AMPATH medical record system (AMRS)

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The AMRS is sub-Saharan Africa’s first electronic medical record system for the comprehensive management of the clinical care of patients infected with HIV. This system, composed of both paper-based and electronic records, has led to uniformity in data collection and facilitated the retrieval of patient data for clinical care and research.

Indiana University School of Medicine and Moi University School of Medicine (Eldoret, Kenya) have been collaborating for over 15 years. In February 2001, this collaboration led to the Mosoriot Medical Record System (MMRS). The MMRS was installed in a primary care healthcare centre in rural Kenya. In November 2001, the MMRS software was adapted to support the AMPATH (Academic Model for the Prevention and Treatment of HIV/AIDS) project and renamed to AMRS.

The AMRS was designed and implemented by programmers at Moi University and the Regenstrief Institute, Inc. at Indiana University. Prior experience in the development of the Mosoriot medical record system guided the creation of this HIV-specific system. The Mosoriot system was focused on primary care and kept simple, with limited numbers of data fields describing comprehensive primary care delivered to all patients visiting a number of different clinics: adult medicine, pediatrics, antenatal, and family planning. The design and structure of the AMRS was influenced by its specialty focus of the clinical care on HIV/AIDS, the documentation requirements of funding programs such as MTCT-Plus.

For the AMPATH project, the network used seven networked computers linked to a single MS Access database. Clerks perform the registration and transcribe visit data. Demographic, clinical, and HIV risk data, diagnostic test results, and treatment information are recorded on paper encounter forms and hand-entered into a central database that prints summary flowsheets 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. 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 require entry of new drugs that may not yet have a dictionary term, accept free text

To date, the EMR contains more than 30,000 visit records for more than 4000 patients, almost half taking antiretroviral drugs. Internal audits found the data entry error rate to be less than 2%. We describe the development and structure of this EMR and plans for future development that include wireless connections, tablet computers, and migration to a Web-based platform. References: • 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 • http://amrs.iukenya.org/http://openmrs.org/wiki/OpenMRS