AMPATH medical record system (AMRS)
AMPATH medical record system (AMRS) is sub-Saharan Africa's first electronic medical record system for the comprehensive management of the clinical care of patients infected with HIV. The system is composed of both paper-based and electronic records and has led to uniformity in data collection. It has facilitated the retrieval of patient data for clinical care and research.
Following a 15 year collaboration between the Indiana University School of Medicine and Moi University School of Medicine in Eldoret, Kenya, the Mosoriot Medical Record System (MMRS) was developed and installed in a in a primary care health center in rural Kenya in February 2001. In November 2001, the MMRS software was adopted to support the AMPATH (Academic Model for the Prevention of and Treatment of HIV/AIDS) project and re-named AMRS (AMPATH medical record system).
AMRS was designed and implemented as a disease specific system (HIV system) by programmers at Moi University in Kenya and the Regenstrief Institute, Inc., at the University of Indiana, with attention paid to documentation requirements of funding programs such as MTCT-Plus. The data fields were kept simple but described comprehensive primary care delivered to all HIV/STD patients across primary care specialties, including adult medicine, pediatrics, antenatal, and family planning care.
Software Architecture and Data Flow
For the AMPATH project, the network used seven computers linked to a single MS Access database. Clerks perform the registration and transcribe visit data. Demographic, clinical, HIV risk data, diagnostic test results, and treatment information are recorded on paper encounter forms and later hand-entered into a central database that prints summary flow sheets and reminders for appropriate testing and treatment. There are separate modules for monitoring the Antenatal Clinic, Pediatrics Food Inventory and Pharmacy. The HIV clinical data repository adopts a graphical user interface that closely follows the pattern of the paper encounter forms. Different subsets of data (e.g., exposure history, review of systems, physical examination) are navigated using tabs so that data can be entered into several hundred fields while keeping the entire data entry form on a single screen. The programming is done using Microsoft’s Visual Basic for Applications (VBA). The input fields are mostly pre-coded, meaning they can only accept valid field values as defined in the data dictionary. However, some fields, particularly those that may require entry of new drugs that may not yet have a dictionary term, accept free text.
The AMRS is deployed at nine AMPATH sites and has collected more than 100 million discrete clinical observations from 2.8 million AMPATH visits made by more than 300,00 enrolled patients . Internal audits have found the data entry error rate to be less than 2%.
Plans for Future Development
Future development plans include wireless connections, tablet computers, and migration to a web-based platform.
- Implementing electronic medical record systems in developing countries. Fraser SF, Biondich P et al. Informatics in Primary Care 2005;13:83–95
- An electronic medical record system for ambulatory care of HIV-infected patients in Kenya Sikka AM, Rotich JK et al International Journal of Medical Informatics, Volume 74, Issue 5, June 2005, Pages 345-355