Baseline Survey on Referrals and Healthcare Provider Needs in View for an Electronic Referral System.

The study aimed to evaluate the formats and completeness of the current paper-based referral system and assess user needs for designing an electronic referral system. Conducted in eight public health facilities in Kigali city, the mixed methods approach identified seven different referral letter formats, with the external transfer form averaging 58.8% completeness.

Evaluation of a Computer-Aided Clinical Decision Support System for Point-of-Care Use in Low-Resource Primary Care Settings: Acceptability Evaluation Study.

Background: A clinical decision support system (CDSS) based on the logic and philosophy of clinical pathways is critical for managing the quality of health care and for standardizing care processes. Using such a system at a point-of-care setting is becoming more frequent these days. However, in a low-resource setting (LRS), such systems are frequently overlooked.

Using Routine EMR Registration on a National Scale for Evaluating the Impact of HIV and ART on Childbirth in Burundi.

A number of international studies have reported that HIV+ mothers under ART on average deliver babies that have low birth weight (LBW), are smaller (LBH) and are more often premature [1,2,3,4,5,6,7,8,9]. These 3 elements are well known risk factors for neonatal mortality. In our study we wanted to assess the actual status of such supposed HIV and ART related neonatal mortality risks in Burundi by taking advantage of the country's large scale EMR implementation.

Evaluating a clinical decision support point of care instrument in low resource setting.

Background: Clinical pathways are one of the main tools to manage the health care's quality and concerned with the standardization of care processes. They have been used to help frontline healthcare workers by presenting summarized evidence and generating clinical workflows involving a series of tasks performed by various people within and between work environments to deliver care. Integrating clinical pathways into Clinical Decision Support Systems (CDSSs) is a common practice today.

Assessment of formats and completeness of paper-based referral letters among urban hospitals in Rwanda: a retrospective baseline study.

Background: Patient referral is a process in which a healthcare provider decides to seek assistance due to the limitations of available skills, resources and services offered locally. Paper-based referrals predominantly used in low-income countries hardly follow any procedure. This causes a major gap in communication, coordination, and continuity of care between primary and specialized levels, leading to poor access, delay, duplication and unnecessary costs.

A Hybrid Approach for Designing Dynamic and Data-Driven Clinical Pathways Point of Care Instruments in Low Resource Settings.

Though a clinical pathway is one of the tools used to guide evidence-based healthcare, promoting the practice of evidence-based decisions on healthcare services is incredibly challenging in low resource settings (LRS). This paper proposed a novel approach for designing an automated and dynamic generation of clinical pathways (CPs) in LRS through a hybrid (knowledge-based and data-driven based) algorithm that works with limited clinical input and can be updated whenever new information is available. Our proposed approach dynamically maps and validate the knowledge-based clinical pathways with the local context and historical evidence to deliver a multi-criteria decision analysis (concordance table) for adjusting or readjusting the order of knowledge-based CPs decision priority.

COVID-19 epidemic in The World Health Organization African Region (WHOAR): Situation and forecast.

To describe the dynamics and forecast the main parameters of the COVID-19 pandemic, the time series of daily cases in the World Health Organization African Region (WHOAR) from February 26th to December 29th, 2020 was analyzed. Estimates for expected values of parameters characterizing an epidemic (size of the epidemic, turning point, maximum value of daily cases, and basic reproductive number) were provided for both the first and the second wave, and for the entire ongoing pandemic in WHOAR. To this aim, the classical SIR (Susceptible-Infected-Removed) model and its approximations were applied to each identified wave.

Open Source HMIS Enabled Evaluation of Financial Burden of Disease and Patient Coverage in Three University Hospitals in Great Lakes Africa.

Since the eighties, case mix evaluation methods based on diagnosis-related groups (DRG) were gradually introduced in developed countries. These methods of assessing the costs of diseases to measure the productivity of the hospital have been introduced in management softwares that are not accessible to low-income countries. In this study, the authors applied these methods to an open source hospital management information system (HMIS) implemented in three university hospitals in Great Lakes Africa.

A Method for Constructing a New Extensible Nomenclature for Clinical Coding Practices in Sub-Saharan Africa.

Clinical coding is a requirement to provide valuable data for billing, epidemiology and health care resource allocation. In sub-Saharan Africa, we observe a growing awareness of the need for coding of clinical data, not only in health insurances, but also in governments and the hospitals. Presently, coding systems in sub-Saharan Africa are often used for billing purposes.

OpenClinic GA Open Source Hospital Information System Enabled Universal Health Coverage Monitoring and Evaluation in Burundian Hospitals.

The Universal Health Coverage (UHC) is at the center of the 2030 Sustainable Development Goals agenda. In this study, the authors made an evaluation of the patient health coverage indicators in eight Burundian hospitals from 2011 to 2016. The relevant UHC indicators were calculated on the basis of patient administrative and health insurance data, collected via OpenClinic GA, an information and communication technology (ICT) supported health management information system (HMIS).

Health Informatics: Developing a Masters Programme in Rwanda based on the IMIA Educational Recommendations and the IMIA Knowledge Base.

Since 2011, the Regional e-Health Center of Excellence in Rwanda (REHCE) has run an MSc in Health Informatics programme (MSc HI). A programme review was commissioned in February 2014 after 2 cohorts of students completed the post-graduate certificate and diploma courses and most students had started preparatory activity for their master dissertation. The review developed a method for mapping course content on health informatics competences and knowledge units.

Human Factors Predicting Failure and Success in Hospital Information System Implementations in Sub-Saharan Africa.

From 2007 through 2014, the authors participated in the implementation of open source hospital information systems (HIS) in 19 hospitals in Rwanda, Burundi, DR Congo, Congo-Brazzaville, Gabon, and Mali. Most of these implementations were successful, but some failed. At the end of a seven-year implementation effort, a number of risk factors, facilitators, and pragmatic approaches related to the deployment of HIS in Sub-Saharan health facilities have been identified.

The Role of Hospital Information Systems in Universal Health Coverage Monitoring in Rwanda.

In this retrospective study, the authors monitored the patient health coverage in 6 Rwandan hospitals in the period between 2011 and 2014. Among the 6 hospitals, 2 are third level hospitals, 2 district hospitals and 2 private hospitals. Patient insurance and financial data were extracted and analyzed from OpenClinic GA, an open source hospital information system (HIS) used in those 6 hospitals.

Evaluating the impact of ICT-tools on health care delivery in sub-Saharan hospitals.

This research explores to what extent Information and Communication Technology (ICT)-based information management methods can help to improve efficiency and effectiveness of health services in sub-Saharan hospitals and how clinical information can be made available for secondary use enabling non-redundant reporting of health- and care performance indicators. In the course of a 6 years research effort between 2006 and 2012, it was demonstrated that patient identification, financial management and structured reporting improved dramatically after implementation of well adapted ICT-tools in a set of 19 African health facilities. Real-time financial management metrics helped hospitals to quickly identify fraudulent practices and defective invoicing procedures.

Evaluating the relevance of disability weights for adjusting disease-cost and comorbidity calculations at the Kigali University Teaching Hospital.

Evaluating the burden of diseases treated in hospitals in terms of (co)morbidity and financial impact is a long standing problem. Proposed solutions often rely on very sophisticated medical registration systems that are less suitable for developing countries. The authors have developed a simple prototype method for calculating financial impact and comorbidity of clinical conditions treated in a Sub-Saharan hospital environment (CALCO method) using disability weights.