A Pilot Electronic Medical Record

Lawrence Loh, MD MPH CCFP

In a previous blog post, we discussed the possibility of developing an electronic medical record for La Romana. During our trip last year, we trialed a tracking system which involved both paper records that were stored by the hospital linked to an Excel spreadsheet that was organized by a unique patient identification number. This identification number, in turn, was linked to a photograph of the patient in question, stored with the Excel spreadsheet, and also linked to a paper record, which was stored at Good Samaritan for review by future teams. This provided two records – aggregate data for research stored in a locked Excel file, and paper records for each patient’s individual continuity of care.

Sample Spreadsheet Attached.

In creating a unique patient identification number, we attempted to overcome one of the biggest difficulties in creating an electronic medical record in La Romana—ensuring that the same record would travel with the same batey resident. Given the nature of our work in the bateyes, we attempted to develop a record system that would maximize the chance that records would follow individual patients.

We came up with a numbering system that followed the format YY-S-NNNNN. YY represented the last two digits of the year that the patient was enrolled; S was 0 for males and 1 for females, and NNNNN represented the number assigned to that patient at enrolment, sequential with each subsequent patient. Thus, the first female that we enrolled in the database had the number 10-1-00001; similarly, a male code might be 10-0-00302.

Setting up a traditional clinic in the bateyes, we followed patients through the process as they registered, were measured and placed in the waiting area, seen by one of our physicians, and dispensed medications. At the entrance to the clinic, patients were registered as above. We created a booklet with the above serial number noted, and took a photo of the patient. Within each booklet, we sought to fully complete the patient’s name and aliases, which batey they were from, and their home phone number and maternal tongue. Each clinic day ended with the creation of an Excel file listing all these details.

We kept a list of patient names and serial numbers, and recorded file names of the photos corresponding to each. Physicians then used the yellow cards to record the cause of the visit along with any medications prescribed and the doses used. The pharmacy volunteers then took these yellow cards and booklets, and double checked the completeness of the information before dispensing the medications.

At the end of each clinic day, we manually entered the information from the booklets and yellow cards into an Excel file. This file linked each line to an individual patient, their identification number, their corresponding photo, and the reasons for their visit and treatments received.

This system, as developed, had the potential to overcome a number of problems. Firstly, with regards to ongoing records safeguarding, the storage and keeping of the records by Good Samaritan Hospital meant that many of the batey residents would have a file upon their next visit from another team. At the same time, the use of a unique identification number and a biometric such as a photograph contributed to that continuity of care while carefully linking each record to a specific batey resident.

The manual entry of data, while seemingly tedious, did have its own benefits as well. It allowed standardization of diagnoses, which, in the context of the Excel sheet, provided valuable data as to what were the key reasons batey patients were seeking care from our clinic. It also allowed us to review each photograph, linking it to a specific record, and ensuring that each booklet represented a unique record that corresponded to a recorded line in the Excel file. We should consider to a proper electronic medical record, with equipment, could streamline this process by allowing entry and linking at the point of care.

The existing system posed a number of challenges for the benefits it provided—it required an additional time and work commitment from clinic staff, particularly with the taking of the photos and ensuring that all the information was properly filled out; it also required an additional time commitment at the end of the day for further data entry. Another challenge of the system, as it existed, was the recording of ongoing visits. While our plan was to have each visit recorded as a new line or entry with the Excel file and to pass the Excel file on to each subsequent team, we were acutely aware that not all teams go to the same bateyes.

What we did glean, however, is that any future electronic medical record in La Romana should ensure continuity within the database. In that sense, biometrics like photographs and fingerprints should be considered for use and linked to a specific personal identification number. Each identification number should also be linked to the individual’s record, which can either be hard copy or electronic, and stored by the hospital (similar to a chart) to reduce the responsibility required for people to hold their own records in the batey setting.

As a next step, we should collectively examine possible platforms and electronic solutions that address these needs and that may serve as tools for Good Samaritan in La Romana.

Lawrence Loh is a family and urgent care physician from Toronto, Canada. He is specialising in public health and preventive medicine at the University of Toronto and is a graduate of the Johns Hopkins Bloomberg School of Public Health. He has been going to La Romana annually for the last few years as a co-founder of the Pluribus Network, a non-profit organization based out of New York.

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