Barriers to implementation of an electronic medical records system to manage HIV clinical and social support data in an urban slum community clinic in Pune, India

Issue: Electronic medical records offer the potential for improvement of patient data management in HIV care, and recent work has begun to explore the realities of implementation of EMR in developing country settings. Description: This project involved the implementation of RW CAREWare, an electronic medical records system for HIV patient data, in a community-based urban clinic in the slums of Pune, India. The findings arose out of program observation and consultation with community-based staff members in the process of EMR implementation from June 2008-March 2009. Lessons Learned: Significant challenges to implementation of RW CAREWare included inconsistent paper record keeping, language barriers in software utilization, limited computer skills/training opportunities among community outreach staff, as well as staff turnover and poor buy-in at the administrator level for rollout of the project. Though unsuccessful, the project did allow for the transfer of basic computer skills to peer outreach workers and for a review of HIV patient charts for future quality improvement activities. Recommendations: Electronic medical records systems can play a crucial role in the provision of quality HIV care and social support in resource-constrained community clinics. However, the findings of this implementation project support the need for buy-in at the administrator-level for the prioritization of EMR activities, as well as the need to create long-term plans for maintenance of technical skills of community-based staff. Lastly, efforts ought to be made to develop software programs that are easily customizable to local languages to help to eliminate language barriers to data entry and utilization.