USC EMR System for Uganda

USC EMR System for Uganda

The following was contributed by Kimberly Marinconz, a student in the Master of Science in Global Medicine program at the Keck School of Medicine of USC.

Program Goals and Overview

Kigezi Healthcare Foundation (KIHEFO) is a non-governmental organization serving the Kigezi region of Southwestern Uganda. It is located in Kabale, a mountainous and rural district with limited access to healthcare. KIHEFO is a forward-thinking organization, which focuses on community development through addressing barriers to healthcare such as poverty, disease, and education. KIHEFO began as an HIV clinic at the height of the HIV epidemic in Africa. Dr. Geoffrey Anguyo, a prominent member of the community, founded KIHEFO with the idea of serving the community by providing high quality health care to the most underserved and rural populations in Kabale.

The town of Kabale, where the KIHEFO clinic is located.

KIHEFO’s HIV clinic, where the Themis server functions as the data storage mechanism for the Uganda EMR project.

The goal of this project was to implement a pilot EMR system at the KIHEFO HIV clinic in Uganda. KIHEFO provides healthcare to a number of medically underserved patients in rural Uganda, and is composed of an HIV, general health, maternal health and rural outreach clinic. This pilot will begin as a research project to evaluate the usefulness of an EMR system in comparison to paper charts at the HIV clinic. After implementation, we will develop a plan for long-term expansion to the general, maternal, and rural outreach clinics. Successful implementation of this EMR system would decrease clerical tasks of physicians, allowing them to see more patients. Additionally, incorporation of standard of care notifications into the chart would facilitate a higher quality of care to patients.

Dr. Cherniak, the co-founder of Bridge to Health, a nonprofit organization that partners with KIHEFO to promote a sustainable healthcare delivery system, has supported this project as our faculty advisor. He states that: “making the transition from paper-based record keeping to electronic medical records will have monumental impacts on patient care and population health in low resource settings. It will make patient records more easily accessible, prevent lose from heat/weather/wear and tear, allow for digital data sharing between providers and specialists, and can allow for mass data analysis to look at the entire clinic to see immediately the number of patients being treated, how often they are being followed up, and their current health status”.

Challenges

The Rural Uganda setting provides unique technological challenges. Air pollution and dust coupled with the poor air circulation, humidity, and constant rainfall do not align with the normal hospital requirements of a “clean room” where servers are usually kept. Due to the inconsistency of power supply, using a cloud based system was not an option, as pulling patient charts for check-ups during frequent power outages would not be possible. We determined that a server with the capacity to handle more extreme environmental conditions, as a clean room is not feasible, would be the best and most sustainable option.

As we researched the most suitable rugged server, we found that we were very limited in our options. Most companies only sold to large businesses, required specific quantity purchases, or were out of budget. After our initial server option fell through, we faced a two-week time constraint before departure, as well as inflexibility with our remaining budget as everything else had already been purchased. We searched online for options and reached out to a number of companies that supplied rugged servers, and Themis was the quickest to respond, and was the most willing to work with our time constraint as well as budget limitations. Without them, the only option moving forward would have been purchasing a temporary non-rugged server which would not have provided long-term sustainability for the project.

Physician’s work room at the KIHEFO HIV clinic. Previously, doctors would complete paper charts and store them in this room. Now, doctors can bring laptops into the patient’s room and complete the notes in real-time, which are backed up on the Themis server featured at the bottom right. This room is where the server is now stored.

A Solution in the Themis RES Server

Roland, our sales representative went above and beyond to accommodate our needs, fit our budget, and even provide a 1 year warranty on the server. The system that he recommended was the RES-XR4 1U, a refurbished server that was immediately available for rush order, testing and delivery before our departure date in less than two weeks. As IT is not our background, he provided his expertise on specifications for the server to custom-fit our needs for the project. Additionally, when we were in the field and required assistance, we received prompt responses from the Themis technical support staff, and were connected immediately to a specialist to troubleshoot issues we faced during the installation process.

Left: Themis packaged the server for transport with foam cushioning to ensure it was intact after over 40 hours of travel. Right: USC group member Pauline Hoosepian-Mer networking the Themis server.

We arrived in Uganda with a Themis RES-XR4 1U server specifically designed for implementation of a sustainable EMR system in rural Uganda. This project required a robust, long lasting system to meet our goal of long-term sustainability. According to the Health Access Corps, there are 12 doctors per 100,000 people in Uganda. Due to this uneven doctor-patient ratio, each clinic serves a large patient population. KIHEFO serves a large population, and is rapidly expanding. In order to ensure the sustainability of this system, we opted for a system with large data storage capacity of at least a 1TB. Themis far exceeded this goal by providing us with a pair of very fast SAS 1TB Hard Drives on a SAS HBA in RAID-1/mirrored configuration.

Initial server setup and transfer of paper charts to the EMR database.

The mirrored hard drives allowed for high capacity data storage, which increased the longevity of the system. Additionally, it utilized both drives, which enhanced data protection, which is an important consideration for ensuring patient medical information is not lost, as this would have devastating consequences. The server contained other impressive specifications, such as a SATA 128GB Solid-State Drive (SSD) with rapid performance. Additionally, the system came equipped with a Quad-port Gigabit Ethernet adapter, providing six Ethernet outlets in total. This was extremely helpful, as we did not have to worry about purchasing other network switches or hardware.

A Reliable Long-Term Infrastructure

The goal of this project was sustainability; creating a reliable, robust, and long-term infrastructure for KIHEFO to build upon. From our research and implementation experience, we have determined that in a rural, rugged setting without capacity for the cloud or a clean room to house a standard server, the most efficient and sustainable option is a rugged server.

Themis server setup in the HIV clinic doctor’s charting station.

After extensive research on implementation of these systems, and many community forums seeking out sustainable options for data storage and configuration, we believe that the rugged server is the most optimal solution. When working in developing countries, it is important to never leave a community worse off than it was before. Ensuring the system is successful, and provides long-term sustainability was our goal, which Themis helped us reach through providing a robust, high-tech and sustainable server, tailored to the project’s needs and specifications.

After much hard work, the project was a success. Hakim, speaking on behalf of the KIHEFO staff, express their sincere gratitude for the server donated to the Kigezi Healthcare Foundation. He states:

“The server has been very helpful to the organization and I’m sure will continue to be helpful for a long time… we are now contented that should our system go down, we are then able to go back and reinstall all the patient and system data so one can get back up and running.”