ABOUT EMR

How did all begin?

The MDS project was started by WHO (World Health Organization) in Sri Lanka at the beginning of the millennium. Several staff members now with Lunar Technologies worked for WHO at the time and helped to set up the project in 5 large State hospitals. In 2006, the project was taken over by Lunar Technologies with funds from the Austrian/ Swiss Red Cross and extended to 27 hospitals in two districts of the Eastern Province.

Multi-disease surveillance (sometimes called epidemiological surveillance) is the ongoing systematic collection, analysis and interpretation of data essential to the planning, implementation and evaluation of public health practice. Its purpose is to prevent and control human disease and injury.

Full notification of infectious cases is essential to prevent outbreaks of disease, and statistical information on all diseases occurring in a country is an essential basis for national and international health policy. However, according to an article in the medical journal The Lancet (June 2005) “…scientists in most parts of the world have to rely on guesswork to understand what makes people sick and why they die.” This lack of reliable health information is a major obstacle to attempts to improve the health of people in developing countries.

Evolution of EHR.mp4

The overall purpose of the MDS project was to improve documentation of the diseases treated in rural hospitals (in accuracy and completeness); to improve the notification of infectious disease to the public health authorities (in speed and completeness) and to automate and improve the production of regular health statistics on hospital patients.

In each of 27 hospitals, a local computer network was set up with a small computer server connected to PCs in each ward. The software was written, the network installed and equipped and the training given by Lunar Technologies staff. It uses the Caché database from the Intersystems Corporation.

Each hospital database was connected with local public health offices via the Internet using a dial-up connection also provided by the project.

Benefit of healthcare

All the patients benefited from the improved clinical documentation that the system brought with it. In the case of infectious disease notifications, the reporting became more legible and more complete as important fields on the forms are not left blank. Patients treated for say malaria or chickenpox were no longer forgotten to be notified. When the first hospital went on line, the Provincial Epidemiologist told us that he received more notifications in the month from that hospital than all the others (without the system) combined. There were also benefits to the hospitals themselves – medical directors of the hospitals benefited from the increased management information available as well as improvement in documentation which the discipline of the computer brought to their staff.

In the case of health statistics, the authorities were able to carry out better data analyses and provide more useful planning and reporting information. The availability of statistical data on out-patients from some of the hospitals, new in Sri Lanka, provided a much clearer overview of the burden of disease. Two of the hospitals produced their quarterly health statistical report one day after the quarter ended, on January 1st of the following year, a task that normally took 6 to 8 weeks.

While Hospital Information Systems have been used in the West for many years, there has been little success in computerizing medical information in low to medium income countries. This has been partly due to the complexity of most high-performance databases and the high price of the hardware necessary to run them. But without computers medical records are often kept on scraps of paper (if at all) and either stored in dusty heaps in the hospitals or given to the patients - sometimes never to be seen again. This project resulted in the computerization of patient and diagnostic data at an affordable cost in 27 rural hospitals in a developing country. It showed that it can be done.

The part of Sri Lanka covered was badly affected by the tsunami of 2004 and the risk of outbreaks occurring was high. The project has resulted in increased notifications to the public health offices of the district and is providing statistical health information on the diseases treated much quicker than before. The application also provides hospital directors with previously unavailable reports such as up-to-the-minute hospital performance indicators, listing of patients in the wards, today's admission and discharges. And in every one of those 27 hospitals it was the health care staff themselves who were entering the data, not administrators or clerks.

The system provides a start to computerization in government and private sector hospitals in a developing country, and should prove useful in other developing countries.

EMR - Flow of patient data

Patient with notifiable disease goes to a hospital
Patient is registered as out-patient (OPD)
Case is not serious, patient sent home and:
Notifiable case flagged in computer
Serious cases sent to admission desk
Registered as in-patient and Bed-Head Ticket (BHT) printed
All data stored on hospital server computer via the LAN
Patient sent to ward where staff can see details and enter working diagnosis
Staff can print off reports such as midnight census, listing of patients, discharge letter
On discharge (or death), final diagnosis entered if different
Discharge record checked by Med Records before case notified
Using this data, management & statistical reports are produced
Notifiable cases, computer generated letter/e-mail to local public health office (MOH)
Notifications stored by MOH in their own computer
MOH can investigate cases by visits of Public Health Inspectors to patient's home