CURE Uganda: Improving Care with Global Electronic Medical Records

By Posted in Nerd Culture, New Relic News, Top Post 19 November 2013

This is a guest post written by Joel Worrall, CTO of CURE, a global nonprofit network of charitable hospitals and surgical programs. CURE provides treatment for children with conditions like clubfoot, bowed legs, cleft lips, untreated burns, and hydrocephalus. New Relic has teamed up with CURE for the ‘30 Days, 30 Kids’ campaign. For each new deployment, New Relic is donating $100 towards the cost of a child’s surgery in a CURE hospital. Learn more here.

It’s Wednesday, and I’m standing in an operating theatre peering over the shoulder of Dr. John Mugamba, the Medical Director of the CURE Children’s Hospital of Uganda, as he performs an ETV/CPC procedure on a three-month-old boy with post-infectious hydrocephalus.

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To say Dr. Mugamba is an expert in his field is an understatement. Not only is he the most skilled and best-trained neurosurgeon in Uganda, but he has also performed more ETV/CPC procedures (an operation that involves draining the cerebrospinal fluid from the brain, and preventing new fluid from producing) than any neurosurgeon on the planet. Doctors from around the world come to the tiny town of Mbale to study with this brilliant, humble, and gracious man as he and the staff of the CURE hospital treat and save the lives of nearly 1,000 children with life-threatening neurological conditions every year.

The surgery I’m watching is a success, and after recovery with time and therapy, this infant boy stands a good chance of catching up developmentally and living a full and productive life. Without the procedure, permanent brain damage was only months away and death was imminent.

I’m in Uganda for many reasons, but electronic medical records (EMR) are at the top of my agenda. Three months ago, my team remotely migrated the data from a dozen years of this hospital’s medical research into our offline-first cloud-based medical record system. This week, I’m here to assess the effectiveness of our pilot EMR implementation. If it’s successful, we plan to extend the pathology and features of the system and make it the standard EMR for the CURE global network of hospitals.

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As software projects go, it’s pretty innovative stuff. The platform allows for local access to data when Internet outages inevitably occur while at the same time permanently and securely storing data in a Rackspace cloud server in the UK. All of this was built in-house using HTML5 technologies available in modern browsers. Updates are deployed like any SaaS product, while our medical staff on the ground enjoys the kind of high-performing UX that other cloud-based EMR platforms wouldn’t afford them, given Uganda’s current Internet infrastructure.

The more years I spend building modern software, the more convinced I am that performance and UX are the true skills in our field and the keys to a successful project. This venture is certainly no exception. The majority of the users of our system have little experience with either EMR or web-based apps, and providing a system that is fault-tolerant, intuitive, and adaptable is critical.

We’ve already deployed a less feature-rich version of the EMR in over a dozen countries for our hydrocephalus training program, but getting an entire hospital on the solution wasn’t a given.

Thankfully, my hopes for the full EMR were confirmed during my time in Uganda. The staff in the operating room and outpatient department are using the system (mostly as intended), and even though there’s more work to be done technically and operationally, both myself and Dr. Mugamba are confident that this EMR deployment was a wise decision and big step forward for the hospital.

The data from this hospital’s research (in partnership with Boston Children’s Hospital, Harvard, and Penn State) is already having an effect on the global treatment of children with hydrocephalus, and the real-time data access that this new system will afford our researchers will only enhance the impact of their work.

This little project is an example of the kind of difference modern software can make in the world, and how the infrastructure afforded us through cloud services, low-cost remotely-managed hardware solutions, and tools like New Relic’s APM make it possible for a team of less than six tech staff to juggle a half-dozen such projects. The Internet and its technology ecosystem are changing the world, even in places where the ISPs aren’t yet as reliable as we’d prefer—which is good news, especially for the kids and families we serve.

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In the coming year, our team hopes to launch similar pilots in our hospitals in Asia and Africa, and with the right support and resourcing, five years from now, we hope to be running a scalable, repeatable set of remotely-managed technology services to support our entire network of hospitals and programs. In the meantime, the fact that several hundred more children throughout our network will have a life-saving or life-transforming experience that we got to play a small part in makes every week a good week to come to work – whether in Uganda or back home in Pennsylvania.

Learn More: 

    • Read Joel’s previous post about his trip to Afghanistan
    • Watch Joel’s talk at FutureStack13
    • Donate to the ’30 Days, 30 Kids’ campaign

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