Health Organization Using PDAs to Help Save Lives in Peru
Socios en Salud (SES) is a Lima-based health organization that works to track, treat and support patients with multi-drug resistant tuberculosis (MDR-TB). Though TB is a curable disease, if the right medication isn't taken in the right doses for the full treatment period, it can become resistant to those drugs.
Hence, by the time a patient has MDR-TB, careful support to ensure proper treatment protocols is an important element for success. SES workers visit the clinics where patients are seen to keep track of the medicines they're taking and to monitor regular test results. Until March 2006, this information was gathered in a manual, four-step process, says Pablo Rodriguez, coordinator for information systems at SES.
A worker would arrive at a clinic in a Lima slum and copy, with pen and paper, the lab results from bacteriology tests. Back at a central office, the results had to be copied onto administrative charts and then onto clinical charts. Finally, this information would be entered into the Electronic Medical Record system. The same process got repeated for each patient.
Joaquin Blaya is a doctoral candidate in the Health Sciences and Technology program at MIT and Harvard Medical School. He saw glaring inefficiencies in the system. So he and some colleagues designed a pilot study that gave four workers a Zire 21, Zire 31 or Z22 PDA.
"The reason we used the low-end was because a.) they were inexpensive and b.) they weren't very flashy," Blaya says, "and when you work in the slums of Lima you don't want something very flashy, for the security of the user." To further camouflage the devices, Blaya says the team used Velcro to attach them to the insides of unassuming folders.
So equipped, the workers were then able to visit a clinic, enter lab data once into their PDAs and then, when they get back to the office, synchronize the handheld with the computer. Blaya says part of the PDA project included digitizing the forms that were previously filled out on paper. And, he says, during the synchronization process there's now a step in which the worker verifies that the information got entered correctly.
"Before, this verification, [it] was them literally sitting at a desk with papers strewn all over the desk and matching up the different tests and the different patients and all that," Blaya says. Now, the workers no longer have to manually check for accuracy, the system does it for them. They just watch as conflicts in the data pop up on the screen, then make any necessary changes or corrections. In addition to saving time, the digital system results in 50 percent fewer errors, Blaya says.
By September 2006, when the pilot study was complete, Rodriguez and his colleagues in Peru were ready to take the system to the rest of the patients in Lima and a half-year later they had expanded it to include nearly all of the MDR-TB patients in Peru.
Rodriguez says the cheap PDAs have the functionality the program requires, though he and his team do find that sometimes the short battery life is an inconvenience as a dead battery can mean losing data stored in the customized software. They get around this by being diligent about charging the devices before heading out to clinics and, in some cases, taking along a second PDA.
In general, though, he says the devices have had few problems and the benefits are many.
Blaya works with Partners In Health, a Boston-based non-profit that helped create SES and gained much public notice when it was featured in Tracy Kidder's 2003 book Mountains Beyond Mountains: the Quest of Dr. Paul Farmer, a Man Who Would Cure the World. PIH currently works with local health organizations in many countries, including Rwanda.
"We're looking at handhelds there but nothing has been implemented yet," Blaya says. For now, Peru remains the only place where PIH has a PDA-based data collection system. Blaya's been working to publish the results of the Peru program in an academic journal, where he will discuss the increased accuracy, efficiency and productivity workers achieved.
The ubiquity of cell phones and the increasing availability of Wi-Fi-enabled devices could influence how the program expands, both in Peru and beyond. Rodriguez says in general people in Peru use cell phones much more than PDAs, and even though more phones are coming with certain PDA-type functionalities, for now the applications SES is using require the dedicated PDA devices.
Example of a PDA Form
(from Evaluating the impact and costs of deploying an electronic medical record system to support TB treatment in Peru)
Eventually, though, some type of Wi-Fi-enabled Smartphone or other combination technology may be an appropriate upgrade.
"Definitely. If we implemented Wi-Fi-enabled PDAs, we could avoid the need to synchronize with a PC and, what's more, we would have the EMR information on-line," Rodriguez says.
The members of the six-person team currently using the PDAs in the MDR-TB program hadn't used such devices before the project began, but Rodriguez says they adapted quickly to the faster, more efficient way of doing their jobs. He adds that the uses for PDAs in the field of public health are diverse.