Using Electronic Medical Record Data to Improve HIV ...
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Using Electronic Medical Record Data to Improve HIV ...
Using Electronic Medical Record Data to Improve HIV Patient Monitoring, Clinical Decision-Making, and Quality Improvement: Lessons from Rwanda Nadine Karemaa, Anatole Manzia, Erick Gajub, Michèle Kayiganwab, Eric Remerac, Alphonse Nshimyiryoa, Gad Niyibizic, Adeline Dukuzec, Neil Guptaa, d, Cheryl Amorosoa a
Partners In Health/Inshuti Mu Buzima, Rwanda b Rwanda Ministry of Health c Rwanda Biomedical Center d Division of Global Health Equity, Brigham and Women’s Hospital, Boston, USA Abstract In developing countries, clinical guidelines and patient followup are primarily paper-based. We describe the use of Electronic Medical Record data for evidence-based clinical decisions and improved HIV patients monitoring in rural Rwanda.
Results Figure 1 reports changes in VL testing before intervention [N = 2223 (children = 135 & adult = 2088)] and after intervention [N = 2387 (children = 138 & adult = 2249)].
Keywords: Electronic Medical Records; HIV; Viral load.
Introduction In 2006 and 2010, two innovative systems were respectively implemented in Rwanda through the joint effort of Partners in Health (PIH) and the Ministry of Health (MOH): the Electronic Medical Record (EMR) system, and the Mentorship, Enhanced Supervision and Quality Improvement Program (MESH-QI). MESH-QI mentors used EMR as a detection and monitoring tool to identify and design QI interventions.
Methods A QI intervention focused on clinical decisions and HIV patients monitoring was conducted by 2 nurse mentors in 14 health facilities of Kirehe district. The aim was to improve rates of eligible HIV patients tested for viral load (VL) from 2.8% to at least 50% within 3 months (Nov 2012-Feb 2013). The number of each facility patients due for VL testing, and proportions of those with test results were aggregated into EMR reports reviewed and discussed during data sharing meetings held with health facilities leaders. EMR was used to track site performance, and Chi-squared test was used to measure differences pre- and post-intervention.
