Technology projects in developing countries often focus on the technology solution and inadequately address human resources, skills building, capacity building of ICT staff, communication, interoperability, data quality, elements which are important elements for a country to have ownership of ICT program. IQCare electronic medical record (EMR) software was specifically designed to address these important components of ICT
•[Sustainability] and collaboration by building into its design, freely available technologies, software, training,databases and tools which enable data entry clerks to build their skills
•[Empowerment] to transition to higher functioning job responsibility such as database administrators or database analyst. IQCare is a free, open source, freely available browser based electronic medical record (EMR) which runs offline in disconnected standalone mode on Intel netbook with the ability to also run in cloud computing environment with occasional connected connectivity. All the architectural components of the software including data dictionary, SQL database, business rules, data quality checks, are well documented and included as resources for learning by any ICT staff within a hospital or clinic facility. We draw on our experience of working resource poor developing countries for past 10 years to develop IQCare as an innovative ICT solution which address not only technology elements but human resources and staff turnover which often are barriers to sustainable ICT programs in the field
Our goal is to provide a robust, innovative ICT solution to address the most remote clinics, extremely rural health facilities,
•[Equal Opportunity]serving "Poorest of the poor" patients located in the farthermost remote villages. The vision of IQCare
• [Sustainability]was to develop an open source, freely available electronic medical record (EMR) solution to serve this type of environment and address the difficult ICT challenges of facilities, lacking internet, operating with intermittent power, lacking trained IT specialist, and sparse phone coverage.
Our challenges is how to bring ICT solutions to areas serving the poorest or the poor which lack any infrastructure or basic resources to support traditional ICT solution. There are health facilities lacking internet connection, operating on intermittent or no power, lacking any ICT staff, in sparsely covered areas lacking in mobile phone coverage, using randomly donated or used equipment. We use our freely available, open source, innovative, IQCare software platform running on inexpensive Intel netbooks
• [Entrepreneurship] interacting with solar power mobile phones, and includes offline e-learning/e-training guides as a sustainable EMR solution to traditional ICT approaches
•[Empowerment Through Peer Support] IQCare, encourages peer support for local hospitals to become mentors, mutually sharing IT knowledge in developing of SQL queries and creating new clinical reports. Bishop Murray hospital M&E staff and Annunciation Hospital M&E department are able to mentor and share SQL queries and reports to other nearby hospitals
• [E-First]i n Nigeria, Clinicians at Annunciation Hospital operate IQCare in paperless or e-first mode are now able to review individual patient history on a secure wireless network infrastructure installed through out the hospital, they are able to prescribed drugs, ordered tests and results, and progress on care and treatment at a glance. At the program level, real-time data on numbers of patients on care and treatment, with disaggregation by age and gender as well as lists of patients missing their clinical, pharmacy, laboratory and other appointments is readily available with capability to query and print out specific clinic days’ scheduled, and missed appointments lists to enable timely reminders and tracking of defaulting clients. Immediate entry of data at point of service has also lead to an appreciable decline in data entry and transcription errors, misplacement to outright loss of patient records, and the hitherto ever-present challenge of management of bulky folders of long-term clients. The problem of data entry backlogs which could arise for a variety of valid excusable reasons at facilities with single-point data entry has virtually disappeared.
• Monitoring of repeat CD4 tests since inception of the e-first IQCare clinic has shown a significant improvement in these rates with the percentages of ART patients missing their repeat CD4 count appointments declining from 26.5% and 12% in the March 2009 ART 6-and 12-month cohorts respectively to 0% in both cohorts by December 2009.
