EMRs in developing countries - Tracking Patients

Experiencing the US health care system has been an awesome experience for me, as far as technology is concerned. My love for electronics drives me towards ideas of implementing Electronic Medical Records (EMR) in developing countries. A number of major obstacles exist before one even thinks about such endeavors, the biggest being the upfront cost of investing in the development of a good EMR system. Even in the US, despite the availability of technology, the cost has been a major deterring factor for smaller practices and hospitals.

Besides the cost however, implementation issues are equally difficult to tackle. Adoption of EMRs has been notoriously difficult in US, where people are supposedly more computer-literate than most developing countries. A variety of factors are involved here, ranging for workflow disruption to non-user-friendly interface.

There is one issue that is unique to developing countries however: The difficulty of tracking patients. From my own experience in Pakistan, rarely do people have any type of ID. Despite the efforts by tyhe government, the majority population in the rural areas does not have a national ID card. Even those who do have one, most do not use it or carry it. Having these people carry yet another card for healthcare purposes doesn't seem like a feasible option at this point in time. It is very common to see patients with chronic diseases who regularly do not bring their past records with them every time they come to see their physician.

In this context, multiple search methods are necessary to identify past records of patients if an EMR system is to be useful. One such method I have seen is the use of telephone/cellphone numbers for ID purposes. Most people in Pakistan do have access to a phone even if they don't carry any ID. Combining patient names with phone numbers will allow a good tracking method in the short term. Indeed there is a privacy concern here but as other forms of ID become common place, hopefully using EMRs will become much safer.

Email Hell

I recently started my internship at a large health care provider organization, apparently struggling a bit with its IT system. Conversations with some staff members revealed that excessive emails are one of the many headaches that clinicians and other staff have to manage. Some said they receive upto 300 mails a day, of which at least 50% are unnecessary/FYI emails. Another major category of mails is the "CCed" conversations. One person will send a mail to another, but will add a bunch of names in the CC, "Just to let them know". If the other end replies, he/she will rather "Reply-to-all" than just reply to sender. This circle goes on and on and fills mailboxes and traffic with unnecessary communication, leading to wasted time, traffic, energy, frustration, anger and adversely affects "Job-Do-ability" for everyone.

Gmail has something to offer to health care IT systems ... not a product but a useful concept. By having conversations threads bunched together in a single packet, it reduces a lot of clutter from the inbox and reduces to a great extent the need for opening up that mail thread again and again for every new reply that comes in. This is not a solution to the actual problem which requires an clever email policy, but it does offer a good work around for this problem. Indeed this will require certain technological upgrades and may be a revamping of the email system, but it still seems worth it.

Why this blog

Welcome to my first blog on the web. I love the internet and every new technology associated with it, but till this point, I was able to keep myself away from blogging. I finally got inspired from several people...Dr. John Halamka has been key, whom I had the honor of listening to, during a course on Quality Improvement in Healthcare.

My interest in blogging is to share, ideas/opinions about the systems caring (or not) for our health. Hopefully, as I quote my naive observations, some of you will join in by commenting/discussing and increase our understanding of the issues facing us.