Medical Decision Support Systems in Africa

G. Bediang; C. O. Bagayoko; A. Geissbuhler

doi:10.1055/s-0038-1638688

Yearbook of Medical Informatics, Table of Contents

Yearb Med Inform 2010; 19(01): 47-54
DOI: 10.1055/s-0038-1638688

Original Article

Georg Thieme Verlag KG Stuttgart

Medical Decision Support Systems in Africa

G. Bediang

¹Department of Radiology and Medical Informatics, Geneva University, Switzerland

,

C. O. Bagayoko

¹Department of Radiology and Medical Informatics, Geneva University, Switzerland

,

A. Geissbuhler

¹Department of Radiology and Medical Informatics, Geneva University, Switzerland

› Author Affiliations

Abstract

Summary

Objective: To present an overview of the current state of computerbased medical decision support systems in Africa in the areas of public health, patient care, and consumer support.

Methods: Scientific and gray literature reviews complemented by expert interviews.

Results: Various domains of decision support are developed and deployed in Sub-Saharan Africa: public health information systems, clinical decision-support systems, and patient-centred decisionsupport systems.

Conclusions: Until recently, most of these systems have been deployed by international organizations without a real ownership policy entrusted to the African stakeholders. Many of these endeavours have remained or ceased at the experimentation stage. The multiplicity of organizations has led to the deployment of fragmented systems causing serious interoperability problems. In addition to basic infrastructures, these studies also highlight the importance of good organization, training and support, as key to the success and sustainability of these decision support systems.

