This fellowship has had a very positive impact on the researchers’ scientific training, research productivity and career, and integration into European Research and International Development. It has also allowed him to attend a range of important conferences, workshops and training courses and to hold workshops and meetings of his own including a workshop on Process Evaluation of eHealth Systems in Leeds in May 2017. The extensive work accomplished will form a strong foundation for the next stage of his career.
Several key innovations have occurred through the fellowship. A new research protocol for the evaluation of electronic medical records was developed for the study in Rwanda. It is designed around the new guidelines for treating HIV that require patients to be started on anti HIV medication as soon as possible after diagnosis, and the use of a more effective test for monitoring HIV treatment called Viral Load. The study is in the process of enrolling 112 clinic sites in a cluster randomized controlled clinical trial, with 56 receiving the Enhanced EMR software. The study also includes the use of a System Monitoring Tool to track the “health” and usage by clinical staff of EMRs in remote sites. Data is automatically uploaded daily (in sites with an internet connection) to a central monitoring system (based on the DHIS2 District Health Information System). The study has also collected data on the costs of developing, rolling out and supporting the EMR system. Objective two included work on the usability and use of EMR systems and assessing cardiovascular risk. Several evaluation studies were carried out of diagnostic decision support systems for patients or clinicians, including testing accuracy of a leading diagnosis system ISOBEL with data from an earlier study on heart disease diagnosis.
The researcher achieved a range of publications during the fellowship including two journal articles in prestigious journals published in summer 2017. The first describes the development, implementation and use of a version of the OpenMRS EMR to support patient care in Sierra Leone during the Ebola crisis [J Med Internet Res 2017;19(8):e294]. The second paper is based on the result of a survey of pharmacists in Kenya on an electronic reporting system for adverse events regarding medications [Agoro O et al, JAMIA 2017 in press] . This was carried out by an MSc student under the researcher’s supervision and showed a range of problems with the system that could explain its low usage. A text book on Global Health Informatics was published with fellow editors from MIT in April 2017, which is now being used by students in courses worldwide [https://mitpress.mit.edu/books/global-health-informatics]. Three chapters were authored or co-authored by the researcher: “Electronic Health Records”, “Monitoring and Evaluation”, and “OpenMRS the Open Medical Record System: Software, Community, Philosophy”. The researcher also published a letter to the editor of the leading journal JAMA Internal Medicine on diagnostic decision support tools for patients, and had three presentations or posters at international conferences, with two more to be presented later in 2017. His work was featured in a short article in the technology magazine “Wired UK” (Sept. 2017). There are four more journal articles at late stage of preparation or under review.
