Douglas, Gerald Paul
(2009)
Engineering an EMR System in the Developing WorldNecessity is the Mother of Invention.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
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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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
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| ETD Committee: |
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| 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: |
http://etd.library.pitt.edu/ETD/available/etd-04302009-101747/, etd-04302009-101747 |
| Date Deposited: |
10 Nov 2011 19:43 |
| Last Modified: |
15 Nov 2016 13:43 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/7744 |
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