Monitoring Rural Countries’ Medical Care: There’s an App For That

A mobile system that manages patients’ medical records with iPads hums throughout a small town in the Dominican Republic this week, thanks to the ingenuity and can-do attitude of a few University of Central Florida students.

The system started as a research project for UCF medical student Bobby Palmer of Avon Park, Fla. When Palmer graduated from Wake Forest University in 2009, he landed a scholarship that allowed him to travel to other countries on medical missions before enrolling in medical school. One of his stops was Santiago, Chile where he took part in earthquake disaster relief.

Palmer observed firsthand the challenges that doctors faced keeping medical records in some of the world’s most remote regions – either through pen and paper or by memory.

So when Palmer arrived at UCF’s College of Medicine in 2011, he set out to create an electronic medical records system that could be run anywhere with little cost and virtually no maintenance.

Palmer’s system runs on iPads, which UCF provides its medical students, a laptop, router and a generator to charge the equipment.

This week, Palmer is monitoring a team of nine UCF medical students, a couple of nursing students and faculty and volunteer physicians from Central Florida who are using his system in San Francisco de Macoris a remote community about 70 miles from the capital city Santo Domingo. The team set up a temporary clinic with the help of a local university Universidad Católica Nordestana (UCNE), and is using Palmer’s system to keep track of patients seen, treated and those given prevention education as part of their visit. More than 300 patients are expected to use the system during the five-day medical mission.

“If all goes well, we’ll be able to upload everything online within six to nine months,” Palmer said while taking a break from rounds at Orlando Regional Medical Center in Orlando where he is completing his neurology clerkship.

“Then anyone with the proper password could have access to the medical records,” he added. “Over time, it will let us look at trends and help teams determine what medicines are needed and which ones are not based on objective data. It will improve health care delivery to that community and help us understand what we’re doing and if in fact we are making a difference in improving the patients’ health.”

For the past several years, groups across the nation have been advocating for the broader use of electronic medical records to help ensure patients get good continuous care no matter where or in what condition they are seen. These records could help in emergency situations by letting medical personnel know everything from patients’ medical allergies to previous surgeries. Some experts say moving to electronic medical records is essential for true health care reform.

Over time, data also will help health care workers see trends, potential patterns and even notice outbreaks of disease earlier. But the move to electronic record keeping has been slow, costly and riddled with privacy questions.

But Palmer isn’t too worried about all those issues. Patient’s names are coded to ensure privacy and he’s found a way to do it cheap thanks to the OpenMRS (Medical Records System). The non-profit based in Virginia is a collaboration of volunteers who created a software platform and reference application that does most of heavy lifting and makes electronic medical record keeping available to everyone for free.

The software was initially created years ago to help medical teams in Africa trying to get a handle on the HIV outbreak. It was then used in countries battling malaria and tuberculosis. More than 45 countries and international nonprofits now use the system, including a few within the United States.

“The most common use is likely still for HIV and TB care in Africa,” said Hamish Fraser, one of cofounders of OpenMRS and the former Director of Informatics and Telemedicine at Partners In Health, a Boston-based nonprofit aimed at helping provide health care for the poor around the world. “But there are now projects supporting many other clinical areas, including primary care, cancer, heart disease, diabetes and women’s health, with active projects developing tools for surgery and hospital-based care.”

Fraser is now an assistant professor at Brigham and Women’s Hospital and Harvard Medical School.

Dr. Judith Simms-Cendan, a professor of obstetrics and gynecology and director of international health programs at UCF’s College of Medicine, said the system Palmer created is remarkable.

“What he’s done really will make a difference,” Simms-Cendan said. “Some of these communities are so rural, they simply don’t keep records, and that’s very important for the delivery of quality health care.”

There are challenges. Sometimes the rain or bad weather in challenging environments requires the equipment to be shut off so it is not damaged. Other times the clinic has gotten so jammed up with people, that paper and pen is used to keep the flow of traffic going. Can’t do much about the weather, but Palmer said the team’s working on trying to speed up the process.

Eventually, Palmer hopes his system will help doctors from all over the world working in remote areas by electronically tracking and storing patients’ information, while helping train him and other aspiring medical professionals.

“We’re doing a pretty cool thing,” Palmer said. “But anyone can do it. The bottom line is that we have this amazing free technology and it can help deliver quality health care to people anywhere, everywhere. That’s what being a doctor is all about, doing all you can to help people.”