Information technology is playing a pivotal role in the work on the ground in earthquake-ravaged Haiti as Boston-based Partners in Health tends to the sick and the maimed.
Partners in Health (PIH) was founded in 1987, two years after the Clinique Bon Sauveur was set up in Cange, Haiti, to deliver healthcare to the residents of the mountainous central plateau.
"We have used satellite Internet at our clinics in the central plateau for over a decade, long before the cell phone system was available there – there are still no landlines in most areas," said Hamish Fraser, director of informatics and telemedicine for PIH. "This has been crucial for our projects in allowing coordination of staff, logistics and supply chain and clinical data management."
After last week's earthquake, PIH maintained communication with its nine medical sites in Haiti through satellite-based Internet services and was able to plan a response even when all the systems in Port-au-Prince were down, Fraser said.
Electronic medical records
Fraser's IT team developed a Web-based electronic medical record for HIV patients in 2002 and deployed it at the beginning of 2003. The system now has records for more than 14,000 patients and is used to track their clinical status, lab results, medications and follow-up status.
"We generate reports for the government and funders and make lab data available to the physicians and medication lists for the pharmacists," Fraser said. "We also built a drug supply management tool to track all the medications in our main warehouse and our 10 hospitals."
A Web-based medication management tool allows staff at each site to record, track and report on local stock and enter online orders.
"We managed 33 container loads of stock to support 2.6 million patient visits in 2008," Fraser said.
Recently the IT team developed an open-source EMR system, called OpenMRS, to support PIH's treatment program for drug-resistant TB. Fraser said PIH worked with partners in the United States and Africa to develop the system, which is deployed at five PIH country projects and in more than 20 countries worldwide.
A world of difference
PIH's use of information and communication technologies has made a significant difference in Haiti, Fraser said.
"The ability to maintain communications by e-mail and Skype has really made our growth and the high-quality care possible," he said. "It was also crucial after the earthquake."
Fraser said the management of clinical data has enabled PIH to monitor quality of care and saved time and resources in reporting to the government and funders.
"We also provide tools to help identify patients lost to follow-up – a very dangerous situation for AIDS patients," Fraser said. "The pharmacy system has helped us to avoid stock-outs despite the rapid growth in volume of patients and supplies."
Fraser said PIH's typical stock-out rates are 2 percent or less, compared to figures of 30 percent to 50 percent that are found in remote clinics in Africa.
To read about the IT team and what's next, click on next page.
The IT team
The IT team for PIH consists of Fraser, four programmers and an administrative person, all based in Boston. There is no resident programmer in Haiti.
"We have Haitian IT and data management staff supervising about 20 data-entry staff at the various clinics," Fraser said. "There is also specialist IT support in Boston for satellite links and advanced networking. We were recruiting a new IT or programming person to work in Haiti this spring."
In Rwanda, PIH has a resident team of four U.S. programmers and has just added 10 Rwandan Java/OpenMRS programmers, who are working with the government's ministry of health on EMR implementation.
Fraser said his team is at work on cell phone-based tools for data collection in various projects around the world and may soon use these tools in Haiti.
Some big-name technology companies – Dimagi, Google and Thoughtworks – have offered to help on various projects, he said.
"We would greatly welcome assistance with programming (Java) and funding to expand the information systems team in Haiti," Fraser said
PIH co-founders Paul Farmer and Jim Yong Kim had been working in the area for years when they founded Partners in Health in 1987. It has ties with Boston-based Partners HealthCare, recognized for its leadership in healthcare information technology. Farmer and Fraser serve as attending physicians at Brigham and Women's Hospital, part of the Partners HealthCare system, and both teach at Harvard Medical School.
Partners HealthCare CIO John Glaser said Partners has served as adviser or consultant from time to time. "But since they are independent of Partners, they have funded and managed their own IT work," he said.
Partners HealthCare recently sent teams of physicians and nurses to Haiti, Glaser said.
Farmer, an anthropologist and physician, is the Presley Professor of Medical Anthropology in the Department of Social Medicine at Harvard University and an attending physician at Brigham and Women's Hospital in Boston.
Farmer's work and that of PIH are the subject of Tracy Kidder's 2003 book "Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World."