Medical records and mobile phones for maternal health

As an organization dedicated to providing great care while being financially sustainable, Jacaranda Health is a strong proponent of automated health management information systems and electronic medical records (EMR), so called ‘eHealth’ systems. A good eHealth system will help us keep rigorous track of our time management, our inventory management, our money management – and, most importantly, our patients’ health outcomes.

Setting up an EMR system is challenging. Even in well-funded practices, implementers struggle to digitize existing paper records, design electronic forms that are easy for clinicians and administrators to use, and establish tech support to maintain the digital records.  So although the benefits of EMR are widely acknowledged, EMR systems haven’t seen broad implementation.

Jacaranda is well-positioned to leap some of the most common EMR hurdles: As a young organization, we don’t have reams of old paperwork to convert or entrenched habits to break. We also have strong technical expertise. But we do have some specialized needs and constraints that will sound familiar to many health providers in Africa and Asia. Power outages are common in east Africa, so our systems can’t rely on consistent electricity. We are operating a mobile clinic, which means that desktop computers – increasingly a fixture in Western exam rooms – are too bulky for us.  And in order to keep our fees low and our business scalable, we have to be ruthless about keeping our costs low: Laptops and netbooks are not great options for us, and it goes without saying that we won’t be able to give each of our nurses an iPad.

For us, the solution has been mobile phones, whose long battery life and portability are tough to beat. Phones with data connectivity to the near-ubiquitous mobile broadband network in Kenya are widely available, and getting cheaper all the time. It only takes a few minutes for patient-data forms to be installed on mobile phones, and if we need to update the forms in the future, doing so is as easy as another download.

Another key advantage is that phones are not intrusive. It’s important that our nurses explain what the phones are for – “here, I’m entering your blood-pressure numbers” – so that our patients understand that the phone is part of, and not a distraction from, their care. Once that’s established, though, our nurses can hold the phone and talk to a patient at the same time, rather than shifting focus back and forth between the patient and a computer screen.

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When there is electronic medical record-keeping at the actual point of care, a provider can pull up a patient’s history in real time and figure out if she has suffered from previous pre-term labor without having to rifle through a sheaf of papers. Even more critically, a good EMR system can help catch warning signs: a patient whose hemoglobin is on the low side will be flagged for anemia treatment, and a high blood glucose test result will trigger a suggestion for further testing for gestational diabetes. An electronic system can even integrate how-to training videos, or timers that require that rapid tests have been given enough time to work before the provider enters the results.

These benefits are plenty valuable within the traditional physician-centered paradigm for medical care. But they can be game-changers in contexts where physicians are too few or too expensive. At Jacaranda, our services are provided by skilled nurses. An EMR system accessed through a smartphone or low-cost tablet that provides guidance on care protocols will let us open more clinics quickly while ensuring a high standard of care – meaning that we can see more patients, sooner, and grow into more areas where high-quality maternal-health services are not currently available.

The smartphone or tablet-enabled EMR system of our dreams is not yet available off the shelf. While we design and build that system, we will be using combination of open-source products: OpenMRS  for the records themselves, OpenXData  for the mobile forms that work on the phones, and a pioneering service called MOTECH, which our Chief Operating Officer, Aliya Walji, developed for use in Ghana, to link the two together. The important thing for us, though, is that we have built it into our practice from day one: Our nurses have been entering data electronically from the very first patient, and we are using this opportunity to define and refine our needs based on our experiences in the field.

Ultimately, the benefits of our point-of-care EMR will be visible in every part of our business. We’ll be able to automate reminder messages to our clients’ mobile phones, sending targeted appointment reminders based on gestational age and our mobile clinic schedule, and savings-plan reminders for mothers who are saving up for delivery. At the same time, our system will help us monitor how many antenatal and post-natal visits we are doing per clinic or per month, and understand our major sources of financial profit and loss. We will be able to track the rates of the various obstetric complications we treat, and make sure we’re handling emergency situations and referrals in accordance with our protocols.

Healthcare providers all over the world are excited about the possibilities of EMR. At Jacaranda, we are evangelists for it. A good records system can be what makes high-quality care at a low cost possible. We will update you with our experiences of our point-of-care EMR and other eHealth and mobile technology based health innovations in action.

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