EMR-lite: A Mobile Digital Medical Record for Primary Healthcare in Low- and Middle-Income Countries
D-tree's newest product is an agile Electronic Medical Records system designed explicitly for primary healthcare settings in low- and middle-income countries. The phone- or tablet-based system works without network connectivity and can send and receive data to a server with very limited network. This allows users in a clinic to document and share patient records and maintain a single patient chart, which improves access to patient information and strengthens decision-making at the point of care.
A World Health Organization survey found that approximately 60% of high-income countries report using mobile health communication tools to improve treatment compliance, while only 30% of low- and middle-income countries report using these tools . Similarly, electronic medical records (EMRs) are ubiquitous in developed countries, but they have had difficulties adapting to low- and middle-income countries and especially to small, rural clinics. Often, rural clinics face a number of difficulties when trying to convert to an electronic medical record:
Connectivity Issues: EMRs must be able to work with no mobile data or wifi and quickly and easily sync when the network is available.
Mobility Barriers: Desktop computers and laptops can be prohibitively expensive and difficult to keep charged in areas with unreliable or non-existent electricity. Many EMRs are not available on mobile devices, making them unsuitable for primary care settings.
Limited Interoperability: The digital health landscape has a plethora of systems. From national DHIS-2 platforms to the home-grown system being used at referral hospitals, easy, cost-effective interoperability is essential for an EMR. Many EMRs, however, rely on data and integration models that make bidirectional interoperability either expensive or impossible.
D-tree’s new EMR-lite system addresses these issues with a modern, easily configurable “mobile-first, cloud based” EMR system for LMICs. This mobile solution walks the user, namely nurses or clinicians managing patient care, through documenting a patient’s record, starting with patient registration and history to log and update a patient’s personal and medical information. After entering the patient’s medical history, the user can then conduct a patient visit to gather key information including the client’s complaints, basic vital signs, and anthropometrics. The user is then alerted to any diagnoses and recommended treatment for the patient and can document lab orders and results when available. At the end of the visit, the system alerts the user to any clinical flags in the patient’s record, such as high blood pressure or fever. The user then documents patient diagnoses, and continues to schedule a follow-up appointment, if necessary.
The system also includes the ability to edit a patient record, view history and clinical information from previous visits, and automate billing calculations based on services provided and diagnoses to support the user in all aspects of the visit and assist with the continuum of care.
As an offline solution requiring limited connectivity for data syncing and integration, we anticipate this system will streamline the patient visit workflow, reduce paper documentation, and provide primary health workers with clear guidance and confidence throughout their work activities. The solution supports data collection and flags any alerts (e.g. lab values indicative for conditions) while also functioning as a comprehensive decision support system that can be easily configured to the extent desired (e.g. for integrated management of childhood illness or STI management). A base version of this solution already exists and can be modified for different contexts.
The base version workflow allows clinicians to securely identify, record, and access patient information. Easily configurable, the system can be updated to meet specific program area patient record documentation and coordination needs to facilitate easy access to a patient record.
Other core benefits of the system include:
Offline capability, rapid syncing with limited connectivity
Phone- or tablet-based, with the option to use on any Android device
Easy integration with DHIS2, biometrics, SMS platforms, and other systems
Agile configuration and deployment: Organizations can quickly add and modify content when they change policies or want to address additional medical conditions
Unique IDs: The system can generate unique IDs and use innovative technology like NFC cards, QR codes, and biometrics to support unique identification. These unique IDs and innovative technologies decrease likelihood of duplication, allow for documentation of patients moving between clinics, and better support tracking of patients allowing for continuum of care.
In addition to incorporating a mobile application solution, the system also includes dashboards and reports to facilitate program feedback and improvement cycles:
Customizable online dashboards:
Real-time program monitoring
In-app supervisory tools:
Offline-first monitoring tools
Health worker feedback:
Individual and facility-based performance tracking
When designed and utilized well, EMRs speed up clinical and administrative workflows, allow for data to be shared between multiple providers, and improve long-term, comprehensive care for patients. With our EMR-lite solution, we’ve created a highly customizable and operational base system that focuses on the entire system to reduce medical errors, streamline collection and monitoring of patient information, and easily visualize trends and issues as they arise. This agile system allows for rapid configuration, rapid deployment, and server-less operation. Our approach focuses not only on the technology at hand, but on the entire system, ensuring it is usable and helpful for the specific context in which it is employed.
Click here view our Vimeo video demo of the EMR-Lite, and please get in touch if you are interested in learning more!
mHealth: New Horizons for Health through Mobile Technologies. Geneva: World Health Organization; 2011.
Zayyad, M. A., & Toycan, M. (2018). Factors affecting sustainable adoption of e-health technology in developing countries: an exploratory survey of Nigerian hospitals from the perspective of healthcare professionals. PeerJ, 6, e4436. http://doi.org/10.7717/peerj.4436