Search

Introduction Electronic medical record (EMR) systems can yield many benefit; however, facilities need to meet certain requirements before they are able to successfully implement an EMR. We evaluated the feasibility and utility of conducting EMR readiness assessments (ERAs) to assess readiness of public facilities in Kenya for deployment of an EMR. Method I-TECH supported the Ministry of Health to deploy KenyaEMR, an HIV/AIDS care and treatment EMR developed using the OpenMRS platform, at over 300 healthcare facilities in Kenya. The ERA tool was designed to assess site readiness for KenyaEMR deployment. The assessments measured health facility internal environment in terms of available resources, security, technical infrastructure, and leadership buy-in and support from MOH and stakeholders for EMR implementation. Results From September 2012 to September 2014, a total of 381facilities received at least one ERA. Of these, 343facilities were rated as highly or moderately prepared to adopt an EMR system and proceeded to EMR deployment. 61% of these sites were set up to implement KenyaEMR at point of care, while 39% were set up to implement KenyaEMR for retrospective data entry. Across 38facilities not implemented with an EMR, common reasons that prevented the implementation were lack of reliable power, security issues such as lack of grills on the windows and un-lockable doors, and existence of another EMR system at the site. Conclusions ERAs conducted in a single day site visit were feasible and were instrumental in determining facilities’ EMR implementation decision. Performing ERAs stimulated engagement of facility-level personnel to cultivate a fertile environment for EMR adoption and ownership. The assessments further assisted in resource mobilization, remediation of barriers to deployment, and increased buy-in from Ministry of Health leadership to support EMR implementation work.

Background Variations in the functionality, content and form of electronic medical record systems (EMRs) challenge national roll-out of these systems as part of a national strategy to monitor HIV response. To enforce the EMRs minimum requirements for delivery of quality HIV services, the Kenya Ministry of Health (MoH) developed EMRs standards and guidelines. The standards guided the recommendation of EMRs that met a preset threshold for national roll-out. Methods Using a standards-based checklist, six review teams formed by the MoH EMRs Technical Working Group rated a total of 17 unique EMRs in 28 heath facilities selected by individual owners for their optimal EMR implementation. EMRs with an aggregate score of ≥60% against checklist criteria were identified by the MoH as suitable for upgrading and rollout to Kenyan public health facilities. Results In Kenya, existing EMRs scored highly in health information and reporting (mean score = 71.8%), followed by security, system features, core clinical information, and order entry criteria (mean score = 58.1% − 55.9%), and lowest against clinical decision support (mean score = 17.6%) and interoperability criteria (mean score = 14.3%). Four EMRs met the 60.0% threshold: OpenMRS, IQ-Care, C-PAD and Funsoft. On the basis of the review, the MoH provided EMRs upgrade plans to owners of all the 17 systems reviewed. Conclusion The standards-based review in Kenya represents an effort to determine level of conformance to the EMRs standards and prioritize EMRs for enhancement and rollout. The results support concentrated use of resources towards development of the four recommended EMRs. Further review should be conducted to determine the effect of the EMR-specific upgrade plans on the other 13 EMRs that participated in the review exercise.

the development of equitable, long-term partnerships with local health systems. During our two-year program, HEAL fellows provide clinical service while rotating between an underserved domestic site and an underserved international site in either Haiti, Liberia, India, or Mexico. At each location, fellows work closely with local counterparts selected by our partner organizations, engaging in a curriculum that teaches core components of global health delivery, including project management, leadership, diseases of poverty, social determinants of health, quality improvement, monitoring and evaluation, and faculty development. In addition, both fellows and their counterparts will obtain an online Master of Public Health (MPH) as part of their training. Outcomes & Evaluation: Since the HEAL Initiative will launch in July of 2015, we do not yet have outcomes for the fellowship. However, we plan to implement a rigorous evaluation structure to assess the skill sets of our fellows and the impact the program’s retention of quality health care professionals within resource-limited settings. Going Forward: As with all innovative educational programs, there are unanswered questions about the ideal structure and content of our curriculum. We anticipate a learning curve with our first cohort of fellows. Given our goal of training an interprofessional cohort, we plan on expanding recruitment in the future to include nurses and pharmacists in addition to physicians. Funding: Funding will come from partner site contributions and philanthropy. Our model is designed to be financially sustainable in three years. Abstract #: 02ETC003