Using a Point-of-Care EMR to Improve Quality of Care & Capacity at University Hospital in
Mirebalais, Haiti
Brittany Eddy, MPH Director Health Information Systems Hôpital Universitaire de Mirebalais
Introduction
• Zanmi Lasante founded in 1983
• Partners In Health founded in 1987
• Ministère de la Santé Publique et de la Population Partnership
• Provide Preferential Option for the Poor Cange, 1983
Introduction
• Plans to construct community hospital
• 2010 Haiti Earthquake
• National Tertiary Teaching Hospital
• Opened in March 2013 o 300 bed facility o 6 operating suites
Partnerships
• Over 170 Donors o Private o Corporate
Introduction
• Around 25% of Haitian trained clinicians leave Haiti*
• HUM Focus on o Capacity building o Professional development
• Building back a better Haiti
• Economic impact * 2006 – www.usi.umontreal.ca/parc
Use of Technology
• Technology used to strengthen workforce o First CT scanner in public
sector o PACS o EMR o Supply Chain Management
Software o State of the art operating
theatres o Telemedicine
Use of Technology
• Leveraging open source technology to build capacity
OpenMRS
• OpenMRS o Open-source software o Global community of
developers o Used in over 50 countries o Improve health care delivery in resource poor settings
HUM EMR
• Patient Registration • Archives Management • Consultation note • Radiology orders • Dispensing application
• Coming soon:
o Scheduling System o Flexible Reporting Framework
HUM Health Information Systems
• Health Information Systems
o Medical Informatics o Monitoring, Evaluation &
Quality Improvement • Clinical Department • Coaching clinical services:
o Data Quality o Transform data into information o Data utilization o Evidence-based decision
making
HUM Health Information Systems
• Service and hospital-wide data dashboards • Monthly presentations for clinical services • Trainings, supervision, support
HUM Catchment
Specialty Services
0
500
1000
1500
2000
2500
3000
3500
4000
Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan
Num
ber o
f con
sulta
tions
HUM Specialty Service Volume (Mar 2013 - Jan 2014)
Internal Medicine⁷
Pediatrics/NICU Ward⁶
Oncology⁵
Maternity Services⁴
Rehabilitation³
Emergency Dept.²
Surgery¹
Surgery
General Surgery; 418;
32%
Neurosurgery; 1; 0%
Obstetrics/Gynecology; 613; 47%
Opthalmology; 1; 0%
Orthopedics; 205; 16%
Otorhinolaryngologie
(ORL); 25; 2%
Pediatric Surgery; 2;
0%
Plastic Surgery; 9;
1%
Urology; 17; 1%
Vascular Surgery; 1;
0%
Unknown; 10; 1%
Number of Operations by surgical type (N=1,302),
(May 2013 – Feb 2014)
Oncology
• Over 2500 patient consultations
• Breast Cancer Registry o Over 260 confirmed cases
(July 2013 – February 2014)
Vision for HUM HIS
• Build culture of data utilization
• Build Academic Partnerships • Specialty care research
o NCD’s o Oncology o Surgery o Sickle cell screening
• Expand on foundation to extend to
operational research
Impact of HUM on quality of care and population health
• Facility based deliveries
• Distance traveled for specialty services
• Costing of specialty services
• Using EMR to identify and reduce wait time for key services
• Using EMR to evaluate hospital performance on post-surgical re-admission
Conclusion
• Building and running a state of the art hospital in a resource poor setting is possible
• Partnerships and technology are transforming health care being delivered in Haiti
• Private/public partnerships are key to this success
• Having a strong information system creates a foundation for programmatic decision making, operational research and more
Acknowledgements
• Boston Monitoring, Evaluation & Quality Team o Alyssa Bilinski o Daniel Chiu o Phil Garrity o Lisa Hirschhorn o Annie Michaelis o Matt Peckarsky
• Boston Medical Informatics Team o Ellen Ball o David DeSimone o Mark Goodrich o Cosmin Ioan o Darius Jazayeri o Andrea Jensen o Renee Orser o Louise Secordel o Mike Seaton o Evan Waters
o Thoughtworks
• Hôpital Universitaire de Mirebalais o Executive Team o Archives Team o Dadie Cazimir o Marie Line Masson o Gabou Mendy o Ricard Pognon o Jean Wesley Thosiac o Data Team
• Zanmi Lasante Monitoring, Evaluation & Quality Team o Gregory Jerome o Jean Paul Joseph
• Ministère de la Santé Publique et de la Population