Best practices in electronic health records (EHR) implementation in low resource settings utilizing free software

Background: In low-resource settings with limited funds and staff, free software plays a vital role in adoption of health information systems. Availability of free software overcomes barriers to adoption (licensing and programming costs), enabling health facilities to implement systems where otherwise they would not exist. This presentation discusses the evidence-based best practices gleaned from wide-scale use of International Quality Solutions IQCare, a freely available software system for EHRs. Objective: The goal of any healthcare information system is to improve the volume, flow and quality of information to facilitate program planning and improve patient outcomes. This paper describes the role and features of the freely available IQSolutions system in patient management and monitoring. Methods: Based on federally funded projects, Futures Group developed a system for electronic medical records that evolved over seven years. Initially, IQCare was introduced to health facilities by demonstrating reporting capabilities. Subsequently, a facility-level implementation plan was developed containing recommendations for infrastructure, training, and documentation. The downloadable system was made available through CodePlex. Best practices were identified during its evolution in over 200 facilities working with ministries of health in Africa and other regions. Results: IQCare was implemented in diverse locations in five countries, with over 500 clinicians and data analysts trained. System enhancements were driven by stakeholders and donors. IQCare met data quality and reporting requirements. Features identified as system requirements and best practices included: robust, relevant system features and interface; easily installed and configured; not requiring programmers; scalability; workable for clinicians; field and form-level validation; enhancements ongoing, driven by stakeholders; meets interoperability standards (HL7); underlying database optimized and open; analytic capabilities; comprehensive system documentation. Conclusion: In low-resource healthcare facilities, availability of free software is a minimum requirement for successful adoption of EHR systems. Tested and mature software using identified best practices leads to better adoption.