Onricha (Natty) Jumreornvong
“During my time volunteering as a pediatric surgeon in rural Thailand, I was supposed to operate on a 13 year old girl who was sexually assaulted and thus, pregnant with HIV and AIDs,” said Dr. Wongpichetchai, a surgeon volunteering for the indigenous villagers in rural Thailand. “However, due to misplaced medical records, I went to the wrong village and my patient died giving birth to her son.”
Dr. Wongpichetchai is not the only one who believes that there’s a gap in proper healthcare delivery in rural areas of developing countries. According to Dr. Paul Wise, a Professor of Pediatrics and Health Policy at the Stanford School of Medicine, the combination of a lack of infrastructure and a lack of trained, experienced staff in developing countries poses a significant barrier to healthcare delivery. Particularly in rural areas, healthcare delivery could be streamlined by taking advantage of electronic information systems, which, Dr. Wise proposes, could be“important [components] in many healthcare projects in the developing world.” In accord with Dr. Wise’s recommendation to implement electronic health records internationally, ORist, a technology company started by Stanford students, aims to develop a way to store and access the medical records of indigenous and immigrant patients.
ORist analyzed the function of electronic medical record (EMR) systems in developing countries and improves upon flaws in the status quo system associated with addressing patients without ID numbers or consistently spelled names across languages. A pilot program implementing Qrist in rural Southeast Asia provides a case study of how electronic medical records (EMR) systems function in developing countries.
In Thailand, nearly a million indigenous villagers and forest dwellers are treated as outsiders and are refused citizenship even though many are natives to the land. Since the villagers do not have government IDs, do not speak the common language and are nomadic, they often face barriers to obtaining healthcare. QRist leverages fingerprint scanning technology featured in new and upcoming smartphones to make patient records accessible through fingerprints. Dr. Wongpichetchai, who uses QRist’s software to access medical records for over 5,000 patients, stated, “Practical lessons in framework and software design in QRist’s platform have proven to be important in making successful implementations of the EMR system.” However, there are both advantages and disadvantages of electronic health records in developing countries.
Dr. Wongpichetchai points out the downfalls of paper medical records. He states, “I’ve lost patients due to misplaced medical information that leads to wrong medications. Sometimes doctors would also take photo[s] of confidential records and send them through online messaging applications. This is unsecure and can breach confidentiality.” Acknowledging the potential advantages of electronic medical records, he emphasizes the improvement in clinical note legibility. For example, with EMRs, prescriptions can now contain legible allergy warnings and drug incompatibilities, and notes can now include reminders to prescribe drugs, administer vaccines, or warn for abnormal laboratory results. Additionally, EMR systems could support program monitoring of reporting outcomes, budgets and supplies, as well as help to manage a patient’s medical history. Mr. Matthew Mistele, co-founder and software engineer of QRist states, “With QRist’s fingerprint scanners, it’s more immediate. In addition to simply saving file-finding time, the EMR is making file-finding (and saving) possible for these patients in the first place.”
However, as Dr. Wise points out, “Despite the potential advantages of EMR systems in developing countries, it is important to not overlook the potential disadvantages of the systems so we can continue to improve the system.” For example, there are usage difficulties, including the lack of user training and poor initial design that limits the system’s capabilities. There are also disadvantages in terms of the lack of involvement of local staff in the design and testing of systems. Such involvement would ensure higher data quality and help to realize the full potential of the technology. Furthermore, Mr. Mistele points out that there are inherent technical difficulties. “A fundamental trade-off in EMR systems is spending more time entering records in order to save time accessing them.In addition to support staff, another technical hurdle is saving records on their own computer/device and uploading it when Internet is back.” This means that before the users see the benefits of EHRs, the doctors have to translate the paper records and input up to thousands of electronic health records per hospital. Although there are ways to make record entry faster (for example, by taking pictures of paper records), these methods rely on cellular data and slow down information exchange. Hence, while there are opportunities for the niche market in rural South East Asia, there are still disadvantages associated with both usage and technical difficulties which serve as barriers to implementing electronic health records in rural areas of developing countries.
Dr. Wongpichetchai agrees that there are flaws to EHR systems. “Most doctors, including me, have horrible handwriting, and most paper records in rural south East Asia are also not in English,” he says. Nevertheless, he believes that the benefits of electronic health records outweigh the disadvantages. He states firmly, “Patients’ lives come first. Electronic Health Records help prevents medical information misplacement and allows us doctors to focus on what really matters most – the patients.” To further understand EHR systems, it is important to perform cost-benefit analyses of systems that have been utilized in similarly challenging environments as well as to examine any available corresponding evaluation data. As demonstrated by QRist, when deciding what EHR systems to deploy in developing countries, having promising ideas is not enough: ideas need to be validated in the field to ensure that they are serving the needs of the target population.