“I would like the system to facilitate monitoring of patients and transfer and referral of patients from one department to another and facility to another (Mchinji DHO during site visit in January 2013). This has been the request for many system users having recognized that they are using the EMR and this can save as a tool to facilitate patient identification across facilities.
With this request, Baobab recognised the need to prioritise modification of patient identification from mainly being unique at facilities to being unique across facilities. Baobab has led in the scale up of the ART electronic medical record (EMR) system in Malawi. The National ART programme adapted the WHO “option B” ART clinical guidelines to accommodate lifetime enrollment onto ART for all HIV positive pregnant women. This is now called “option B+”. This approach has had implications on the need to follow up patients across facilities in order to understand their outcomes. These use cases confirm the definition of the patient record that is supposed to be a lifetime documentation of all the patient encounters with any health system. At the centre of this is unique identification.
Baobab health has thus since designed a component for its EMRs that allows for unique patient identification across facilities. This system component has several key functions as follows:
1 Centralised generation of patient IDs
2 Distribution of IDs to facilities
3 Synchronisation of Unique IDs and demographics among sites.
Baobab has built on its experience and world standards to generate the Unique IDs. “The WHO properties of generating unique IDs has been used to design the format for the IDs,” Mwatha Bwanali who is the lead software developer explains. He further says that the adopted format promotes privacy and confidentiality of the patient because it is not location specific but is centrally generated. A key feature of DDE will also help follow up of pregnant mothers that may choose to go and access other services.
As of now Baobab has rolled out the DDE to Kamuzu Central Hospital and Bwaila Hospital which acts as a district hospital for Lilongwe. The DDE currently operates in Master-Slave mode, with connected facilities synchronizing demographics with and IDs every 10 minutes.
An upbeat Baobab Executive director observes “the implementation of the DDE component will act as a platform for facilitating continuum of care and tracking of patient outcomes across facilities”.