HIT in Low Resource Countries

At the recent HIMSS Annual Conference held March 3-7 in New Orleans, researchers from the Regenstrief Institute discussed and demonstrated how the Open Health Information Exchange (OpenHIE) operates in Rwanda.

OpenHIE an open source HIE using a community approach, was developed by the Regenstrief Institute, Jembi Health Systems, and Instedd. These partners initially came together to improve the national health infrastructure in Rwanda with support from the U.S. President’s Emergency Plan for AIDS Relief.

To accomplish the mission, the group collaborated with the Rwandan Ministry of Health on the Rwanda Health Enterprise Architecture (RHEA) project initially supported by the Rockefeller Foundation and the International Development Research Center.

OpenHIE was first implemented in rural Rwanda to create an integrated health information system that would improve maternal care delivery at health centers throughout the country. The initial clinical focus for the system centered on developing a shared EHR for expectant mothers visiting prenatal clinics in eastern Rwanda. The project enables access to an expectant mothers’ health information that includes details from visits to clinics and data obtained by community health workers.

The software developed by the collaboration was displayed at the HIMSS conference, demonstrating how OpenHIE helped in the case of a pregnant Rwandan patient who developed medical complications but was able to be seen across the spectrum of the country’s healthcare system.

In another research project directed toward helping in resource-limited settings, a large randomized controlled study led by the Regenstrief Institute was initiated to rigorously demonstrate how HIT can improve compliance with patient care guidelines by clinicians in developing countries.

The researchers found that overdue clinical tasks were more likely to be completed when clinicians received computerized reminders to perform tests to diagnose HIV in infants, provide chest X-rays to rule out TB, perform laboratory tests for HIV along with kidney and liver function tests, and provide referrals so that malnourished children can receive dietary support.

The findings from this study have already propelled the use of computer-generated clinical reminders for the care of adults and children in over 50 additional clinics in Western Kenya. All are Academic Model Providing Access to Healthcare (AMPATH) sites initiated by a partnership with Moi University, Moi Teaching and Referral Hospital, and a consortium of North American institutions led by the Indiana University (IU) School of Medicine.

So far, in response to the challenge of providing life-saving HIV care, AMPATH has enrolled over 160,000 HIV-positive people with almost 2,000 new patients being enrolled each month at over 60 urban and rural clinic sites throughout Western Kenya.

According to Regenstrief Institute investigator Martin Chieng Were, MD., and Assistant Professor of Medicine at the IU School of Medicine, “Many countries in Africa and other developing settings are investing heavily in health information systems. We need to provide evidence of the benefits, costs, and impact of these systems to be able to decide on the right policy decisions.”

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