IT4LIFE wants to achieve the development of a Data Management System, known as Buendia2. It is an Electronic Medical Record (EMR) system designed to be used on a tablet computer. It is built for use by a clinician performing a consultation and analysing individual patient records. It is capable of exporting aggregate data to be brought into a Health Information System (HIS), to be integrated in HIS as DHIS2. It is adapted to poor resource settings: built to function without internet access, reliable power, access to tech support, or a local network.
This technology has multiple potential applications in health care in emergencies humanitarian situations. It has been settled on the nutritional crisis as the clinical issue to address. Thanks to its flexibility it can be implemented in future nutritional crises or easily repurposed for other types of emergency.
Delivering high quality care in a nutrition program requires collecting and visualising data on large numbers of patients over time, often in remote and dusty locations; as such, a portable weatherproof EMR can: Increase quality of clinical decision-making by providing a faster, more accessible, and more error-free view of individual patient data, facilitating better decision-making. Increase reach to more decentralised sites, since the system should enable less highly-trained consultants to provide an acceptable standard of care and spend less time on paperwork.
Digital technologies facilitate communication, coordination, collection and analysis of data, enabling timely responses in humanitarian contexts, improve the health and social well-being of populations affected by both acute and protracted crises.Decisions in nutrition such as exit criteria are linked not only to current status, but to past clinical evolution. For example, a child with a specific weight-for-height at triage might not be admitted, but the same measurements partway through a course of treatment would still require ongoing care. Therefore a longitudinal view, including the whole history of the patient, is necessary to make the right decisions.
Buendia v2 technology can radically increase the efficiency (time savings) and productivity (cost savings) of humanitarian effort, and reshape aid so it is fit for the 21st century. This means being proactive in response to risks, collaborating across organizations, localizing response and thinking about all this from the perspective of those who are affected by crises. A better and faster quality of care will be provided, with lower rate of medical errors and long-term monitoring of patients, thanks to accurate and flexible digital technologies.
The reach of nutrition projects is often limited by HR,and by the amount of highly-trained consultants we can deploy.The ability of these staff to perform quality consultations, and to refer as needed, is a common limitation preventing projects from having more satellite sites.If nutrition consultations could be performed more reliably by local, less highly-trained staff, many projects might be able to open more decentralized sites, increasing the reach and life-saving potential of the projects.
The output of this innovation project will be a data management system that has been piloted and works, and can be implemented in future nutritional crises or easily repurposed for other types of emergency. The Buendia v2 system is well suited to the nutrition context, and with a few modifications will reach the desired state outlined above. it is unusually robust, intended to function in an extreme environment with no internet, intermittent power, little or no IT support, and comes packaged in a single, easily transported padded case. However, the more important aspects of the “fit” for nutrition relate to the workflow.
Step 1 : Buendia2 installation consists of tablets (in a nutrition context, one per consultant plus a spare), a microserver, and a Local Area Network (LAN) kit. The tablets run a clinical user application that allows the creation, retrieval, and modification of individual patient records. The patient records are synchronized to a local server via a secure private LAN, and therefore accessible to all authorized users (and can be downloaded by an authorized manager onto a laptop for importation into data tools for detailed analysis and/or integration into HIS platforms, current or future).
Step 2 : The tools will be piloted and evaluated in an agreed field site.This will be an opportunity to identify and correct bugs in a field setting, where the conditions will match the actual environment of the end users. At the same time, the team will work with the medical and operational managers to assess the appropriateness and impact of the tool; looking at the medical workflow and expected impact on patient outcomes rather than simply seeing if the tool performs technically as expected. The development of the nutritional tool will be done such that the system can be more easily modified for other use-cases in the future.
Buendia v2 is sustainable for resource-poor settings : the system is built to function without a need for internet access, reliable power, access to local IT or tech support, or a pre-existing local network.
Two sets of indicators will be designed to assess impact : the technical functioning of the system (does it do what it is says on the label) and medical/operational impact of the system (does it improve quality of data collection and clinical care).
