Electronic Patient Records as a Substrate for Collaboration for Distributed Care in Low-Resource Contexts

Collaboration to provide patient care in low-resource contexts has been a challenge due to heavy patient load, limited connectivity, and knowledge-gap between primary and tertiary care. Through the design, development, and implementation of a private social network-connected, large-scale hospital information system, which has scaled to several zonal and district hospitals in a small hilly country in South East Asia, we present the case study of a system that has enabled collaboration. Using coordination mechanisms as a theoretical framework, we discuss some methods of collaboration. In the paper, we present electronic patient records (EPR) as the substrate that enables collaboration between providers, departments, developers throughout the health systems. In our analysis, we present useful learnings of collaboration between provider-provider, developer-developer, provider-patient, implementer-provider, and how the balance of these is a necessary condition to create a useful substrate for collaboration.