1. Patient-Centered Information Systems
ROUTINE HEALTH INFORMATION SYSTEMS
A Curriculum on Basic Concepts and Practice
MODULE 8:
Information and Communication Technology for RHIS
SESSION 3:
Patient-Centered Information Systems
The complete RHIS curriculum is available here: routine-health-information-systems/rhis-curriculum

2. Learning Objectives and Topics Covered
Define what patient-centered information systems are
Topics Covered
Electronic medical records (EMRs) and aggregate-information systems
Types of EMRs
Benefits of EMRs
Patient unique identifiers (PUIDs)

3. Electronic Medical Records
Contain data related to a single patient, such as diagnosis, name, age, and earlier medical history
Data typically based on a single patient/healthcare worker interaction
Systems used largely by clinicians for diagnosis and treatment, but also by administrative staff for accounting and file management
EMR is not just one system; it may include interfaces with many other systems and applications

4. Aggregate Information Systems
Contain consolidated data relating to multiple patients, and therefore cannot be traced back to a specific patient. They are merely counts, such as incidences of malaria, TB, or other diseases.
Aggregated data are used for the generation of routine reports and indicators, and for strategic planning and guidance within the health system.

5. Types of Electronic Medical Records
Custom-developed
Commercial off-the-shelf
Free prepackaged
Open-source software
Software as a Service (SaaS)

6. Acquisition Assessment Matrix
TYPE
PROS
CONS
Custom-developed:
application built from
scratch
Controls design to serve specialized needs
Development fosters innovative capacity, sustainable ownership
Able to engage local IT industry
Initially requires more time and budget
Needs development team
Depends on availability of long-term support
Commercial off-the shelf:
a commercially available product
Short time from selection to implementation
Able to evaluate before buying; app is maintained and upgraded (at a cost)
Typically pretested and reliable
May not fit country needs
May be expensive or have complex fee structure
May not be designed for low-resource environment
Free prepackaged:
app developed by donor, university, or other project or country
Shorter lead time
Able to evaluate before buying
Less upfront cost, but there are costs to customize and maintain
May lack accompanying IT support and warranty
Hidden implementation and maintenance costs
May not be suitable for or adaptable to country needs

7. Acquisition Assessment Matrix
TYPE
PROS
CONS
Open source:
source code and software freely
available
Lower development costs
Able to adapt software
Able to engage local IT industry
Benefits from open source communities, if available
Product may not be supported
Open source community may be too fragmented to rely on
Hidden implementation and maintenance costs
Software as a Service (SaaS): hosted on a remote server and provided in increments
Easy to implement; maintain
Clear cost structure
Upgrades can be shared easily (maybe at a cost)
Data hosted on remote servers, which may conflict with privacy or policy
Governments may not be able to take over regular fee
May not be suitable for or adaptable to country needs

8. EMR Benefits
Individual patient data that are collected and accessible at the point of care can support clinical management
Generates warnings for abnormal laboratory and imaging results
Provides reminders for appointments, routine screenings, prescriptions, administration of vaccines, and other health maintenance benefits
Improves legibility of clinical notes, reducing clinical errors associated with illegible handwriting
Better diagnosis of disease and mortality (linked to ICD-10)
Facilitates speed and accessibility in obtaining consultations from distant specialists (referral systems)

9. EMR Benefits
Supports service monitoring (reporting outcomes, budgets, and supplies)
Data back-up and archiving
Easy information transfer and sharing with other databases
Supports clinical research

10. EMR Implementation Considerations
Poor IT infrastructure (power outages; limited network connectivity and bandwidth) increases the cost to set up and maintain the systems
Limited healthcare staff with heavy workload
Insufficient investment in research to develop patient-centered information systems that would meet the needs of a particular healthcare system
Security, confidentiality, and reliability

11. EMR Implementation Considerations
Technology, access, and interoperability
Staff buy-in and political will/buy-in (IT culture: behavioral aspects)
Licensing and contracting
Timelines
User fit: Does system fit well within existing culture, language, and user workflows?
Sustainability and adaptability
Scalability

12. Patient Unique Identifier (PUID)
Numeric or alphanumeric string that is associated with a single patient within a given health register or a health-records system
PUIDs should be portable across different systems

13. PUID Components An identifier (numeric; alphanumeric) scheme
Identification mechanism
Index links the PUID and the identification information of the patient
Mechanism to hide or encrypt the identifier
Technology infrastructure to search, identify, match, encrypt, etc.
Administrative infrastructure including the central governing authority
The index serves as the directory of PUIDs. It must be capable of supporting identification functions within an organization and an enterprise. and across the entire national healthcare system.

14. PUID: Functions and Objectives
Support the protection of privacy and confidentiality through accurate identification (explicit identification of patient information) and dis-identification (mask/encrypt/hide patient information)
Help prevent, detect, or mitigate problems caused by duplicate records and patient mix- ups or mistaken identity

15. PUID: Functions and Objectives
Help retrieve a complete history of patient’s medical history regardless of where patient received services
Provide positive identification of patient for delivery of care and administrative functions
Track patients across multiple facilities (locations), systems, programs, or services; hence supporting the continuum of care

16. Discussion
Do EMRs contribute important benefits to healthcare projects?
Do EMRs have a beneficial impact on patient care?
What EMR implementation challenges have you faced?

17. ROUTINE HEALTH INFORMATION SYSTEMS
A Curriculum on Basic Concepts and Practice
This presentation was produced with the support of the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AID-OAA-L MEASURE Evaluation is implemented by the Carolina Population Center, University of North Carolina at Chapel Hill in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Palladium; and Tulane University. The views expressed in this presentation do not necessarily reflect the views of USAID or the United States government.