Implementing an electronic health record as an objective measure of care provider accountability for a resource-poor rural area in the Dominican Republic

Open source medical record software provides a low-cost way of implementing electronic health record (EHR) systems in resource-poor areas. This facilitates provision of longitudinal care of a patient population and offers an objective means for evaluating a short term medical trip's impact. The goal for this project was to assess the feasibility of implementing the Open Medical Record System (OpenMRS)-an open source EHR developed by Partners in Health (PIH) and the Regenstrief Institute-by medical students at various resource-poor rural sites on the outskirts of Jarabacoa, Dominican Republic. An EHR based on an OpenMRS platform was developed for use in the primary care setting of a short term international medical trip (STIMT). Medical and nursing students were trained to use the system in a sitespecific simulated environment with Spanish-speaking standardized patients at the Clinical Skills and Simulation Center of UCF College of Medicine. The EHR system, utilizing a laptop, battery pack, router, and school-issued iPads, was transported and deployed in rural communities near Jarabacoa in the Dominican Republic. The data of 125 patients was recorded using the EHR system. Patient demographics, medical history, physical exam, and the physician's assessment and plan were entered into the EHR. Patient data is stored presently on a Dell Latitude E6410. The patient records are accessible via this host laptop and may be exported to other clients via a Microsoft Excel file. Preclinical medical students and nursing students successfully deployed a highly-portable EHR system for three different resource-poor communities across the Greater Jarabacoa area. Future uses of the proven mobile EHR system include: an objective means for evaluating interventions, assessing healthcare needs, and providing continuity of patient care. Data obtained from this trip will be used to generate new patient scenarios for pre-trip simulation training and determine the appropriate medications and supplies for the subsequent trip.