Browsing by Author "Fraser, Hamish S F"
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- ItemAdaptation of a web-based, open source electronic medical record system platform to support a large study of tuberculosis epidemiology.(2012-12-28) Fraser, Hamish S F; Thomas, David; Tomaylla, Juan; Garcia, Nadia; Lecca, Leonid; Murray, Megan; Becerra, Mercedes CBACKGROUND In 2006 we were funded by the US National Institutes of Health to implement a study of tuberculosis epidemiology in Peru The study required a secure information system to manage data from a target goal of 16 000 subjects who needed to be followed for at least one year With previous experience in the development and deployment of web based medical record systems for TB treatment in Peru we chose to use the OpenMRS open source electronic medical record system platform to develop the study information system Supported by a core technical and management team and a large and growing worldwide community OpenMRS is now being used in more than 40 developing countries We adapted the OpenMRS platform to better support foreign languages We added a new module to support double data entry linkage to an existing laboratory information system automatic upload of GPS data from handheld devices and better security and auditing of data changes We added new reports for study managers and developed data extraction tools for research staff and statisticians Further adaptation to handle direct entry of laboratory data occurred after the study was launched RESULTS Data collection in the OpenMRS system began in September 2009 By August 2011 a total of 9 256 participants had been enrolled 102 274 forms and 13 829 laboratory results had been entered and there were 208 users The system is now entirely supported by the Peruvian study staff and programmers CONCLUSIONS The information system served the study objectives well despite requiring some significant adaptations mid stream OpenMRS has more tools and capabilities than it did in 2008 and requires less adaptations for future projects OpenMRS can be an effective research data system in resource poor environments especially for organizations using or considering it for clinical care as well as research
- ItemDevelopment, implementation and preliminary study of a PDA-based tuberculosis result collection system.(2007-01-22) Blaya, Joaquin; Fraser, Hamish S FPartners In Health PIH and its sister organization in Lima Peru Socios En Salud SES treat a majority of multidrug resistant tuberculosis MDR TB patients in Peru in conjunction with the Peruvian National TB Program NTP Monthly bacteriology tests which must be collected from health establishments located across this major city are an integral part of this treatment Currently a SES employee visits each health establishment to collect this information by hand process it and type it into an electronic medical record system PIH EMR In this paper we describe the development and implementation of a personal digital assistant PDA based electronic system to collect verify and upload monthly bacteriology data into the PIH EMR After an initial implementation period we performed a pilot study to test the use of this system We completed a baseline assessment in two health districts and then implemented the electronic system in one of the districts while the control site continued to use the paper based system during the same period The PDA based system had a processing time of 6 2 days significantly lower than measurements for both the baseline 54 8 and control sites 64 4 both pUnder0 0001 It was also able to reduce the frequency of discrepancy from 10 1 to 2 8 pUnder0 0001 and receive positive feedback from the users Finally the system s cost would be recuperated in three months from time savings due to increased work efficiency This system will be the subject of a larger study to determine its impact on delays errors and costs
- ItemDiagnostic accuracy of chest X-rays acquired using a digital camera for low-cost teleradiology.(2004-03-23) Szot, Agnieszka; Jacobson, Francine L; Munn, Samson; Jazayeri, Darius; Nardell, Edward; Harrison, David; Drosten, Ralph; Ohno-Machado, Lucila; Smeaton, Laura M; Fraser, Hamish S FStore and forward telemedicine using e mail to send clinical data and digital images offers a low cost alternative for physicians in developing countries to obtain second opinions from specialists To explore the potential usefulness of this technique 91 chest X ray images were photographed using a digital camera and a view box Four independent readers three radiologists and one pulmonologist read two types of digital JPEG and JPEG2000 and original film images and indicated their confidence in the presence of eight features known to be radiological indicators of tuberculosis TB The results were compared to a gold standard established by two different radiologists and assessed using receiver operating characteristic ROC curve analysis There was no statistical difference in the overall performance between the readings from the original films and both types of digital images The size of JPEG2000 images was approximately 120KB making this technique feasible for slow internet connections Our preliminary results show the potential usefulness of this technique particularly for tuberculosis and lung disease but further studies are required to refine its potential