IQCare System supports open standards for data exchange, and can be used for information on HIV/AIDS and other health prevention areas including tuberculosis, voluntary counseling and testing, vital statistics and population data, and other data
•[Empowerment and Better Forecasting] The staff at Al Noury Hospital use IQCare to identify trends in order to forecast supply and drug needs. For example, an M&E officer at Al Noury, found that patient enrollment tends to increase during the summer months due to a higher prevalence of opportunistic infections. Now, when the summer months approach, the hospital can better forecast its supply and drug needs
•[Data Demand Information Use] IQCare generates important reports for target group, such as “Patient ARV Pickup Report”, “Missed ARV Pickup Report” or “Defaulter Report” to assist clinicians and community health workers (CHW) to proactively, address patient adherence issues, as missed refill appointments are a useful predictor of treatment failure in resource-limited settings Reports generated from IQCare, has reduced the number of patients missing their ARV’s (not adhering to the treatment) in Kenya2. Patient transferring from local hospitals to different clinic facility within regions can be tracked and followed up3. Program and hospital administrators can make effective decision regarding resource allocation based on the workload analysis reports, or advocate for additional resources based on data. IQCare has enabled clinicians, nurses, laboratory staff to directly enter data and electronically transfer medical records to different department, reducing need for manual retrieval and transfer of paper medical records throughout the hospital facility4
•[Inspiration and Transferability E-first Entry] The staff at Al Noury Hospital in Nigeria use IQCare to identify trends and forecast drug supply and demand. For example, an M&E officer, found that patient enrollment tended to increase during the summer months due to a higher prevalence of opportunistic infections. Now when summer approaches, the hospital can better stock necessary drugs and get patients on treatment sooner
•[Strengthening Referrals] In Kenya, the EMR is able to track patient transferring to other hospital facilities within the region. Patients transferring themselves (self transfer) to new ART clinics within a region often do not inform old clinic they have transferred, after 90 days their status becomes lost to follow-up (LTF).Through the EMR, staff can track patient visits occurring at new clinics within the same region, updating patient status from LTF to transferred and ensuring records are transferred to the new provider. The goal is to eventually track patients’ visits occurring across different regional partner programs.
1. Bisson GP et al. Pharmacy refill adherence compared with CD4 count changes for monitoring HIV-infected adults on antiretroviral therapy. PLoS Medicine 5 (5): e109. doi:10.1371/journal.pmed.0050109 23 Apr 2008
2. Reference IQCare paper Kenya abstract IAS conference
3. Using IQMerge and IQChart which is installed in 100 clinics and hospitals in Rwanda.
4. Annunciation Hospital Enugu, Nigeria, paperless, e-first hospital using IQCare
• Recently won CDC HMIS Grant funding in Kenya to expand national use of IQCare EMR software in Kenya.
• IQCare software was evaluated by Center for Diseases Control (CDC) Kenya and World Health Organization (WHO) Kenya.
•IQCare System has been reviewed by the CDC ESIS team, National AIDS and STD Control Program (NASCOP), and WHO as the top recommended electronic medical records system to be used by implementing partners in Kenya.
•These results of WHO assessments mentioned the following in executive summary
• "After successful assessment, the IQ Care system developed and supported by the Futures Group came up top in terms of overall features (technical and non technical) and also in terms of largest number of installations " THE EMR SYSTEMS IN KENYA May 2009, AuthorDr. William Motende, WHO, Dr. Sergon Kibet, Head HMIS, Anne Barsigo, NASCOP
• CDC KENYA ELECTRONIC PATIENT MONITORING SYSTEM (EPMS) ASSESSMENT DEC 2007. Based on our analysis of functionality, support available to the users and resource required to properly implement and use the software, the assessment team recommends IQ Care – for large sites with complex data needs, Strength Supported by large U.S. based non-governmental organization (NGO) with multi-country presence, Users in several other countries, Fairly new software, but seems to be of high quality, Strong and flexible data model capable of supporting complex HIV/AIDS patient record format, Stable and expandable,Well documented
• "Kenya Electronic Patient Monitoring System (EPMS) December 2007, Corresponding Author – Dr.Steven Yoon, CDC/NCHHSTP/GAP/ESIB, Dr.Janise Richards, CDC/NCPHI"
• 2010 Signed MOU with DOD HIV Prevention Program to install IQCare EMR to all 20 Walter Reed hospitals in Kenya
• In 2009 29 Hospitals and Clinics in Kenya using IQCare
• In 2008 27 Hospitals, clinics, in Nigeria
• 28 Hospitals, clinics, in Uganda
• IQCare System currently manages longitudinal data for over 65,000 Kenyan HIV patients in 29 hospital facilities across 24 districts in six geographic provinces.
• IQCare manages over 180,000 HIV Adult and pediatric patients in 4 countries
• IQCare manages over 65,000 HIV Adult and pediatric patients in Kenya
• Electronically manages over 300,000 clinical encounter, laboratory, pharmacy forms in Kenya 29 Hospitals, clinics in Kenya using IQCare
• 27 Hospitals, clinics, in Nigeria
• 28 Hospitals, clinics, in Uganda
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