Zambia’s Electronic Medical Record – Patient Flow

Post Sequence

1. Background
2. Initial Release
3. Patient Flow
4. Reporting Server
5. Version 2.0
6. Continuity of Care
7. (More on the way…)

These are a series of posts on the history of Zambia’s first national Electronic Medical Record or EMR. The EMR was known by a few names: PTS, PMRS, Continuity of Care and finally SmartCare. The EMR was originally targeted at supporting care and treatment of the estimated 17% of the adult Zambian population infected with HIV. The project was successful on a grand scale. It grew to serve the population of Zambia as a general EMR addressing other illnesses such as Tuberculosis, Malaria and general health. It is still in operation today has served millions of patients not just in Zambia but in other African nations as well.

Defining the “Product”

The purpose of software systems is to support some human process. Even in the case of games, the purpose is recreation. The original purpose of the Zambian Electronic Medical Record was to capture data at specific times and functions during the flow of patients HIV Anti-Retroviral Care and Treatment.

After the initial rollout and issues, we decided that we needed a more systematic approach to the documenting and the development of the patient software. Before we could extend the Patient Tracking System (PTS) from version 1.0 to version 2.0 we needed to apply some organizational rigor to the way we were documenting how patients should flow through the clinics.

Working with the excellent program manager to understand, refine and then diagram and document the actual process I produced the following diagram which details how patients flowed through the clinics and were tracked by our system.

Above you can see how a patient progressed through evaluation for ARV care all the way through treatment and follow up according to the protocol we developed for the clinics. This was the basis for not just the day to day operations at the clinics but also for how the PTS software system worked.

The Data Collection Forms

Below are the forms themselves. Note that these are from a later version of the system:

A Template for HIV Care

As the project progressed we found that many sites were interested in our process and our software. This was to occur later in the project but I think one of the main reasons for our success and for others copying that success was our excellent forms and the rigorous way that we documented our protocol. The clinical and data management teams did an outstanding job in not just designing the forms themselves but in designing a process that optimized patient care. Without that work no system would have been possible at all.

It is of course also much easier to develop software for a well defined and documented process than it is to develop software based on conversations and undocumented ways of working!

In the next post I will discuss the Patient Management & Reporting Server or PMRS. It was the main tool used by program administrators to produce reports to evaluate clinic performance.