Digitising Medical Records to Improve Efficiency and Quality of Care

The last few decades have seen enormous growth and adoption of Information and Communication Technology (ICT) across many sectors. In particular, the unprecedented growth in mobile technology is helping break barriers to accessing information and services. In healthcare, use of ICT has emerged as a key strategy for addressing challenges facing health systems and is already reshaping the ways services are delivered. Given the ever limited resources available for healthcare delivery, leveraging on ICT has been promoted for its potential to improve effectiveness, efficiency and quality. The County Innovation Challenge Fund (CICF), through selected grantees, is investing in a number of innovative ICT solutions aimed at enhancing availability and use of data for evidence-based planning and decision-making. We present a synopsis of two of these solutions: STONE-HMIS®: Developed by Afya Research Africa (ARA) and rolled out in Homa Bay and Turkana counties, STONE-HMIS is a digital platform that integrates hospital and community health systems. It is designed to be modular and incorporates the various components of the health environment, supporting seamless work-flow across departments. It includes relevant clinical protocols, administrative and pharmaceutical databases. Other unique features of STONE-HMIS include its ability to be easily deployed over a cloud or wide-area network and integration of biometric-based unique person identification. The biometric client identification feature supports longitudinal, inter-facility, and community follow-up of clients.

STONE-HMIS is designed to be interoperable with other digital data platforms, including DHIS2. By porting data directly to the DHIS2, the platform automates data capture and reporting functions thus enhancing data quality, a critical feature that lacks in most other digital data tools. The system also promotes provider adherence to clinical care protocols, client follow-up and tracking of medical commodities for accountability. ARA has deployed STONE-HMIS in its network of 25 community medical centres (Ubuntu-Afya Kiosks) and 13 public and faith-based health facilities in the two counties. The development of the solution was participatory and iterative, where user specifications and feedbacks informed its architecture and functionality. The deployment process involved intensive user training and ongoing technical support. ARA is currently working on a scale-up strategy that will facilitate wider adoption and replication of STONE-HMIS in other counties.

Electronic Maternal and Child Health Register (eMCHR): One of the ways to improve health outcomes for mothers and babies is to ensuring that they receive comprehensive, high impact interventions across the continuum of care from pre-pregnancy to postnatal periods. However, in most health facilities significant drop-outs and missed opportunities are common. Longitudinal tracking and follow-up of mother-baby pairs is limited for many reasons, such as the multiplicity of service delivery points, stand-alone paper-based registers, undocumented self-referrals, and errors in patient identification. With funding from CICF, RCTP-FACES developed a web-based electronic MCH register that integrates five stand-alone services thus allowing for longitudinal follow-up of mothers, newborns and children. The five registers are: antenatal, maternity, postnatal, immunization and the HIV-exposed infants’ registers. It also innovatively integrates biometrics for accurate identification of clients, inbuilt provider prompts to support clinical decision making, and automated text messaging and call centre to aid in client follow-up and defaulter tracing.

The electronic register was piloted in 6 health facilities in Homa Bay County to test its feasibility and effectiveness in improving retention of mother-child dyads along the continuum of care, ultimately translating to better health outcomes. Pregnant women are registered on the eMCHR platform on a rolling basis as they seek antenatal care services, and then followed up until their exit upon their baby completing immunization calendar. More than 4,500 women have been enrolled and data collection for key outcome measures is ongoing. Preliminary analysis shows that the electronic register is feasible and has potential to improve retention and overall quality of MNCH services.