Quality of nutritional care is evaluated based on SPHERE standard including recovery, default and death rates.Expected results are: Increases quality of clinical decision-making: Consultants have a faster, more accessible, and more error-free view of individual patient data, facilitating better decision-making. Consultants spend less time dealing with paperwork, allowing more time for the clinical interaction.Some amount of algorithmic guidance is built into the system, increasing the speed and proportion of correct decisions (either in direct clinical decisions or decisions to refer). Increases reach: The system should enable less highly-trained consultants to provide an acceptable standard of care. Hence, more decentralized sites can be managed, capturing more children and doing so earlier in the progression of their condition. Consultants spend less time looking for and filling out paperwork and making calculations, allowing them to see more patients while maintaining quality of care.
The team will work with the medical and operational managers to assess the appropriateness and impact of the tool; looking at the medical workflow and expected impact on patient outcomes rather than simply seeing if the tool performs technically as expected.
The tools will be piloted and evaluated in an agreed field site.This will be an opportunity to identify and correct bugs in a field setting, where the conditions will match the actual environment of the end users. The adaptation of the tool will proceed by first designing a tool to modify the system, then using that tool to build the nutrition application. This will “future proof” the system by making it more easily modifiable with minimal (or perhaps even no) input from expensive and hard-to-find software engineers.
The 2013 conflict in CAR has had dire consequences on an already very weak health system.The lack of qualified HR, essential medicine, effective gratuity of care combined with the financial difficulties met by the population hinder access to quality care. In 2018: the humanitarian situation is predicted to deteriorate, and access to people in need could be restricted by continued and escalating violence,2.2 million people, require immediate humanitarian assistance.
The local staff will be the direct beneficiary of this innovation, this will strengthen the ability of the local staff to perform quality consultations, and to provide better care for patients. Quality of care requires an overview of the patient's clinical evolution over time. Improvements on the application will be possible thanks to a proactive participation of the local staff; focusing on the specific needs of patients.
We plan to do it in consortium with previous collaborators on this project as Ivan GAYTON or Ka-Ping YEE and with ALIMA NGO.
Alima design programs so that impact can be measured continuously and incrementally, focusing on outcomes, not just outputs, using data responsibly according to international norms and standards.
ALIMA has teams of public health specialists and NICT experts both at the operational headquarter in Dakar and at the national coordination level. These teams are all supported by experts in finance, management and logistics.Currently, ALIMA manages grants from ECHO, OFDA, ELMA, AFD...ALIMA works hand-in-hand with a network of local and national medical organizations to provide life-saving care to neglected communities. ALIMA’s programs are managed in a decentralized manner. Each crisis is unique, and the response must be adapted to the context. Decisions are made in tandem with local partners at ground level.
Since its creation in 2009, ALIMA treated more than 2 million patients, conducted 56 programs in 13 countries and launched 10 research projects focusing on malnutrition, malaria, Ebola, and surgery. ALIMA has teams dedicated to acute emergencies and recurring crises. ALIMA invests in operational and clinical research to improve medical care in humanitarian emergencies, including trauma surgery, nutrition, paediatric care, and Ebola prevention and treatment.
As members of the international community and independent humanitarian organization, Alima respect the nine Principles for Digital Development (build for sustainability, design with the user, understand the existing ecosystem, design for scale, , be data driven, use open standards, open data, open source, and open innovation, reuse and improve, address privacy and security, be collaborative) and contribute to environmental awareness and behaviour change.
The Buendia technology will allow better health surveillance, performing a consultation and analysing individual patient records leading to effective interventions in line with SDG 3: Good health and well-being.
The project takes into account the specific needs of the most vulnerable beneficiaries (children and pregnant and lactating women), and raise awareness among teams, both at headquarters and in the field, to the analysis and integration of gender-related risks and to the implementation of appropriate measures in the activities carried out.
This proposal differs from other grants because it mainly takes into account the data lifesaving dimension in application not only to the nutritional context but also to different crisis contexts and easily repurposed for other types of emergency.
An extension of this project it to build a microserver powered by solar panels capable to run an instance of Bahmni or Odoo in an antena care or a mobile clinic.
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