in developing countries

Abstract

HIV/AIDS has become the world’s leading infectious cause of adult deaths and takes its greatest toll in remote, resource poor areas. Dramatic improvements in survival have been seen with use of antiretroviral drugs in developed countries and in Brazil. At the same time TB has reemerged as a growing threat worldwide, worsened by and worsening the HIV epidemic. In many countries multi-drug resistant TB (MDR-TB) is a growing threat. Since 2001, substantial resources have been pledged to treat HIV and TB in developing countries, but concerns have been expressed that many such countries lack the infrastructure to support the complex treatment regimen for these chronic diseases. In this talk I will describes our approaches to improving important infrastructure components for HIV and MDR-TB treatment in very impoverished areas—clinical communications, data analysis, and drug supply management.

 We have created a web-based medical record system, the PIH-EMR to support the treatment of MDR-TB in Peru and the Philippines. The system contains data on the patients’ initial clinical assessment, previous treatments, lab results, current treatment and outcomes. Digital images of the patients X-rays are also stored in the system. Uses of the system include clinical care, telemedicine assessment, analysis and reporting and clinical research. Tracking drug requirements and usage is also a key function. A second version of the system, the HIV-EMR is used in our 7 clinics in rural Haiti through satellite internet connections. This version of the system can be used offline as well as with the web interface to cope with network outages. We are currently evaluating the effects of using such systems on clinical care. A new version of the EMR is under development with colleagues in Africa, the US and the WHO that has been designed to be usable and configurable for multiple projects around the world. It uses open standards and open source code and a prototype is operational in rural Kenya.