- ItemE-health systems for management of MDR-TB in resource-poor environments: a decade of experience and recommendations for future work.(2013-08-07) Fraser, Hamish S F; Habib, Ali; Goodrich, Mark; Thomas, David; Blaya, Joaquín A; Fils-Aime, Joseph Reginald; Jazayeri, Darius; Seaton, Michael; Khan, Aamir J; Choi, Sharon S; Kerrison, Foster; Falzon, Dennis; Becerra, Mercedes CINTRODUCTION Multi drug resistant TB MDR TB is a complex infectious disease that is a growing threat to global health It requires lengthy treatment with multiple drugs and specialized laboratory testing To effectively scale up treatment to thousands of patients requires good information systems to support clinical care reporting drug forecasting supply chain management and monitoring METHODS Over the last decade we have developed the PIH EMR electronic medical record system and subsequently OpenMRS TB to support the treatment of MDR TB in Peru Haiti Pakistan and other resource poor environments RESULTS We describe here the experience with implementing these systems and evaluating many aspects of their performance and review other systems for MDR TB management CONCLUSIONS We recommend a new approach to information systems to address the barriers to scale up MDR TB treatment particularly access to the appropriate drugs and lab data We propose moving away from fragmented vertical systems to focus on common platforms addressing all stages of TB care support for open data standards and interoperability care for a wide range of diseases including HIV integration with mHealth applications and ability to function in resource poor environments
- ItemEvaluating the impact and costs of deploying an electronic medical record system to support TB treatment in Peru.(2007-01-22) Fraser, Hamish S F; Blaya, Joaquin; Choi, Sharon S; Bonilla, Cesar; Jazayeri, DariusThe PIH EMR is a Web based electronic medical record that has been in operation for over four years in Peru supporting the treatment of drug resistant TB We describe here the types of evaluations that have been performed on the EMR to assess its impact on patient care reporting logistics and observational research Formal studies have been performed on components for drug order entry drug requirements prediction tools and the use of PDAs to collect bacteriology data In addition less formal data on the use of the EMR for reporting and research are reviewed Experience and insights from porting the PIH EMR to the Philippines and modifying it to support HIV treatment in Haiti and Rwanda are discussed We propose that additional data of this sort is valuable in assessing medical information systems especially in resource poor areas
- ItemPersonal digital assistants to collect tuberculosis bacteriology data in Peru reduce delays, errors, and workload, and are acceptable to users: cluster randomized controlled trial.(2009-04-24) Blaya, Joaquín A; Cohen, Ted; Rodríguez, Pablo; Kim, Jihoon; Fraser, Hamish S FOBJECTIVES To evaluate the effectiveness of a personal digital assistant PDA based system for collecting tuberculosis test results and to compare this new system to the previous paper based system The PDA and paper based systems were evaluated based on processing times frequency of errors and number of work hours expended by data collectors METHODS We conducted a cluster randomized controlled trial in 93 health establishments in Peru Baseline data were collected for 19 months Districts n 4 were then randomly assigned to intervention PDA or control paper groups and further data were collected for 6 months Comparisons were made between intervention and control districts and within districts before and after the introduction of the intervention RESULTS The PDA based system had a significant effect on processing times pUnder0 001 and errors p 0 005 In the between districts comparison the median processing time for cultures was reduced from 23 to 8 days and for smears was reduced from 25 to 12 days In that comparison the proportion of cultures with delays 90 days was reduced from 9 2 to 0 1 and the number of errors was decreased by 57 1 The intervention reduced the work hours necessary to process results by 70 and was preferred by all users CONCLUSIONS A well designed PDA based system to collect data from institutions over a large resource poor area can significantly reduce delays errors and person hours spent processing data