Electronic Medical Records in Africa

I have to talk a little bit about what I came to Rwanda to do, and some of the lessons I learned. My trip started out with a week-long conference at the posh Kigali Serena Hotel, where I worked with the World Health Organization and governments of several central and western African nations including Rwanda, crafting policy and architecture guidelines for eHealth. Us Americans are naturally amazed by this – if we in the United States can’t figure out how to effectively deploy electronic medical record systems, how can Rwanda? Nigeria? Ethiopia? Tanzania? But the really cool thing is how unencumbered they all are – they are open books ready to do this stuff right. They have the opportunity to avoid the ridiculous issues we have here, like bureaucratic IT contractors who convince complicated hospital networks to let them send in 200 people to bumble around with computers and write lengthy processes for two years, only to be left with a system that meets nobody’s real needs. (Sorry, that was kind of a lengthy, bumbling example!) And they have a mission – a mission in addition to the goals of practice efficiency and streamlining of patient care (they want that, too). But this other mission is to really track and properly treat HIV/AIDS and Tuberculosis patients. I didn’t know this until recently, but if you are on Anti-Retrovirals for AIDS or on the TB treatment program (I don’t know what that’s called), you absolutely MUST take your meds according to your treatment plan. They are not nearly as effective otherwise. And can you imagine how hard it would be to track patients and their individual plans, track their test results, track whether they’ve picked up their meds at the pharmacy, track their scheduled weekly treatment appointments, track who’s paying for all of this, without a good computer system? So many people slip through the cracks. These Sub-Saharan African governments seem to really get how devastating these diseases have been to their economies, and they want so badly to control them, reign them in, and ease population suffering as much as possible. How can you re-instill economic activity and growth with a large percentage of your population too sick to work? (By the way, I can just hear some of you skeptics and realists reacting and telling me all about the corrupt government officials who funnel money away from important care and treatment programs. I am sure that also happens – I’m not a total idealist – I’m just telling you that I saw a really refreshing other side to that picture. I saw representatives from Ministries of Health across this region really dedicating themselves to technologies that they believe can help their countries.) Overall, I think it’s exciting. I think soon in Rwanda, you will be able to walk into these little one- or two-room village health clinics with dust on the floor and people lined up outside, and you will see a computer in the corner, with power and internet (um, at least sometimes). And I think it’ll be really beneficial. Doctors or nurses will be able to access recommended treatment plans for patients of a specific diagnosis. Community Health Workers who help administer drugs can enter and track commonly seen side-effects – which is especially important for new drugs being introduced to this market. Patients can go to the district hospital for emergency care, and the clinicians there will be able to quickly access their basic health summary to understand who they’re treating – whether it’s an AIDS patient, for example, or access a list of their allergies or adverse reactions to drugs. Yes, there are a lot of other problems in Africa – violence in the Congo, potential famine in Kenya, etc. – but it is cool to see that there are also steps being taken in many Ministries to build infrastructure that will help their countries move forward.