Keywords

Decision support system - Africa - telemedicine - eHealth - mHealth

Full Text

References

References
1 Miller RA, Masarie FE. The demise of the “Greek Oracle” model for medical diagnostic systems. Methods Inf Med 1990; 29: 1-2.
2 Miller RA. Medical diagnostic decision support systems—past, present, and future. J Am Med Inform Assoc 1994; 01: 8-27.
3 Geissbuhler A, Miller RA. Computer-Assisted Clinical Decision Support. In: Chapman G, Sonnenberg F. editors. Decision Research in Health and Medicine. Cambridge UK: Cambridge University Press; 2000
4 Dick RS, Steen EB. The Computer-based Patient Record. An Essential Technology for Health Care. Washington DC: National Academy Press; 1991
5 Gardner RM, Hawley WL, East TD, Oniki A, Young HF. Real Time Data Acquisition: Experience With the Medical Information Bus (MIB). Proceedings Symposium on Computer Applications in Medical Care 1992; 813-7.
6 Haynes RB, McKibbon KA, Walker CJ, Ryan N, Fitzgerald D, Ramsden MF. Online access to MEDLINE in clinical settings. A study of use and usefulness. Ann Intern Med 1990; 112: 78-84.
7 McDonald CJ, Tierney WM, Overhage JM, Martin DK, Wilson GA. The Regenstrief Medical Record System: 20 years of experience in hospitals, clinics, and neighborhood health centers. MD Comput 1992; 09: 206-17.
8 Tierney WM, Miller ME, Overhage JM, McDonald CJ. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA 1993; 269: 379-83.
9 Cimino JJ, Socratous SA, Clayton P. Internet as clinical information system: application development using the World Wide Web. J Am Med Inform Assoc 1995; 02: 273-84.
10 Geissbuhler A, Miller RA. A new approach to the implementation of direct care-provider order entry. Proc AMIA Annu Fall Symp 1996; 689-93.
11 Evans RS, Pestotnik SL, Classen DC, Clemmer TP, Weaver LK, Orme Jr JF. et al. A computerassisted management program for antibiotics and other antiinfective agents. N Engl J Med 1998; 338: 232-8.
12 Ball MJ, Collen MF. Aspects of the Computer-based Patient Record. New York: Springer Verlag; 1992
13 Coiera E, Lau AYS, Tsafnat G, Sintchenko V, Magrabi F. The Changing Nature of Clinical Decision Support Systems: a Focus on Consumers, Genomics, Public Health and Decision Safety. Yearb Med Inform 2009; 84-95.
14 Tan JKH. An introduction to health decision support systems: definition, evolution, framework. In: Tan JKH, Sheps S. editors. Health Decision Support Systems. 1998: 3-32.
15 Lippeveld T, Sauerborn R, Bodart C. Design and Implementation of Health Information Systems. Geneva: WHO Press; 2000
16 Shaw V. Health information system reform in South Africa: developing an essential data set. Bull World Health Organ 2005; 83: 632-6.
17 Rommelmann V, Setel PW, Hemed Y, Angeles G, Mponezya H, Whiting D. et al. Cost and results of information systems for health and poverty indicators in the United Republic of Tanzania. Bull World Health Organ 2005; 83: 569-77.
18 Geissbuhler A, Bagayoko CO, Ly O. The RAFT network: 5 years of distance continuing medical education and tele-consultations over the Internet in French-speaking Africa. Int J Med Inform 2007; 76: 351-6.
19 Odhiambo-Otieno GW, Odero WW. Evaluation criteria for the district health management information systems: lessons from the Ministry of Health, Kenya. Afr Health Sci 2005; 05: 59-64.
20 Odhiambo-Otieno GW. Evaluation of existing district health management information systems: a case study of the district health systems in Kenya. Int J Med Inform 2005; 74: 733-44.
21 Williamson L, Stoops N, Heywood A. Developing a District Health Information System in South Africa: a social process or technical solution?. Stud Health Technol Inform 2001; 84: 773-7.
22 Tessier SF. [The role of a health information system as an aid in making regional public health decisions. Experience in Botswana (Southern Africa)]. Med Trop (Mars) 1989; 49: 163-9.
23 Hanmer L. Criteria for the evaluation of district health information systems. Int J Med Inform 1999; 56: 161-8.
24 Lungo JH. The reliability and usability of district health information software: case studies from Tanzania. Tanzan J Health Res 2008; 10: 39-45.
25 Garrib A, Stoops N, McKenzie A, Dlamini L, Govender T, Rohde J. et al. An evaluation of the District Health Information System in rural South Africa. S Afr Med J 2008; 98: 549-52.
26 Mate KS, Bennett B, Mphatswe W, Barker P, Rollins N. Challenges for routine health system data management in a large public programme to prevent mother-to-child HIV transmission in South Africa. PLoS One 2009; 04: e5483.
27 Mghamba JM, Mboera LEG, Krekamoo Senkoro KP, Rumisha SF, Shayo E. et al. Challenges of implementing integrated disease surveillance and response strategy using the current health management information system in Tanzania. Tanzania Health Research Bulletin 2004; 06: 57-63.
28 Makombe SD, Hochgesang M, Jahn A, Tweya H, Hedt B, Chuka S. et al. Assessing the quality of data aggregated by antiretroviral treatment clinics in Malawi. Bull World Health Organ 2008; 86: 310-4.
29 Otwombe KN, Wanyungu J, Nduku K, Taegtmeyer M. Improving national data collection systems from voluntary counselling and testing centres in Kenya. Bull World Health Organ 2007; 85: 315-8.
30 Heywood AB, Campbell BC. Development of a primary health care information system in Ghana: lessons learned. Methods Inf Med 1997; 36: 63-8.
31 WHO. Framework and standards for country health information systems. 2nd Edition.. Geneva: 2008
32 Boerma T, Chopra M, Evans D. Health system performance in the Bulletin. Bull World Health Organ 2009; 87: 2.
33 WHO. Toolkit for Monitoring Health Systems Strengthening: Service Delivery. 2008
34 Africa Health Infoway. http://www.who.int/africahealthinfoway/en/ last accessed on April 2010.
35 Wolfe BA, Mamlin BW, Biondich PG, Fraser HS, Jazayeri D, Allen C. et al. The OpenMRS system: collaborating toward an open source EMR for developing countries. AMIA Annu Symp Proc 2006; 1146.
