At the University of Chicago Gleacher Center on January 9, to an audience of Biomedical Informatics and Threat and Response Management students, Devin Mehta, MD, and Bobby Bacci of Global Health Coalition shared their experience and insight into improving the quality of care for underserved populations by developing and deploying a low-cost, energy-efficient electronic medical record system.
Christine Clark, associate director of Health and Human Sciences at the University of Chicago, called the event, which was titled Leveraging Data and Analytics to Decrease the Disparity in Global Health Equity, “a terrific case study intersecting both fields of knowledge—healthcare and emergency management.”
As background both to the presentation and his founding of Global Health Coalition, Dr. Mehta, an advanced heart failure cardiologist, described for the audience his trip to Haiti with a group of doctors from Rush Medical Center after the devastating 2010 earthquake. He was just starting medical school at the time.
With the capital Port-au-Prince nearly uninhabitable, the population had fled into the countryside where they had resettled in unplanned tent cities largely lacking in electricity, clean water, and other basic services—including healthcare. The doctors’ primary concerns upon arriving revolved around providing basic care for wounds and preventing illnesses from becoming endemic.
“Imagine us in an open-air church that’s now become a medical clinic,” said Dr. Mehta, who currently serves as the director of heart failure at Northwest Community Hospital in Arlington Heights, Illinois. “It’s a completely dry landscape and getting off the bus that first day, there are hundreds of people waiting in line. We unpack our medical supplies and get started by positioning 12 providers around the room.”
In this way, they developed a basic assessment protocol that included everything from registering patients with ID cards to directing them to a pharmacy station.
Over the next couple years, as aid trickled in and as the doctors returned, a rudimentary medical infrastructure was established.
But Dr. Mehta remained disheartened. He could not help but compare the state of healthcare services on the ground in Haiti to what he was learning about in medical school. With electronic medical records widespread by this point in the United States, he realized that a key element to his frustration was the difficulty involved in understanding longitudinally what was happening to his Haitian patients. For that, he needed a better picture of their medical history.
“It was sometimes hard to see the difference we were making,” he admitted. “When all you have to work with are scribbles on paper, steering a patient to health can be challenging. It made it especially difficult to learn all these advanced medical techniques when all I was thinking about was clean water, access to healthcare, putting a roof over someone’s head, and electricity.”
Friends since third grade with Mr. Bacci, Dr. Mehta had an opportunity to share his experience in Haiti upon returning. With a degree in finance and four years working as a project manager at Epic Health Services, Mr. Bacci had recently started his own company, Prominence Advisors, which helps healthcare organizations with electronic medical record implementation and data governance.
While listening to Dr. Mehta recount the difficulties he encountered, Mr. Bacci was quick to note that the challenges his friend described were fundamentally no different from those that drove the development of electronic medical records in the United States.
“You’re talking about creating an offline electronic medical record system that will provide a network for people to communicate and collaborate that can also stay powered for at least 18 hours out in the field. That’s really where the problem solving got interesting.” —Bobby Bacci
“When all the information you’re trying to leverage to make decisions is on paper, it’s almost impossible to compile the data into a model that will help you make better decisions,” he said. “Productivity is down and accessibility is next to zero: only one person can hold the record at once. And quality is also low since there’s fragmentation in the delivery of care when there’s no collaboration.”
For these reasons, it seemed clear that implementing an electronic medical record system would be an important step to increasing the impact of Dr. Mehta’s work in Haiti. The obstacle to doing so, however, went well beyond the fact that hospital systems in the United States spend up to half a billion dollars building one.
“There was no power where Devin was working, no WiFi, no information technology infrastructure,” Mr. Bacci said. “You’re talking about creating an offline electronic medical record system that will provide a network for people to communicate and collaborate that can also stay powered for at least 18 hours out in the field. That’s really where the problem solving got interesting.”
The challenge was really twofold. First, they had to find a software and hardware solution that could be scalable within a limited budget across rural communities. Second, it was a matter of developing an electronic medical record system sufficiently intuitive that volunteers could be trained to use it without difficulty.
After scouring the internet for low-cost, energy-efficient options, they arrived at the solution of daisy-chaining portable AC battery packs to a router that would then serve as a local area network. Using a laptop as a server, providers in the field would then use Chromebooks to enter patient data.
“We set out to build a mobile and easy-to-use electronic medical record system that a person could pack in a bag and take from the US down to Haiti,” Dr. Mehta explained. “That person, who might be fairly inexperienced with the system, would then take it out into a community, unroll it, deploy it, and use it with a team that might never see it again. After that, the system gets carried back into Port-au-Prince, hooked up to WiFi, and the data gets uploaded back to the US where the analytics work can be done.”
“We take pride in understanding the people and knowing what the healthcare workers on the ground will need in order to succeed. We build the system with them in mind. Being able to modify it is really the beauty of it.” —Devin Mehta, MD
Rather than creating their system from scratch, they opted to use OpenMRS Bahmni, an open source system which allowed them, with the help of Tableau, to pick and choose the features they would work with. To understand what functionalities they needed, Dr. Mehta and Mr. Bacci had to spend time on the ground assessing workflow.
“The onsite needs assessment is really critical,” Mr. Bacci said. “You can’t solve a problem until you’re in the space of that problem. You have to use your eyes and all your senses to understand how it’s going to be deployed. And the way we made those decisions was by asking ourselves what data would be most essential to making decisions that would lead to a higher quality of care.”
Dr. Mehta highlighted that every deployment that Global Health Coalition makes to different health clinics entails matching the electronic medical record software to the workflow of the community.
“That’s very unique in what we do,” he added. “We take pride in understanding the people and knowing what the healthcare workers on the ground will need in order to succeed. We build the system with them in mind. Being able to modify it is really the beauty of it.”
With 3.75 billion people, or half the world’s population, lacking access to essential healthcare services in the world today, Dr. Mehta and Mr. Bacci noted how the work they’re doing through Global Health Coalition has the potential to impact the standard of care far beyond Haiti.
“When we create data where no data exists today, we are building a bridge to connect those who are currently unconnected,” Mr. Bacci said. “By connecting data from a ‘data dark population,’ like a resettlement community in Haiti, to our healthcare system, physicians in the US can now look at it and make recommendations over FaceTime or a phone call with community members.”
While their work in Haiti was done in collaboration with Rush Global Health, Dr. Mehta and Mr. Bacci are looking for new ways to partner with nonprofits as a way to provide critical care. As an example, they mentioned their current work with One World Surgery, a nonprofit operating out of Ecuador and the Dominican Republic that provides surgeries to patients who would otherwise lack access to critical life-altering care.
“We’re thinking more and more about how can we work with nonprofits that are providing critical care in rural communities,” Mr. Bacci said. “By giving them the platform to collect data, research can then be driven off that data that creates a global population health picture. With that, you can start to drill into some of the areas that positively impact longevity and care in these rural communities.”
In concluding, Dr. Mehta pointed to a critical paradox impacting global healthcare today. Because international aid organizations base their funding decisions on quantifiable measures derived from data, impoverished off-the-grid populations often need aid the most while, at the same time, remaining invisible to the organizations delivering it.
“Unless we know about these populations, unless we know who these people are and what diseases they have—unless we’re able to construct narratives around them—the folks driving funds and making decisions won’t be able to reach them,” he said. “Global Health Coalition’s mission is to improve health outcomes for the world’s poorest communities through data-driven problem-solving that increases visibility and the impact of care-related decisions.”