Thread by @MaFielding

In 2016 I was working on a fascinating @SEIresearch project with the goal of increasing the number of women seeking medical care for their pregnancies and deliveries in rurlal #Kenya. I dove down a rabbit hole looking into #electronichealthrecords #EHR and published a..

quickly forgotten conference paper for @NairobiIW and @uonbi. "From paper to data: taking medical health
records into the future". Here are the notes for interested twitterers...

1) A robust health care infrastructure is crucial for protecting public health, particularly during crises such as epidemics, civil wars and disasters. This has never been clearer than it is right now.

2) In #Kenya its a daily challenge updating written health records in rural clinics. A study from rural South Africa found two major deficiencies: 1) data were incomplete – 50% of the clinics studied had gaps in data 2) accuracy – the rate of error in completed data was 0.4–8%.

The main reason cited for these deficiencies was a lack
of time due to higher priorities. Time taken to fill in logbooks is a burden, doesn’t fit into realistic workflows by clinic staff, and doesn’t serve to visibly improve patient care.

Research has also shown that even where records are present and correct, errors will occur in the readability, the
tallying and collation, and in the transfer clinic and national office locations. In general, unnecessary complexity is caused by multiplicity of records.

Electronic health records have been widely embraced in industrialized countries as a way to improve medical data collection and the sharing of data across providers.
Well-designed E-systems can save time, increase accuracy, and thus save money and improve health care outcomes.

In addition, when (anonymized) data are also combined and analysed, they can provide crucial insights to improve patient care and can guide national health policy and investments leading to reductions in national healthcare costs.

The size and scope of the health system in #Kenya is massive, with such high rates of #migration between regions and high levels of #AIDS/#HIV and pregnancy rates. A national, uniform, easy-to-access electronic
health records system would leapfrog that of more developed countries

This would mean that patient health record data could be accessed with 1 ID and that data can be input from multiple sites, means that test results, X-rays, prescriptions and alike can be added without the need for a paper record, with all the risks that brings.

However, it is not entirely risk free switching over to an #EHR system either. The costs of such a shift would be large, as would be the need to upgrade all health facilities throughout the country would include reliable electrical and internet connectivity. A massive investment.

But a system could give ownership of an individuals health data back to the individual where they could decide how and where it is used. A service still emerging in countries like the UK. There is even scope to use #blockchain as a way of securely storing these data.

Improvements in healthcare records in a country such as #Kenya are necessary and possible. Our case study bit.ly/2U2mZNp shows a glimpse of what can be achieved with comparatively small resources and usage of newer technologies. @gatesfoundation @SEIresearch @swapkenya

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