36 Hannan TJ, Rotich JK, Odero WW, Menya D, Esamai F, Einterz RM. et al. The Mosoriot medical record system: design and initial implementation of an outpatient electronic record system in rural Kenya. Int J Med Inform 2000; 60: 21-8.
37 Rotich JK, Hannan TJ, Smith FE, Bii J, Odero WW, Vu N. et al. Installing and implementing a computer-based patient record system in sub-Saharan Africa: the Mosoriot Medical Record System. J Am Med Inform Assoc 2003; 10: 295-303.
38 Siika AM, Rotich JK, Simiyu CJ, Kigotho EM, Smith FE, Sidle JE. et al. An electronic medical record system for ambulatory care of HIV-infected patients in Kenya. Int J Med Inform 2005; 74: 345-55.
39 Tierney WM, Rotich JK, Hannan TJ, Siika AM, Biondich PG, Mamlin BW. et al. The AMPATH medical record system: creating, implementing, and sustaining an electronic medical record system to support HIV/AIDS care in western Kenya. Stud Health Technol Inform 2007; 129: 372-6.
40 Douglas GP, Deula RA, Connor SE. The Lilongwe Central Hospital Patient Management Information System: a success in computer-based order entry where one might least expect it. AMIA Annu Symp Proc 2003; 833.
41 Allen C, Jazayeri D, Miranda J, Biondich PG, Mamlin BW, Wolfe BA. et al. Experience in implementing the OpenMRS medical record system to support HIV treatment in Rwanda. Stud Health Technol Inform 2007; 129: 382-6.
42 Milberg J. Adapting an HIV/AIDS clinical information system for use in Kampala. HELINA 2003. Johannesburg: HELINA; 2003: 44-5.
43 Mamlin BW, Biondich PG, Wolfe BA, Fraser H, Jazayeri D, Allen C. et al. Cooking up an open source EMR for developing countries: OpenMRS a recipe for successful collaboration. AMIA Annu Symp Proc 2006; 529-33.
44 Were MC, Mamlin BW, Tierney WM, Wolfe B, Biondich PG. Concept dictionary creation and maintenance under resource constraints: lessons from the AMPATH Medical Record System. AMIA Annu Symp Proc 2007; 791-5.
45 Williams F, Boren SA. The role of the electronic medical record (EMR) in care delivery development in developing countries: a systematic review. Inform Prim Care 2008; 16: 139-45.
46 Safran C, Rind DM, Davis RB, Ives D, Sands DZ, Currier J. et al. Guidelines for management of HIV infection with computer-based patient’s record. Lancet 1995; 346: 341-6.
47 Bates DW, Cohen M, Leape LL, Overhage JM, Shabot MM, Sheridan T. Reducing the frequency of errors in medicine using information technology. J Am Med Inform Assoc 2001; 08: 299-308.
48 Fraser HS, Biondich P, Moodley D, Choi S, Mamlin BW, Szolovits P. Implementing electronic medical record systems in developing countries. Inform Prim Care 2005; 13: 83-95.
49 Tierney WM, McDonald CJ, Martin DK, Rogers MP. Computerized display of past test results. Effect on outpatient testing. Ann Intern Med 1987; 107: 569-74.
50 Whiting-O’Keefe QE, Simborg DW, Epstein WV, Warger A. A computerized summary medical record system can provide more information than the standard medical record. JAMA 1985; 254: 1185-92.
51 Shea S, DuMouchel W, Bahamonde L. A metaanalysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. J Am Med Inform Assoc 1996; 03: 399-409.
52 Seebregts CJ, Mamlin BW, Biondich PG, Fraser HS, Wolfe BA, Jazayeri D. et al. The OpenMRS Implementers Network. Int J Med Inform 2009; 78: 711-20.
53 McDonald CJ. The barriers to electronic medical record systems and how to overcome them. J Am Med Inform Assoc 1997; 04: 213-21.
54 Brauchli K, O’mahony D, Banach L, Oberholzer M. iPath - a Telemedicine Platform to Support Health Providers in Low Resource Settings. Stud Health Technol Inform 2005; 114: 11-7.
55 Brauchli K, Oberli H, Hurwitz N, Kunze KD, Haroske G, Jundt G. et al. Diagnostic telepathology: long-term experience of a single institution. Virchows Arch 2004; 444: 403-9.
56 Kaddu S, Kovarik C, Gabler G, Soyer HP. Teledermatology in developing countries. In: Wootton R, Patil NG, Scott RE, Ho K. editors. Telehealth in developing world. London: 2009.;
57 O’Mahony D, Banach L, Mahapa DH, Lancaster EW, van der Linde GD, Williams BH. et al. Teledermatology in a rural family practice. SA Fam Pract 2002; 25: 4-8.
58 Soyer HP, Hofmann-Wellenhof R, Massone C, Gabler G, Dong H, Ozdemir F. et al. telederm.org: freely available online consultations in dermatology. PLoS Med 2005; 02: e87.
59 Iluyemi A. Community-based health workers in developing countries and the role of m-health. In: Wootton R, Patil NG, Scott RE, Ho K. editors. Telehealth in developing world. London: 2009.;
60 Merrell RC, Merriam N, Doarn C. Information support for the ambulant health worker. Telemed J EHealth 2004; 10: 432-6.
61 IDRC. Uganda Health Information Network (UHIN). www.idrc.ca/ev_en.php?ID=86353_201&ID2=DO_TOPIC last accessed on April 2010.
62 Deber RB, Kraetschmer N, Irvine J. What role do patients wish to play in treatment decision making?. Arch Intern Med 1996; 156: 1414-20.
63 Berner ES. Clinical decision support system: Theory and pratice. New York: Springer-Verlag; 1999
64 O’Connor AM, Stacey D, Rovner D, Barry M, Col NF, Eden KB. et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2001; CD001431.
65 Horner V, Hanmer LA, Mbananga ND. A consumer decision support system for common health ailments in South Africa. Stud Health TechnolInform 2006; 122: 1027.
66 Hüsler J. Evaluation of the On Cue Compliance Service Pilot. Testing the use of SMS reminders in the treatment of Tuberculosis in Cape Town, South Africa. Technology Associate, bridges.org. City of Cape Town Health Directorate and the International Development Research Council (IDRC); 2005
67 O’connor A. Using patient decision aids to promote evidence-based decision making. ACP J Club 2001; 135: A11-2.
68 O’connor AM, Fiset V, Degrasse C, Graham ID, Evans W, Stacey D. et al. Decision aids for patients considering options affecting cancer outcomes: evidence of efficacy and policy implications. J Natl Cancer Inst Monogr 1999; 25: 67-80.