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From Haiti, Part II: Implementing an EHR at St. Boniface Hospital

by Pierre Valette, VP of Content Communications

Yesterday (see Part I), athenahealth VP of Content Communications, Pierre Valette, provided a first-hand account of his team’s travels through Haiti to teach and learn from Haitian and American caregivers at the St. Boniface Hospital. In Part II of Pierre’s journal, we hear about the team’s implementation of our cloud-based electronic health record (EHR) system for the St. Boniface Haiti Foundation’s Spinal Cord Injury Program, and find out about the day-to-day hurdles caregivers and patients there have to overcome—not only to provide care, but to travel to and from the hospital. – Michelle, Social Media Manager

From Fond Des Blancs,

This morning, I started the day jogging to the nearby village of Gaspard. I ran far more slowly than I ever do—which is very slow to begin with—as I zigged and zagged to avoid large ruts and divots in the road, as well as dogs and chickens, and adjusted to the poor grading just to avoid twisting an ankle. It took me 40 minutes to cover a distance that would normally take me about 20. I imagined how hard it would be if I had to navigate these roads on a standard-issue wheelchair. (Forget about sidewalks here, they don’t exist. If you want to get anywhere under your own steam, you have to walk on a dirt road—or goat path).

The St. Boniface Haiti Foundation’s Spinal Cord Injury (SCI) Program has responded to the very poor road conditions by partnering with a group called the Rough Rider Foundation to equip every SCI patient with an off-road wheelchair called a Walkabout. The Walkabout’s heavy-duty wheels and tires, along with its solid metal frame (think mountain bike converted into a wheelchair) allow SCI patients to navigate just about any road in Fond Des Blancs, including the short road that brings three of the students to the public school each morning. Maxsony, SCI patient
The Walkabouts are also quickly collapsible and relatively lightweight, allowing them to be strapped easily to the roof of the program’s SUV. This comes in handy when Kenny and Maxsony (pictured, right)—SCI patients on the program’s psycho-social team—travel throughout Haiti on remote patient visits.

The wheelchairs are just one manifestation of what the SCI program is doing to respond to the needs of its patients. The psycho-social program helps patients overcome the stigma associated with physical handicaps in Haiti. A rehabilitation team gives the patients a steady regimen of physical therapy designed specifically for spinal cord injury. And the medical team focuses on wound care, treating the persistent infections that contribute to the high mortality rates in Third World settings.

Over the past few years, the SCI program has generated hundreds of pounds of paper documenting the interventions of these teams, which is, in part, why Dr. Roland Desiree, director of the SCI program, was particularly excited about the potential of an EHR to provide for more seamless, quality care coordination. A member of one team can immediately see what a colleague on another team is doing without sifting through paper binders. Subsequently, if a Haitian doctor needs to consult with an expert in the U.S., she can do so while her counterpart in the U.S. looks at the exact same medical record.

The potential of implementing a cloud-based health records system in Haiti sounds great in theory, but can a go-live in a rural setting, with a non-English-speaking medical staff that’s unaccustomed to electronic documentation actually work? Well, so far, so good!

Over the past 72 hours, all signs have been positive. The Internet connection has remained strong throughout. During their initial training, the rehabilitation staff actually competed to see who could log in and enter a test patient the fastest—with the winner giving a big fist pump when he completed the task first.

Dr. Desiree, a very quiet man, let out a big “Wow!” when the system calculated BMI (Body Mass Index) immediately after he entered height and weight. Throughout all the training sessions, staff members with computer knowledge helped those who were a little slower at mastering new electronic skills. All, like Dr. Desiree, seem to understand the value of what health records can do for the program. According to Betsy Sherwood, Coordinator of the program, participants are very proud to be on the cutting-edge of health care delivery in Haiti, and are eager to learn skills that will enable them to deliver better care and develop professionally.

By midday, phase one of the EHR go-live was successful. When the team took their lunch break, more than two dozen patients had already been entered into the system. A few problems did emerge while the Monitoring & Evaluation team entered patients, but most were largely due to cultural and language differences.

For example, many of the patients don’t know their birthdates—so what should caregivers enter in that required field? How do you translate, “spinal injury from gunshot wound” into Creole? These problems are minor and, ultimately, addressable. The good news is we’ve discovered that cloud-based EHRs can indeed be implemented here in rural Haiti. And, more important, the clinical staff is completely engaged and committed to making it work—no matter what idiosyncrasies emerge and need to be resolved.

And with dozens of patients now entered into the EHR system, next on our agenda are the patient visits.

To be continued.

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