Using a web-based electronic medical record
in a developing country setting

Managing a complex disease such as drug-resistant tuberculosis (TB) in a developing-country setting is a challenge that has only recently started to be met. In addition to excellent clinical skills and access to resources such as medications, this type of project demands proper data management. Multidrug-resistant strains of TB (MDR-TB) further complicate disease treatment, and add to the importance of maintaining well-organized patient data. Partners in Health (PIH) is faced with this challenge in Peru.

To meet this challenge, PIH is using a web-based electronic medical record (EMR) to track patient data. By putting this tool on the Web, it gives internationally-based physicians access to patient information from any location with an internet connection. The system, which holds data on over 2000 Peruvian patients, has three main functions:

1. Individual clinical care ? physicians are able to view summaries that contain demographic data, drug sensitivity results and other laboratory results, current and previous regimen data, allergies and other relevant patient information. The system generates warnings and reminders for potential problems, such as patients taking drugs to which they are resistant. We recently implemented a nurse order entry system with decision support that provides alerts for allergies or medication doses that are inappropriate for a given weight. Additionally, we upload digital images of patient x-rays and CT scans so that doctors can review them when the physical image is unavailable. Finally, we will begin experimenting data downloads on Palm Pilots¢ç using the AvantGo¢ç application on the web.

2. Patient group analysis ? we have developed a series pages that automate aggregate patient analysis. These pages are useful in identifying groups of patients that may need special attention, and for creating reports for public health reporting or for funding organizations.

3. Drug supply management ? this is a powerful function in projecting future drug needs. We can calculate needs on a month-by-month basis, or for the full two years of treatment.

EMR use for patient data is a relatively new phenomenon, particularly in the developing world. As little has been published on the subject, there is a compelling need to continue to assess the best approaches to medical information management in the developing world. Our studies have shown that a low-cost, web-based electronic medical record can be used effectively to help in the treatment of a complex disease such as MDR-TB.

Additionally, a well-optimized system should help clinicians to save time, and computerizing patient data can add an element of robustness that does not exist with the paper chart. Furthermore, there exists great potential to use these tools in HIV management in developing countries, as it too is a disease with complex treatment regimens. Further studies of the PIH-EMR will be very valuable in assessing the best way to support the management of chronic diseases in developing countries.

December, 2003

Harvard Medical School, Sharon Choi