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The development of an Electronic Medical Record system to improve quality of care for individuals with type 1 diabetes in Rwanda
ABSTRACT
Background:
Electronic Medical Record (EMR) systems have the potential to improve quality of care and clinical outcomes for individuals with chronic and complex diseases. However, studies on the development and use of EMR systems for type 1 (T1) diabetes management in sub-Saharan Africa are few.
Objective:
To analyse need for improvements in the care processes that can be facilitated by an EMR system and to develop an EMR system for increasing quality of care and clinical outcomes for individuals with T1 diabetes in Rwanda.
Methods:
A qualitative, co-creative and multi-disciplinary approach involving local stakeholders guided by the framework for complex public health interventions were applied. A Focus group discussion, interactive workshops, participant observation and patient stories were conducted to understanding the clinical care context and define features and content of an EMR. Data were analysed using thematic analysis.
Results:
The identified themes related to features requirements were; 1. Ease of use, 2. Automatic report preparing, 3. Clinical decision support tool, 4. Data validity, 5. Patient follow-up, 6. Data protection and 7. Training. The identified themes related to content requirements were: 1. Treatment regimen, 2. Mental health and 3. Socioeconomic and demographic condition. A theory of change was developed based on the defined feature and content requirements to demonstrate how these requirements could strengthen the quality of care and improve clinical outcomes for people with T1 diabetes.
Conclusions:
The EMR system, including its functionalities and content, can be developed through an inclusive and co-creative process, which improved the design phase of the EMR. The development process of the EMR system is replicable but the solution needs to be customized to fit local context.
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