title: Scale-up of networked HIV treatment in Nigeria: creation of an integrated electronic medical records system.
abstract: OBJECTIVE
  The implementation of PEPFAR programs in resource-limited settings was accompanied by the need to document patient care on a scale unprecedented in environments where paper-based records were the norm. We describe the development of an electronic medical records system (EMRS) put in place at the beginning of a large HIV/AIDS care and treatment program in Nigeria.
  
  
  METHODS
  Databases were created to record laboratory results, medications prescribed and dispensed, and clinical assessments, using a relational database program. A collection of stand-alone files recorded different elements of patient care, linked together by utilities that aggregated data on national standard indicators and assessed patient care for quality improvement, tracked patients requiring follow-up, generated counts of ART regimens dispensed, and provided 'snapshots' of a patient's response to treatment. A secure server was used to store patient files for backup and transfer.
  
  
  RESULTS
  By February 2012, when the program transitioned to local in-country management by APIN, the EMRS was used in 33 hospitals across the country, with 4,947,433 adult, pediatric and PMTCT records that had been created and continued to be available for use in patient care. Ongoing trainings for data managers, along with an iterative process of implementing changes to the databases and forms based on user feedback, were needed. As the program scaled up and the volume of laboratory tests increased, results were produced in a digital format, wherever possible, that could be automatically transferred to the EMRS. Many larger clinics began to link some or all of the databases to local area networks, making them available to a larger group of staff members, or providing the ability to enter information simultaneously where needed.
  
  
  CONCLUSIONS
  The EMRS improved patient care, enabled efficient reporting to the Government of Nigeria and to U.S. funding agencies, and allowed program managers and staff to conduct quality control audits.
authors.affiliation: Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Chaplin
authors.affiliation: Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Seema
authors.initials: S
authors.lastname: Meloni
authors.affiliation: Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Eisen
authors.affiliation: AIDS Prevention Initiative in Nigeria, Abuja, Nigeria.
authors.forename: Toyin
authors.initials: T
authors.lastname: Jolayemi
authors.affiliation: AIDS Prevention Initiative in Nigeria, Abuja, Nigeria.
authors.forename: Bolanle
authors.initials: B
authors.lastname: Banigbe
authors.affiliation: AIDS Prevention Initiative in Nigeria, Abuja, Nigeria.
authors.forename: Juliette
authors.initials: J
authors.lastname: Adeola
authors.affiliation: Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Wen
authors.affiliation: Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Harry
authors.initials: H
authors.lastname: Reyes Nieva
authors.affiliation: Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Chang
authors.affiliation: AIDS Prevention Initiative in Nigeria, Abuja, Nigeria.
authors.forename: Prosper
authors.initials: P
authors.lastname: Okonkwo
authors.affiliation: Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA. Electronic address: pkanki@hsph.harvard.edu.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Kanki
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D003625:Data Collection; D006678:HIV / Q000472:pathogenicity; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy*; D006284:Health Plan Implementation; D006295:Health Resources / Q000600:supply & distribution*; D006751:Hospital Information Systems / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000458:organization & administration* / Q000706:statistics & numerical data*; D009549:Nigeria; D011787:Quality of Health Care
keywords: Africa; Continuity of patient care; Electronic medical records; HIV therapy; Nigeria; User–computer interface