Gerald Douglas

• University of Pittsburgh

BACKGROUND: Pediatric growth tracking has been identified as a top priority by international health agencies to assess the severity of malnutrition and stunting. However, remote low-resource settings often lack the necessary infrastructure for longitudinal analysis of growth for the purposes of early identification and immediate intervention of stu...

Background and Purpose: Patients are increasingly seeking care from multiple institutions and practitioners, making it necessary for practitioners using disparate electronic health record (EHR) systems and in different geographical locations to access a shared patient record. Health information exchanges (HIEs) that can uniquely identify patients t...

Background& Purpose: The ability to reinforce clinical guidelines to optimize quality of care is a driving factor for electronic health records implementation. Digital systems that ensure completeness of data required for health programs, especially HIV, are now commonplace in most low-and middle-income countries. However, these systems are designe...

The inability to quickly design, develop electronic medical record (EMR) systems and deploy new clinical guidelines remain bottlenecks to successful scale up and continued use in low- and middle-income countries (LMIC). Significant gaps persist in EMR designs for LMIC settings. These gaps result from failure to understand how the environments, mode...

Background: Sharing medication data between different health systems is essential for continuity of care. To provide common and consistent representation of medication data across disparate health systems, the National Library of Medicine (NLM) developed RxNORM; a normalized naming system for generic and branded drugs that facilitates semantic inte...

Background: Availability of complete, accurate, and timely information is essential for efficient planning and purchasing of medications. This is especially important in remote low-resource clinics that are often difficult to access, have limited health personnel, and receive supplies infrequently. Appropriate application of information technology...

Background: Reducing laboratory errors presents a significant opportunity for both cost reduction and healthcare quality improvement. This is particularly true in low-resource settings where laboratory errors are further exacerbated by poor infrastructure and shortages in a trained workforce. Informatics interventions can be used to address some of...

Background eHealth—the proficient application of information and communication technology to support healthcare delivery—has been touted as one of the best solutions to address quality and accessibility challenges in healthcare. Although eHealth could be of more value to health systems in low- and middle-income countries (LMICs) where resources are...

Background: To address challenges related to medication management in underserved settings, we developed a system for Prescription Management And General Inventory Control, or RxMAGIC, in collaboration with the Birmingham Free Clinic in Pittsburgh, Pennsylvania. RxMAGIC is an interoperable, web-based medication management system designed to standa...

Setting: Eighty-three villages without electricity in Mtema Traditional Authority, Lilongwe District, Malawi. Objectives: To describe 1) the expansion of the electronic village register (EVR) to 83 villages in Mtema Traditional Authority, 2) the challenges encountered and changes made to render the system robust and user-friendly, 3) the value prop...

Background: The distribution of printed materials is the most frequently used strategy to disseminate and implement clinical practice guidelines, although several studies have shown that the effectiveness of this approach is modest at best. Nevertheless, there is insufficient evidence to support the use of other strategies. Recent research has sho...

Background Free and charitable clinics are a critical part of America’s healthcare safety net. Although informatics tools have the potential to mitigate many of the organizational and service-related challenges facing these clinics, little research attention has been paid to the workflows and potential impact of electronic systems in these settings...

Setting: Patients with chronic non-communicable diseases attending a primary health care centre, Lilongwe, Malawi. Objective: Using an electronic medical record monitoring system, to describe the quarterly and cumulative disease burden, management and outcomes of patients registered between March 2014 and June 2015. Design: A cross-sectional s...

Adequate laboratory infrastructure in sub-Saharan Africa is vital for tackling the burden of infectious diseases such as human immunodeficiency virus and acquired immune deficiency syndrome, malaria, and tuberculosis. Despite the need for laboratory testing in addressing the infectious disease burden, laboratories are ill-integrated into the diagno...

Background: The Birmingham Free Clinic (BFC) in Pittsburgh, Pennsylvania, USA is a free, walk-in clinic that serves medically uninsured populations through the use of volunteer health care providers and an on-site medication dispensary. The introduction of an electronic medical record (EMR) has improved several aspects of clinic workflow. However,...

Although performance feedback has the potential to help clinicians improve the quality and safety of care, healthcare organizations generally lack knowledge about how this guidance is best provided. In low-resource settings, tools for theory-informed feedback tailoring may enhance limited clinical supervision resources. Our objectives were to estab...

Introduction: Sub-optimal performance of healthcare providers in low-income countries is a critical and persistent global problem. The use of electronic health information technology (eHealth) in these settings is creating large-scale opportunities to automate performance measurement and provision of feedback to individual healthcare providers, to...

Background: There has been little formal analysis of laboratory systems in resource-limited settings, despite widespread consensus around the importance of a strong laboratory infrastructure. Objectives: This study details the informational challenges faced by the laboratory at Kamuzu Central Hospital, a tertiary health facility in Malawi; and pro...

