we do things here ! © dimagi, 2005 informatics in the design of healthcare systems in developing...
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We do things here !
© Dimagi, 2005
Informatics in the design of Healthcare Systems in developing countries
Vish Anantraman, MD
We do things here !
© Dimagi, 2005
Ca:shCa:sh
We do things here !
© Dimagi, 2005
Ca:shCa:sh
We do things here !
© Dimagi, 2005
Ca:shCa:sh
• Over 300,000 healthcare workers
• Go door to door delivering primary healthcare
• Can we use technology to improve healthcare delivery in some of the poorest communities in the world ?
We do things here !
© Dimagi, 2005
Ca:shCa:sh
We do things here !
© Dimagi, 2005
Ca:shCa:sh
Ca:sh – Disease case management
system for health workers in rural India
• Linux handhelds• Population over 80,000• Over two years in operation• Antenatal care, Immunization,
Census records
We do things here !
© Dimagi, 2005
• High incidence of HIV – 22%• HIV Cost of HIV resistant medication• Migration patterns of population• Nationwide coverage of universal
healthcard – 10 million people• Diverse computing environments• Multiple providers of ART treatment• Monitoring and evaluation of ART
Continuity of Care – ZambiaContinuity of Care – Zambia
We do things here !
© Dimagi, 2005
Continuity of Care – ZambiaContinuity of Care – Zambia
We do things here !
© Dimagi, 2005
Continuity of Care – ZambiaContinuity of Care – Zambia
• Too much of paper – ANC alone has 16 forms
• Register maintenance often a difficult task
• Very little usable data• Data trapped in paper format
We do things here !
© Dimagi, 2005
HIV Clinic
Prenatal Clinic
TB Clinic
HIV Clinic
Outreach clinic
Smartcard
Circuit rider/SneakerNet
Wireless networks
Cellular networks
Continuity of Care - ZambiaContinuity of Care - Zambia
We do things here !
© Dimagi, 2005
•Low cost memory - $1.5 for 128Kbit card (enough to store lifelong EMR)•Same technology as SIM cards (GSM phones)•Highly durable, non-volatile memory•Allows imbedded security and access control
Technology Being UsedTechnology Being Used
•Low cost, low power full fledged PCs•<$200 without display and <10Watts power consumption, can run off car battery•Standard PC parts, easy maintenance in developing countries, can be locally assembled•No moving parts, durability in dusty environments
•Handheld devices, Pocket PC™ and WinCE™ based•Used only for outreach clinics•Low power, fully functional EMR
We do things here !
© Dimagi, 2005
Informatics issuesInformatics issues
• Standards – HL7, SNOMED, ICD
• Interoperability
• Generalizibility of data architecture
• Operating system , low initial cost is not always best for all
We do things here !
© Dimagi, 2005
System issuesSystem issues
• Power
• Redundant technology ?
• Future maintenance
• Cost – how important?
• Transfer of technology – are there people to continue the project?
We do things here !
© Dimagi, 2005
Implementation issuesImplementation issues
• End user training – is this easy ?
• Language and cultural barriers – don’t make assumptions
• Buy in of end users very important
• Barriers to adoption – Social status– Practical issues – weather,
theft?
We do things here !
© Dimagi, 2005
Lessons learntLessons learnt
• IT is a buzz word – how you use it matters
• Technology is only a medium – appropriate use is what makes it useful
• Design with end-users’ input
• Replicate a paper process – is that a reasonable approach ?
• Stakeholders’ buy in very important
• Design bottom up
We do things here !
© Dimagi, 2005
QuestionsQuestions
Contact: Contact: [email protected]
(www.dimagi.com)(www.dimagi.com)