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The Zambia Electronic Perinatal Record System (ZEPRS) is an Electronic Medical Record
Electronic medical record
An electronic medical record is a computerized medical record created in an organization that delivers care, such as a hospital or physician's office...

 (EMR) system used by public obstetric clinic
Clinic
A clinic is a health care facility that is primarily devoted to the care of outpatients...

s and a hospital (the University Teaching Hospital) in Lusaka
Lusaka
Lusaka is the capital and largest city of Zambia. It is located in the southern part of the central plateau, at an elevation of about 1,300 metres . It has a population of about 1.7 million . It is a commercial centre as well as the centre of government, and the four main highways of Zambia head...

, Zambia
Zambia
Zambia , officially the Republic of Zambia, is a landlocked country in Southern Africa. The neighbouring countries are the Democratic Republic of the Congo to the north, Tanzania to the north-east, Malawi to the east, Mozambique, Zimbabwe, Botswana and Namibia to the south, and Angola to the west....

.

Background

In early 2001 a team of physicians at the University of Alabama at Birmingham
University of Alabama at Birmingham
The University of Alabama at Birmingham is a public university in Birmingham in the U.S. state of Alabama. Developing from an extension center established in 1936, the institution became an autonomous institution in 1969 and is today one of three institutions in the University of Alabama System...

 (UAB) and visiting Zambian physician Dr. Moses Sinkala conceived the idea based on a successful electronic perinatal record system that the UAB had developed and proven in clinics in Birmingham. in July 2001 the Bill & Melinda Gates Foundation awarded a grant to the UAB to develop a similar system to serve public obstetric clinics in Lusaka, Zambia.

The UAB team solicited proposals for the technical design and implementation of the system from several private sector information technology firms, including Electronic Data Systems
Electronic Data Systems
HP Enterprise Services is the global business and technology services division of Hewlett Packard's HP Enterprise Business strategic business unit. It was formed by the combination of HP's legacy services consulting and outsourcing business and the integration of acquired Electronic Data Systems,...

, before awarding a contract to RTI International (RTI), a large 501(c)3 not-for-profit research organization based in Research Triangle Park
Research Triangle Park
The Research Triangle Park is a research park in the United States. It is located near Durham, Raleigh, and Chapel Hill, in the Research Triangle region of North Carolina...

, North Carolina
North Carolina
North Carolina is a state located in the southeastern United States. The state borders South Carolina and Georgia to the south, Tennessee to the west and Virginia to the north. North Carolina contains 100 counties. Its capital is Raleigh, and its largest city is Charlotte...

. Other project partners included the Center for Infectious Disease Research in Zambia (CIDRZ) and the Lusaka District Health Management Team of the Zambian Central Board of Health.

Objectives

ZEPRS was designed to improve maternal and perinatal outcomes by:
  1. Improving perinatal care for women and postnatal care for neonates by:
    1. Promoting adherence to good standard of care practices
    2. Identifying and document potential medical/ obstetrical problems so that effective therapies can be administered
    3. Improving communication and referrals among providers
    4. Enhancing monitoring and evaluation of outcomes, clinics, and providers
  2. Improving efficiency, completeness, accuracy of documentation and reporting

Major components

ZEPRS achieves these objectives by providing the following:
  • An electronic patient record system with patient record database shared among facilities
  • A system that guides clinicians through the Zambian standard of care
  • Intelligent rules that alert clinicians to problems and recommend patient referral when appropriate
  • Standard & ad hoc reporting for supportive supervision, surveillance, and analysis
  • An electronic-first system used by clinicians during the course of patient care
  • An electronic referral system to improve the efficiency and effectiveness of referrals


ZEPRS components include a high-speed point-to-point voice and data wireless network that interconnects facilities; wired and wireless networks within facilities; a data center managed by CIDRZ; and an electronic perinatal record system with integrated patient referral system.

ZEPRS uses a tabbed user interface and role-based access control system
Role-Based Access Control
In computer systems security, role-based access control is an approach to restricting system access to authorized users. It is used by the majority of enterprises with more than 500 employees, and can be implemented via mandatory access control or discretionary access control...

 to enable several clinicians to share the same computer to retrieve and enter data for different patients.

Software architecture

ZEPRS has been developed using the Java programming language. Other technologies used include AJAX
Ajax (programming)
Ajax is a group of interrelated web development methods used on the client-side to create asynchronous web applications...

, Quartz , MySQL
MySQL
MySQL officially, but also commonly "My Sequel") is a relational database management system that runs as a server providing multi-user access to a number of databases. It is named after developer Michael Widenius' daughter, My...

, and others. ZEPRS has its own content management system called DynaSite, that makes it easy to add forms, fields, form flows, and business rules without programming. RTI has developed a locally installable version of the software using the Eclipse
Eclipse (software)
Eclipse is a multi-language software development environment comprising an integrated development environment and an extensible plug-in system...

 Rich Client Platform
Rich Client Platform
A rich client platform is software consisting of the following components:* A core , lifecycle manager* A standard bundling framework* A portable widget toolkit* File buffers, text handling, text editors...

 (RCP) and the Apache Derby
Apache Derby
Apache Derby is a relational database management system developed by the Apache Software Foundation that can be embedded in Java programs and used for online transaction processing. It has a 2 MB disk-space footprint.Apache Derby is developed as an open source project under the Apache 2.0 license...

 embedded database. This version uses the free and open source zcore platform, which uses an implementation of RSS
RSS
-Mathematics:* Root-sum-square, the square root of the sum of the squares of the elements of a data set* Residual sum of squares in statistics-Technology:* RSS , "Really Simple Syndication" or "Rich Site Summary", a family of web feed formats...

 to transmit data over intermittent networks, such as mobile phone networks.

