Health Information Technology (Health IT), 2004

Mosoriot Rural Health Centre

February 2004

As a result of AHRQ-funded studies on electronic order writing and computer reminders, a number of interesting and extremely important activities are occurring in the quality of health care delivery in Africa.

AHRQ-funded research by Dr. William Tierney and his colleagues in Indianapolis identified factors that were important to the design and successful implementation of electronic medical record (EMR) systems. They used this research as the foundation for an EMR system that has been implemented in a rural clinic in Western Kenya—the Mosoriot Rural Health Centre (MRHC). The EMR system was also implemented in a number of HIV clinics and the Moi Teaching and Referral Hospital in Eldoret, Kenya.

The Mosoriot Medical Record System (MMRS), a computerized electronic medical record system, changed the flow of health care in the Mosoriot clinic. Before the MMRS, each clinic in the MRHC had a separate logbook in which information identical to that entered into the registration logbook was duplicated. In addition, each patient had a small booklet in which patient notes were written by clinic staff in longhand. With the development of the MMRS, the logbooks and the patient booklets were both replaced by the computerized "encounter form." At the conclusion of the visit, a printed version of the encounter form was handed to the patients to take home after the data were entered into the MMRS.

After the electronic system was implemented, the duplicate recording of information was eliminated, resulting in patient visits that were 22 percent shorter, and patients spent 38 percent less time waiting. These changes in management allowed the MRHC to either expand the role of the providers (e.g., increase patient education) or to reduce personnel in a cash-strapped clinic.

The Mosoriot Medical Record System has had far-reaching impact. For example:

• Reports required by the Kenyan Ministry of Health can be generated. These include, for example, the number of patients seen with selected infectious diseases and the number of childhood vaccinations given. Prior to the MMRS, creating these reports by hand from the MRHC logbooks took a clerk two weeks. Now they take just minutes. This has allowed the Director of the MRHC to reassign two medical records clerks to perform other duties in the MRHC where they are experiencing staff shortages.
• Patterns can be traced. For example, it was noticed that there was a cluster of sexually transmitted diseases in one village. The clinic Matron dispatched a team of nurses to investigate. In another instance, it was discovered that a significant number of children in one particular village was not being immunized.
• For health care providers, the MMRS also saved time, creating a resource that the managers of the MRHC could use for other activities, such as patient education.
• The MRHC pharmacist has used the MMRS reports to manage drug inventories.
• Clinicians are able to document the amount of free care (as required by the Ministry of Health) that is provided to pregnant women, children under age five, and adults with sexually transmitted diseases. Such reports have increased the Ministry of Health's funding of the MRHC.

As a result of the success of the Kenyan experience, the Presidential Emergency Plan For AIDS Relief (PEPFAR) has committed funding to ramp up the HIV care system in Kenya from 2,000 to 15,000 patients. In addition, the number of HIV care sites will double from two to four with the AHRQ-supported information system managing all data for all patients at all the sites.

During the first year, PEPFAR has obligated $1.6 million to the project through a contract with the U.S. Agency for International Development (USAID), with a promise for a full five years of funding, including the costs of the antiretroviral drugs to be provided by PEPFAR. An additional five-year, $15 million proposal was funded by the Centers for Disease Control and Prevention (CDC) through another track of PEPFAR funding. This will again double the number of sites to eight and further increase the number of patients served to 30,000.

In addition, the U.S. Army has also had a proposal funded through PEPFAR funds that will use the electronic medical record system at both of its sites in Kenya.

Speaking at the Health Informatics in Africa (HELINA 2003) Meeting, Dr. Tierney reported there was significant interest in the EMR systems as it is one of only two such systems in sub-Saharan Africa. The MMRS model is the only one dedicated to HIV/AIDS care. A Web site that was established and made available free of charge to those who wished to download the system along with its paper encounter forms can be found at: http://openmrs.org/wiki/OpenMRS. To date, clinics and programs in nine African countries and India have downloaded the software.

Dr. Tierney's goal is to establish an international practice-based HIV/AIDS research network in sub-Saharan Africa using the information system he and his colleagues developed and to be a major player in the upcoming vaccine and drug trials. Additionally, Dr. Tierney is in discussion with USAID, CDC, World Health Organization, and the World Bank concerning the need for electronic information in the battle against AIDS in Africa.

Impact Case Study Identifier: CP3 04-06
AHRQ-Sponsored Activity: Research
Topic(s): Information Technology
Scope: Kenya

Hannan TJ, Rotich JK, Odero WW, Menya D, Esamai F, Einterz RM, Sidle JE, Sidle J, Tierney WM. The Mosoriot Medical Record System: Design and initial implementation of an outpatient electronic record system in rural Kenya. International Journal of Medical Informatics 2000; (60):21-28.

Rotich JK, Hannan TJ, Smith FE, Bii J, Odero WW, Vu N, Mamlin BW, Mamlin JJ, Einterz RM, Tierney WM. Installing and implementing a computer-based patient record system in sub-Saharan Africa: The Mosoriot Medical Record System. Journal of the American Medical Informatics Association 2003; (10):293-303.

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Current as of September 2009

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Internet Citation:

Impact Case Studies and Knowledge Transfer Case Studies: Health Information Technology (Health IT), 2004. September 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/casestudies/healthit/hit2004.htm

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