E-health systems for management of MDR-TB in resource-poor environments: a decade of experience and recommendations for future work.
BACKGROUND
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.
Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
Hamish S F
HS
Fraser
Ali
A
Habib
Mark
M
Goodrich
David
D
Thomas
Joaquin A
JA
Blaya
Joseph Reginald
JR
Fils-Aime
Darius
D
Jazayeri
Michael
M
Seaton
Aamir J
AJ
Khan
Sharon S
SS
Choi
Foster
F
Kerrison
Dennis
D
Falzon
Mercedes C
MC
Becerra
D003906:Developing Countries; D057286:Electronic Health Records / Q000458:organization & administration*; D055695:Electronic Prescribing; D054908:Extensively Drug-Resistant Tuberculosis / Q000175:diagnosis* / Q000628:therapy*; D006205:Haiti; D063025:Health Information Management / Q000458:organization & administration*; D006801:Humans; D008510:Medication Systems, Hospital / Q000458:organization & administration*; D010154:Pakistan; D019114:Remote Consultation / Q000458:organization & administration*