A Tablet-Based Electronic Medical Record System to Improve Cancer Early Detection and Linkage to Care at Health Facilities In Rwanda

Jul 03, 2021; Global Cancer Research and Control: Looking Back and Charting a Path Forward. https://doi.org/10.1158/1538-7755.ASGCR21-99


Purpose: For a cancer early detection program to improve cancer outcomes, patients with abnormal initial tests must be linked to timely diagnosis and care. We describe the development and early implementation of a tablet-based electronic medical record (EMR) at rural Rwandan health care facilities to facilitate clinical documentation and tracking of patients participating in a cervical cancer screening and breast cancer early detection program.

Methods: To develop the EMR tool, a multi-institutional team was established consisting of software developers and health informatics implementers from Rwanda Biomedical Centre, Partners In Health, and the Clinton Health Access Initiative. We utilized the open-source software OpenMRS linked with an android mobile app, mUzima, used on tablets offline at rural health centers. Data are synchronized to a national OpenMRS server. In four workshops, clinicians and project leaders from Rwanda's Women's Cancer Early Detection initiative identified key clinical variables and workflows to track and link patients to care. Quality assessment of data from June-November 2020 is underway to identify gaps.

Results: Twenty-two informatics trainers trained 269 clinicians at 81 health facilities from June- November 2020, enabling the tablet-based tool to be routinely utilized in the cancer early detection program in 4 districts. From June-November 2020, OpenMRS data show 13,783 patients were evaluated for cervical cancer screening and 3,608 had breast evaluation. Early implementation challenges included form completion burden for clinicians and insufficient validation rules limiting data quality. Additionally, clinical reports have not been finalized, requiring manual tracking of missed visits. Informatics, programmatic, and clinical partners discussed strategies to resolve challenges at a weeklong workshop in December 2020.

Conclusion: Building an informatics system to facilitate cancer early detection in rural low-resource health facilities is feasible but requires continuous adaptation, training and multidisciplinary cross-institutional collaboration. Further evaluation will investigate the tool's impact on timely patient care.

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