In the late 1990s, an international consultant told me that a proposed electronic health information system in the Dominican Republic was “like Star Wars and will not work in this country.”
Our objective was to improve service delivery by virtually connecting health providers to share medical records with one another as patients moved from health centers to hospitals. We learned that this was much more than an overnight task, requiring a sustained medium-term effort by the government to get the system fully up and running.
In recent years, I’ve seen similar efforts realized in the Russian Federation, Georgia, Azerbaijan and Botswana. In two Russian regions, Chuvash Republic and Voronezh Oblast, for example, electronic records are helping coordinate the flow of clinical and financial information across the health systems as facilities, departments within hospitals, and health insurance agencies have been “virtually” connected through broadband networks. The electronic records are supporting clinical decision-making, facilitating performance measurement and pay-for-performance initiatives, and ultimately the continuity of care as patients move across the health system. Inter- and intra-regional medical consultations and distance learning activities are also being supported by telemedicine networks that connect specialized hospitals with general facilities.
In Georgia, the Social Information Management System (SIMS) at the Ministry of Labor, Health and Social Affairs is providing consolidated automated information about all the registered beneficiaries (each with a unique identifier) of government-funded social programs. This has improved management of the Mandatory Health Insurance for the Poor (MIP) and other programs, such as pensions, means-tested targeted assistance, and internally displaced person allowance distribution, bringing transparency in the use of public funds.
In Azerbaijan, electronic case reporting forms, supported by geographic information systems, is helping track and fight, in real time, communicable disease outbreaks.
And in Botswana, the government has rolled out an electronic medical records system to all of the country’s main hospitals, and the country continues to improve the coding and reporting of health conditions and internet connectivity.
These examples from countries clearly show that in reshaping the global health agenda, we need to support the spread and local adaptation of health information technology and overcome the thinking that implementing this information and communications technology is beyond the capacity of countries at different levels of development.
The Star Wars movie saga was entertaining science fiction, but transforming health service delivery in countries is not. Helping deploy the power of electronic health records is not only environmentally friendly (less paper-based medical records), but it has the potential to transform the decision-making capacity and the quality of services in the health system of a country.