1. We do things here ! © Dimagi, 2005 Informatics in the design of Healthcare Systems in developing countries Vish Anantraman, MD

2. We do things here ! © Dimagi, 2005 Ca:sh

3. We do things here ! © Dimagi, 2005 Ca:sh

4. We do things here ! © Dimagi, 2005 Ca:sh Over 300,000 healthcare workers Go door to door delivering primary healthcare Can we use technology to improve healthcare delivery in some of the poorest communities in the world ?

5. We do things here ! © Dimagi, 2005 Ca:sh

6. We do things here ! © Dimagi, 2005 Ca:sh Ca:sh –Disease case management system for health workers in rural India Linux handhelds Population over 80,000 Over two years in operation Antenatal care, Immunization, Census records

7. We do things here ! © Dimagi, 2005 High incidence of HIV – 22% HIV Cost of HIV resistant medication Migration patterns of population Nationwide coverage of universal healthcard – 10 million people Diverse computing environments Multiple providers of ART treatment Monitoring and evaluation of ART Continuity of Care – Zambia

8. We do things here ! © Dimagi, 2005 Continuity of Care – Zambia

9. We do things here ! © Dimagi, 2005 Continuity of Care – Zambia Too much of paper – ANC alone has 16 forms Register maintenance often a difficult task Very little usable data Data trapped in paper format

10. We do things here ! © Dimagi, 2005 HIV Clinic Prenatal Clinic TB Clinic HIV Clinic Outreach clinic Smartcard Circuit rider/SneakerNet Wireless networks Cellular networks Continuity of Care - Zambia

11. We do things here ! © Dimagi, 2005 Low cost memory - $1.5 for 128Kbit card (enough to store lifelong EMR) Same technology as SIM cards (GSM phones) Highly durable, non-volatile memory Allows imbedded security and access control Technology Being Used Low cost, low power full fledged PCs <$200 without display and <10Watts power consumption, can run off car battery Standard PC parts, easy maintenance in developing countries, can be locally assembled No moving parts, durability in dusty environments Handheld devices, Pocket PC™ and WinCE™ based Used only for outreach clinics Low power, fully functional EMR

12. We do things here ! © Dimagi, 2005 Informatics issues Standards – HL7, SNOMED, ICD Interoperability Generalizibility of data architecture Operating system, low initial cost is not always best for all

13. We do things here ! © Dimagi, 2005 System issues Power Redundant technology ? Future maintenance Cost – how important? Transfer of technology – are there people to continue the project?

14. We do things here ! © Dimagi, 2005 Implementation issues End user training – is this easy ? Language and cultural barriers – don’t make assumptions Buy in of end users very important Barriers to adoption –Social status –Practical issues – weather, theft?

15. We do things here ! © Dimagi, 2005 Lessons learnt IT is a buzz word – how you use it matters Technology is only a medium – appropriate use is what makes it useful Design with end-users’ input Replicate a paper process – is that a reasonable approach ? Stakeholders’ buy in very important Design bottom up

16. We do things here ! © Dimagi, 2005 Questions Contact: vish@dimagi.com vish@dimagi.com (www.dimagi.com)