Introduction: Continuity of care is critical in the delivery of health care services between health departments in a health facility and across different health facilities. It is mostly achieved through the use of unique patient identifiers, electronic medical record systems (EMRs), and data connectivity services, which promote access to and exchan...

There are two types of chronic disease. First, there is the chronic disease that can be cured after a period of several months or several years, tuberculosis being the classical prototype with drug-sensitive disease requiring six months of anti-tuberculosis treatment and drug-resistant disease requiring treatment for up to two years. In tuberculosi...

Background Evidence shows that clinical audit and feedback can significantly improve compliance with desired practice, but it is unclear when and how it is effective. Audit and feedback is likely to be more effective when feedback messages can influence barriers to behavior change, but barriers to change differ across individual health-care provide...

Setting:Chalasa village, Traditional Authority Mtema, Lilongwe District, Malawi. Objectives: To report on the deployment of an electronic register in a rural village with no electricity. Specific objectives were to document 1) challenges in setting up the electronic village register (EVR); 2) demographics of village residents, along with births an...

Objective: To model the financial effects of implementing a hospital-wide electronic medical record (EMR) system in a tertiary facility in Malawi. Materials and methods: We evaluated three areas of impact: length of stay, transcription time, and laboratory use. We collected data on expenditures in these categories under the paper-based (pre-EMR)...

The simple, straightforward touch-screen electronic medical records (EMR) are successfully employed in Malawi for managing anti-retroviral therapy (ART) and diabetes. The Baobab anti-retroviral therapy (BART) system is Baobab's largest current deployment, with systems currently deployed at 15 high-burden sites managing clinical data for more than 1...

Setting: Antiretroviral treatment (ART) clinics at one central hospital, three district hospitals and one mission hospital in the central and southern regions of Malawi. Objective: To measure the extent of inaccuracies in the transcription of case registration and recorded deaths between electronic medical data (EMR) and paper registers. This wa...

The global burden of diabetes mellitus (DM) is immense and predicted to reach 438 million by 2030, with 80% of the cases being in the developing world. The management of chronic non-communicable diseases like DM is poor in most resource-limited settings, and the 'directly observed therapy, short course' (DOTS) framework for tuberculosis control has...

To determine the feasibility of using electronic medical record (EMR) data to provide audit and feedback of antiretroviral therapy (ART) clinical guideline adherence to healthcare workers (HCWs) in Malawi. We evaluated recommendations from Malawi's ART guidelines using GuideLine Implementability Appraisal criteria. Recommendations that passed selec...

Identifying specific needs for informatics solution in Low and Middle Income Countries (LMIC) is a critical step to disseminate the benefits of advanced information technology on a global scale. We set out an exploratory visit to a medical a school and its affiliated university hospital to describe how information technology could improve their dai...

Power Backup Solutions and Low-Power Computing (0.17 MB PDF)

The Touchscreen Clinical Workstation Appliance (0.06 MB DOC)

The Touchscreen Toolkit (0.53 MB PDF)

Benefits of the Point-of-Care Model (0.01 MB PDF)

Challenges and Solutions in Implementing the EMR in Malawi (0.01 MB PDF)

Commitment to Open-Source Software (0.10 MB PDF)

Importance of Flexibility to Support Varying Workflows (0.09 MB PDF)

The Malawi Health Passport (0.12 MB PDF)

Scalability, Localization, and Customization of the ART EMR (0.01 MB PDF)

Dynamic and Two-Level Data Validation (0.07 MB PDF)

Complete, accurate, and timely data are critical for providing high quality patient care, programmatic monitoring and evaluation of antiretroviral therapy scale-up, continuity of care for chronic illness, and rational drug forecasting. Manual paper-based aggregation of data and compilation of reports become unfeasible as patient cohorts on treatmen...

Due to the fact that health care professionals in Malawi are often overstretched, the use and quality of health data can be compromised. The Malawi Health Management Information System (HMIS) has streamlined data collection and reporting and increased the use of data to improve care. Obstacles remain, including incomplete reporting and low staff mo...

The objective of this study was to determine the relative efficiency of novices compared to a prediction of skilled use when performing tasks using the touchscreen interface of an EMR developed in Malawi. We observed novice users performing touchscreen tasks and recorded timestamp data from their performances. Using a predictive human performance m...

Electronic data systems are being implemented in resource-poor HIV clinics to track and improve patient care. The great majority of these systems rely on paper forms and retrospective data entry, while a few have chosen to deploy point-of-care systems to collect data in real time. This study describes a comparison of data quality between these two...

Objective Methods To determine the frequency and distribution of guideline-adherence feedback that can be automatically generated using patient-level EMR data and a national guideline for delivery of Anti-Retroviral Therapy (ART) in Malawi, Africa. References 1. Rowe AK, de Savigny D, Lanata CF, Victora CG. How can we achieve and maintain high-qual...