Development history

RTI worked with South African firm Communications Solutions (Comsol) to conduct a wireless site survey of all facilities, and to design a line-of-sight wireless network to connect them. By March 2003 this network was operational. Before the end of 2003 RTI had worked with Comsol to add Voice over Internet Protocol (VoIP) to provide voice communication between facilities, and had extended the network to connect multiple buildings in clinic compounds and to multiple wards of the University Teaching Hospital.

Three to nine networked PC
Personal computer
A personal computer is any general-purpose computer whose size, capabilities, and original sales price make it useful for individuals, and which is intended to be operated directly by an end-user with no intervening computer operator...

s and one laser printer were installed in each clinic, as well as additional PCs and printers in the University Teaching Hospital and administrative offices. The ZEPRS data center was installed at CIDRZ, which housed the combined ZEPRS technical support team.

Approximately 800 clinicians, many of whom had never used a computer, were trained in basic computer literacy. Standard clinical protocol reference works and email were made available to clinicians electronically over the ZEPRS network.

By early May 2004 RTI had completed an open source
Open source
The term open source describes practices in production and development that promote access to the end product's source materials. Some consider open source a philosophy, others consider it a pragmatic methodology...

 electronic patient referral system. This was launched into production use in clinics on 22 June 2004. Clinicians adopted this component readily and the system was soon rolled out to all 24 clinics and the University Teaching Hospital.

Also in May 2004, CIDRZ asked RTI whether the ZEPRS software could be adapted to help in managing antiretroviral therapy
Antiretroviral drug
Antiretroviral drugs are medications for the treatment of infection by retroviruses, primarily HIV. When several such drugs, typically three or four, are taken in combination, the approach is known as Highly Active Antiretroviral Therapy, or HAART...

 (ART) to treat patients infected with the Human immunodeficiency virus
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...

 (HIV). Version 1.0 of this software, the ART Patient Tracking System (ART/PTS), was launched into use at Kalingalinga Clinic on 1 June 2004.

RTI reviewed the completed Beta version of the fully integrated perinatal record system with the UAB team in July 2005, and released Version 1.0 on 21 November 2005. This version was pilot tested in a limited number of clinics in Lusaka from December 2005 through January 2006. ZEPRS was launched into production use in two clinics in February 2006. The system was rolled out to all clinics at the average rate of one clinic each month until the roll out was completed in August 2007.

Current status

Since roll out was completed in August 2007, ZEPRS has been used by 24 public obstetrics clinics, as well as six wards (blocks A-D, adult ARV ward, and pediatric ARV ward) within the University Teaching Hospital in Lusaka. The ZEPRS patient record database has been used since February 2006 for routine health surveillance, monitoring, and supervision of health care. A 2006 study cited the use of a ZEPRS-based patient record system as one of four key factors in the successful rapid scale-up of antiretroviral therapy at primary care sites in Zambia.

By September 2011 ZEPRS contained medical records for more than 510,000 patients. In 2011 an average of more than 8,000 new antenatal patients are being registered in the system each month. Clinicians in 25 facilities have used ZEPRS during more than 5,000,000 patient encounters to manage perinatal care.

ZEPRS links multiple pregnancies of the same mother to the mother's record. ZEPRS had been used to manage multiple pregnancies for more than 20,000 mothers.

In 2011 ZEPRS has been used by 278 individual users to help care for perinatal patients and analyze related health care data in Lusaka.

Information regarding the impact of ZEPRS on the quality of health care and health outcomes can be obtained by contacting the Center for Infectious Disease Research in Zambia or the Zambian Central Board of Health.

Ongoing development

Since ZEPRS was launched in February 2006 it has been continually refined and enhanced based on input from clinicians and emerging needs. In 2008 RTI worked with CIDRZ to implement an interface with the Laboratory Information Management System (LMIS) at Kalingalinga Clinic, enabling lab test results such as CD4
CD4
CD4 is a glycoprotein expressed on the surface of T helper cells, monocytes, macrophages, and dendritic cells. It was discovered in the late 1970s and was originally known as leu-3 and T4 before being named CD4 in 1984...

 counts to be transferred to patient records automatically twice daily. RTI has developed a version of the software that can be installed locally, be used within a facility in the absence of network connectivity, and can synchronize records automatically when connectivity is detected. This version is based on the free and open source Zcore platform, which can transmit data automatically over intermittent networks, such as mobile phone networks.

Adaptability

The Zcore software platform that emerged from ZEPRS has been used for managing pharmaceutical supplies in health centers in Nairobi, Kenya, managing malaria indoor residual spraying operations in Kenya, and managing medical and legal care for rape survivors in South Africa.

Availability

ZEPRS has been released by RTI as free and open source software under the Apache Software License (Version 2.0). RTI has released ZEPRS documentation under a Creative Commons
Creative Commons
Creative Commons is a non-profit organization headquartered in Mountain View, California, United States devoted to expanding the range of creative works available for others to build upon legally and to share. The organization has released several copyright-licenses known as Creative Commons...

 Attribution-NonCommercial-ShareAlike 2.5 License.

See also


Other References

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
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