Health Records

This Friday at my internship my co-intern, Sarah, and I were tasked with developing some form of electronic method for their patient data. Here’s their current system:

They have two normal books with paper on the desk. One is for new patients; the other is for returning patients. They log basic information about the patient (name, age, sex, residence, and diagnosis), then the patients are given a card where the health officer writes notes regarding their symptoms, the diagnosis, and finally the action to be taken (medication, etc.). This card is then stored on the bookshelf.

Now, this system doesn’t sound terrible, right? It works to record the number of patients each day, but to try to reference any information regarding a patient this system is incredibly inefficient. Each patient is assigned a number when they arrive, and this is recorded. However, in the returning patient book these are not in order because they are logged on the date.

Our task was to come up with a system where they could eliminate the paper and do everything electronically. We were given a laptop with the Microsoft Office Suite on it. First, we developed a Spreadsheet that could work fine although isn’t terribly convenient for entering in new data. After they were happy with that, I fiddled with Microsoft Access, which is meant as a database. This system could work but is a little trickier to edit once it is set-up.

We had completed our task, and helped create an electronic system for their patient data as well as their Ministry of Health Records! Here’s the true kicker: the computer we used, is used mainly for accounting, the lab, and orphanage. They all share one. We created a rudimentary system for them to use, but they cannot dedicate a computer for the front desk. They do not have the funds to purchase one, but nonetheless they were ecstatic to have a system created for when they do have one.

This experience was mind-blowing. At a typical Doctor’s office in the US the doctor will walk in with a tablet, which includes all your medical records, and is even be able to simply dictate to the software. At the MACODEP clinic, they can’t afford a computer for the front desk, let alone another one for the doctor.

As I read through some of the logs, I noticed another major problem with this paper system – a much larger problem. Nearly everyday they encounter at least one case of Typhoid or Enteric Fever. With simply jotting this down, there is no way to share this information or follow-up on these cases. Typhoid can spread through water, and in a setting like Kibera it is very likely. It would be near impossible for an epidemiologist (or aspiring epidemiologist like myself) to track these cases and attempt to find some source of this Typhoid. If this clinic is seeing a case a day, I would be very interested to see what other clinics are seeing, as well as what cases aren’t making it to the clinic.

I know this post wasn’t terribly exciting or descriptive, but to the public-health side of me this is incredibly point.

Those of you who are reading this: do you know of any programs / grants for small clinics to acquire computers for this purpose? What about any software? While Electronic Medical Record software would be absolutely stellar, it seems a bit out of reach. Do you know of any other database programs out there that would work better? Please comment or email me if you know of anything, or anyone who could help me out!! I do have the ability and time to apply for grants as well so that is a huge option.