Improving On AMPATH Kenya EMR: Prototype
William Freas, Niles Guo, and Hannah Rosen

Problem Statement
AMPATH-Kenya has implemented Electronic Medical Records (EMR) across their 24 healthcare clinics in Western Kenya, and a wealth of patient data are being collected. However, while the data now exists, they are not presented effectively, with much of it going to waste when it could be used to improve care delivery and planning.

Solution Approach
The system is ingesting lots of patient data from the clinic medical staff, but the data analysis and visualization tools are lacking. AMPATH would like to improve the efficiency of use of their data to be able to effectively use it to impact patient outcomes and healthcare planning.

We plan on interviewing some of the AMPATH team to learn about what data could be most important to them, develope an early data visualization mockup that could best serve their immediate goals, and complete one round of user testing and iterate on the first visualization.

Schedule (Total 3x20=60 person hours)

Research: Interview with current AMPATH team to understand current data requirements, their specific pain points, and their needs. (15 Hours)

Prototyping: Create first round of data visualization mockups for feedback. (25 Hours)

User Testing: Receive feedback from AMPATH team, and iterate on V1 design. (5 hours)

Final Prototype: Create final data visualization mockups for the AMPATH team based on feedback (15 Hours).


Preliminary Literature Review
Williams, Faustine, and Suzanne Boren. "The role of the electronic medical record (EMR) in care delivery development in developing countries: a systematic review." Journal of Innovation in Health Informatics 16, no. 2 (2008): 139-145.

  • EMRs create a healthcare infrastructure that can survive disaster (epidemics, natural disasters, civil war).
  • Benefits: reduce medical errors, chart legibility, improved population health
  • Challenges: hardware and software standardization, privacy and confidentiality, cost
  • EMR systems should be designed specifically for the communities they will be used in, not transplanted in from developing countries.
  • Better care seen through faster recovery and economic benefits of less time spent accessing paper charts.
  • Benefit to planning health care based on data, allocate limited resources effectively
  • Facilitates research

Tierney, William M., Joseph K. Rotich, Terry J. Hannan, Abraham M. Siika, Paul G. Biondich, Burke W. Mamlin, Winstone M. Nyandiko et al. "The AMPATH medical record system: creating, implementing, and sustaining an electronic medical record system to support HIV/AIDS care in western Kenya." Studies in health technology and informatics 129, no. 1 (2007): 372.

  • Funding agencies often deny funding unless a program can document the number of patients treated and their outcomes.
  • In 2001, a simple primary care EMR was implemented for rural and urban health centres in Western Kenya.
  • Since its implementation, over 10 million observations from 400,000 visits on 45,000 patients have been recorded.
  • This information is now used by an increasing number of clinical staff, including clinician managers to assess productivity, data managers to report progress to funding agencies, outreach workers to assess no-shows and help to plan future visits, and nurses to assess reasons for medical non-adherence.
  • However, the lack of training in medical informatics will continue to hinder the effectiveness of EMR projects.

Ledesma, Andres, Hannu Nieminen, Päivi Valve, Miikka Ermes, Holly Jimison, and Misha Pavel. "The shape of health: A comparison of five alternative ways of visualizing personal health and wellbeing." In 2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), pp. 7638-7641. IEEE, 2015.

  • The researchers conducted a small study with 30 participants on the effects of data visualization for understanding health metrics.
  • The study compared data visualizations created using the Cleveland-McGill framework (using Angle, Length, Area, and Position along aligned scales), the hGraph framework, and a control group of numerical values in a table.
  • It found that health data visualization was able to help those without medical backgrounds to better the overall health situation, and could be used to help medical professionals to enhance the care process.



Other Research
We had a preliminary conversation with __Jonathan Dick__, a medical doctor and computer scientist, who helped establish the EMR system in AMPATH clinics and is involved in its ongoing operations and expansion. He gave us a background on the EMR technology, how it operates now, and identified the area of wasted data and absent or ineffective analysis and visualization tools as a point of concern.

Expected Outcomes
  • Detailed requirements from the medical community in Kenya on their current data pain points.
  • Early prototype of a data visualization tool to handle data from the EMR

Bibliography

Ledesma, Andres, Hannu Nieminen, Päivi Valve, Miikka Ermes, Holly Jimison, and Misha Pavel. "The shape of health: A comparison of five alternative ways of visualizing personal health and wellbeing." In 2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), pp. 7638-7641. IEEE, 2015. DOI: 10.13140/RG.2.1.1321.6725

Tierney, William M., Joseph K. Rotich, Terry J. Hannan, Abraham M. Siika, Paul G. Biondich, Burke W. Mamlin, Winstone M. Nyandiko et al. "The AMPATH medical record system: creating, implementing, and sustaining an electronic medical record system to support HIV/AIDS care in western Kenya." Studies in health technology and informatics 129, no. 1 (2007): 372.

Williams, Faustine, and Suzanne Boren. "The role of the electronic medical record (EMR) in care delivery development in developing countries: a systematic review." Journal of Innovation in Health Informatics 16, no. 2 (2008): 139-145.