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Engineering an EMR System in the Developing WorldNecessity is the Mother of Invention

Douglas, Gerald Paul (2009) Engineering an EMR System in the Developing WorldNecessity is the Mother of Invention. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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While Electronic Medical Record (EMR) systems continue to improve the efficacy of healthcare delivery in the West, they have yet to be widely deployed in the developing world, where more than 90% of the global disease burden exists. The benefits afforded by an EMR notwithstanding, there is some skepticism regarding the feasibility of operationalizing an EMR system in a low-resource setting. This dissertation challenges these preconceptions and advances the understanding of the problems faced when implementing EMR systems to support healthcare delivery in a developing-world setting.Our methodology relies primarily on eight years of in-field experimentation and study. To facilitate a better understanding of the needs and challenges, we created a pilot system in a large government central hospital in Malawi, Africa. Learning from the pilot we developed and operationalized a point-of-care EMR system for managing the care and treatment of patients receiving antiretroviral therapy, which we put forth as a demonstration of feasibility in a developing-world setting.The pilot identified many unique challenges of healthcare delivery in the developing world, and reinforced the need to engineer solutions from scratch rather than blindly transplant systems developed in and for the West. Three novel technologies were developed over the course of our study, the most significant of which is the touchscreen clinical workstation appliance. Each of the novel technologies and their contribution towards successful implementation are described in the context of both an engineering and a risk management framework. A small comparative study to address data quality concerns associated with a point-of-care approach concluded that there was no significant difference in the accuracy of data collected through the use of a prototype point-of-care system compared to that of data entered retrospectively from paper records. We conclude by noting that while feasibility has been demonstrated the greatest challenge to sustainability is the lack of financial resources to monitor and support EMR systems once in place.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Douglas, Gerald
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairGadd, Cynthia
Committee CoChairChapman, Wendy Wwec6@pitt.eduWEC6
Committee MemberFraser, Hamish S
Committee MemberDay, Roger Sday01@pitt.eduDAY01
Date: 14 May 2009
Date Type: Completion
Defense Date: 20 March 2009
Approval Date: 14 May 2009
Submission Date: 30 April 2009
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Institution: University of Pittsburgh
Schools and Programs: School of Medicine > Biomedical Informatics
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Clinical Decision Support; Computerized Physician Order Entry; Electronic Health Record; Electronic Medical Record; Touch Screen Computer
Other ID:, etd-04302009-101747
Date Deposited: 10 Nov 2011 19:43
Last Modified: 15 Nov 2016 13:43


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