Evaluating the Performance, Impact and Costs of a Large Scale eHealth System Impl -
Project summary
This application addresses the urgent need for more and better evidence on the appropriate
selection, implementation and use of electronic health (eHealth) systems to support the care of
HIV patients in developing countries. eHealth system including electronic medical records
(EMRs) are potentially powerful instruments to strengthen health systems, to improve access to
and quality of care, and reduce costs. While these technologies show great promise in countries
whose health systems face severe financial, infrastructural, technical and human resource
constraints, key questions remain for decision makers: (1) How can eHealth facilitate scale up of
health initiatives in resource poor environments? (2) How can such systems be more effectively
developed, and implemented to ensure high quality information for clinical and programmatic
use? (3) Have the large investments in eHealth in resource-poor environments demonstrated
clinical impacts such as improving HIV patient outcomes? (4) What are the short term and long
term costs of implementing such systems and how can their sustainability be improved?
While eHealth is proliferating in resource poor environments, often for HIV care supported by
large investments from agencies including PEPFAR, data on their implementation, clinical
impact and costs is very sparse. Countries like Rwanda and Kenya whose eHealth plans call for
national rollouts of EMRs critically need evidence from rigorous, and generalizable studies.
The core issue being addressed in this study is: What is the benefit of using an eHealth system to
collect and manage clinical data at clinics that are often in remote sites with limited staff, and
infrastructure? It builds on a critical opportunity to assess an open source EMR system,
OpenMRS, that is being adapted by a technical team from the Rwandan MOH, and rolled out to
several hundred clinics. With 11 sites implemented to date, this is the ideal time to perform a
randomized controlled trial with 50 or more sites randomized to receive the system early or late.
We will address three related questions: how to optimize systems and ensure they are stable,
usable and used, what are the impacts on clinical processes and outcomes, and what are the costs
of deploying and sustaining such systems? Clinical indicators will include mean CD4 count and
viral load, activities such as ordering of laboratory tests, and rate of loss to follow up of pre-ART
patients. The results should inform policy and care in many countries for HIV and other diseases.
We will also create a training course in eHealth evaluation at the National University of Rwanda
School of Public Health, training evaluators to take a lead in designing and carrying out studies.
