title: Development, implementation, and evaluation of a hybrid electronic medical record system specifically designed for a developing world surgical service.
abstract: BACKGROUND
  The Pietermaritzburg Metropolitan Trauma Service previously successfully constructed and implemented an electronic surgical registry (ESR). This study reports on our attempts to expand and develop this concept into a multi-functional hybrid electronic medical record (HEMR) system for use in a tertiary level surgical service. This HEMR system was designed to incorporate the function and benefits of an ESR, an electronic medical record (EMR) system, and a clinical decision support system (CDSS).
  
  
  METHODS
  Formal ethical approval to maintain the HEMR system was obtained. Appropriate software was sourced to develop the project. The data model was designed as a relational database. Following the design and construction process, the HEMR file was launched on a secure server. This provided the benefits of access security and automated backups. A systematic training program was implemented for client training. The exercise of data capture was integrated into the process of clinical workflow, taking place at multiple points in time. Data were captured at the times of admission, operative intervention, endoscopic intervention, adverse events (morbidity), and the end of patient care (discharge, transfer, or death).
  
  
  RESULTS
  A quarterly audit was performed 3 months after implementation of the HEMR system. The data were extracted and audited to assess their quality. A total of 1,114 patient entries were captured in the system. Compliance rates were in the order of 87-100 %, and client satisfaction rates were high.
  
  
  CONCLUSIONS
  It is possible to construct and implement a unique, simple, cost-effective HEMR system in a developing world surgical service. This information system is unique in that it combines the discrete functions of an EMR system with an ESR and a CDSS. We identified a number of potential limitations and developed interventions to ameliorate them. This HEMR system provides the necessary platform for ongoing quality improvement programs and clinical research.
authors.affiliation: Department of Surgery, Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospital Complex, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Post-Net Suite #156, Private Bag X918, Pietermanitzburg, 3200, South Africa, grantlaing@me.com.
authors.forename: G L
authors.initials: GL
authors.lastname: Laing
authors.forename: J L
authors.initials: JL
authors.lastname: Bruce
authors.forename: D L
authors.initials: DL
authors.lastname: Skinner
authors.forename: N L
authors.initials: NL
authors.lastname: Allorto
authors.forename: D L
authors.initials: DL
authors.lastname: Clarke
authors.forename: C
authors.initials: C
authors.lastname: Aldous
mesh_terms: D003906:Developing Countries; D057286:Electronic Health Records / Q000458:organization & administration*; D013502:General Surgery / Q000458:organization & administration; D066275:Health Information Exchange; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000458:organization & administration; D016730:Program Development; D015397:Program Evaluation; D013019:South Africa; D013503:Surgery Department, Hospital