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Developing and Implementing a Hybrid Electronic Medical Records System Authors: Ndwapi Ndwapi 1, Hermann Busmann2, Chris Vanderwarker2, Lesego Busang2, William Wester2, Eric Wildenfelt2, Tendani Gaolathe2, Howard Moffat2, Ernest Darkoh3, Donald DeKorte4, Patson Mazonde3, Max Essex 2,5 and Richard Marlink 2,5 Affiliations: 1 Infectious Disease Care Clinic; Princess Marina Hospital, Gaborone, Botswana, 2 Botswana-Harvard AIDS Institute Partnership for HIV Research and Education, 3 Ministry of Health, Gaborone, Botswana, 4 African Comprehensive HIV/AIDS Partnerships, Gaborone, Botswana, 5Harvard School of Public Health, Department of Immunology and Infectious Disease, Boston, USA Track: D14, Surveillance of HIV in clinical settings including STI and TB clinics Issues: Botswana has traditionally maintained medical records through the utilization of out-patient department cards (OPD Cards). Medical information is kept by the patient and travels with the individual. In January 2002 the Botswana government initiated a public antiretroviral treatment program at the Infectious Disease Care Clinic. Within one year the clinic began following over 3,000 patients and providing ARV therapy to approximately 2,500. Developing an accurate clinic-based medical records system was of paramount importance. Description: Clinic staff designed a hybrid medical records system integrating existing chart techniques with optical scanning technology. In addition to the standard doctor’s note in the OPD card, physicians filled out a single page form capturing data on four key areas: 1) ARV drug history and OI medications; 2) toxicities, allergies, and adverse events associated with therapy; 3) opportunistic infections; and 4) patient weight and adherence. Data is captured by a series of check box options (free text available as well). Forms are collected and processed by FAX/scanning to a centralized data station. Once processed, a patient report is generated and issued to the clinic electronically via email or physically on paper. Patients are registered electronically at the clinic and their laboratory results are manually entered by data clerks. Lessons Learned: A hybrid system of paper and electronic charts accommodates unforeseen technical difficulties by immediately producing a physical summary record. Batch processing minimizes computer needs and centralizes data storage. In the event of computer malfunctions, patient data is still available on both the generated summaries and the OPD card. Recommendations: Electronic data collection allows for easy analysis of laboratory usage, trends in clinical management, and crude statistics on clinic operations. This information can rapidly be used to modify clinic function during periods of rapid scale up, with great potential for monitoring multiple sites without internet access. |