Planning the execution and deployment of an electronic medical records (EMR) system in Kakuma Refugee Camp is no easy task. Vecna Cares, a non-profit tech firm based in Cambridge, Massachusetts, and a representative from the International Rescue Committee (IRC) joined the NetHope Solutions Center for a webinar to discuss the planning, development, and deployment of a digitized version of the IRC’s health information system in this low-resource environment.
Emily Taylor, Director of Communications for Vecna Cares, introduced the speakers and the Vecna Cares’ mission. “We design and deploy information management and technology solutions to create measurable impact, helping people live healthier and better lives,” she said. Paul Amendola, Executive Director of Vecna Cares followed with a brief description of products, services, and criteria that they used to determine the design and feasibility of deploying an EMR through remote assessments and field visits.
The International Rescue Committee contracted Vecna Cares to install a digital health information system in their six health care facilities across the Kakuma refugee camp. The Kakuma refugee camp, run by the UNHCR, is in northwestern Kenya along the border with South Sudan and is currently home to over 160,000 refugees. The health care system at the camp includes two in-patient hospitals, four clinics, and several pharmacies. The hospitals have a 240-bed capacity, and approximately 200 community health workers support the providers and administrators. The camp’s hospitals and health clinics have no internet and have limited access to electricity, but they still manage to serve at least 1,500 patients every day.
At the heart of the EMR system that Vecna Cares deployed at Kakuma is the CliniPAK Suite. Seth Reddy, Director of Programs for Vecna Cares, explained the suite as a combination of both hardware and software built around the ClinkPAK Node device. Capable of being powered through solar power, alternating or direct currents, the CliniPAK system is optimized for use in ultra-low-resource environments. Reddy described the Node as a ruggedized delivery vehicle for a variety of software platforms that Vecna Cares uses in many projects around the world. A versatile piece of hardware, the CliniPAK Node is a local server and power management device. When deployed, the Node instantly launches a local Wi-Fi network. In addition to its software hosting capabilities, the Node is a power management system that uses a built-in inverter to relay power created by an attached solar panel to devices plugged into the Node via Ethernet or USB. Reddy noted one development that allows camp surgeons to perform nighttime surgeries by powering lights in the operating room with the CliniPAK Node .
Reddy explained that ClinkPAK Suite includes a web-based piece of software installed locally on the Node. “It is designed for use at the point of service with a built-in patient flow management that eliminates a lot of the need for paper records. It’s not a retroactive data entry system. It’s designed to be used at point of care,” he said. Whether a physician, pharmacist or lab technician, all have access to information as it is added to the system. The software allows for data to be collected from multiple wireless devices anywhere in the camp into a centralized database onsite. Real-time, digital patient records allow for standardized health care protocols to be administered from the top down and for detailed, timely reports. This saves valuable time during which the clinics often shut down and cannot see patients. “Instead of spending a couple of days to compile paper records and produce the data required by the government of Kenya, it can now be accomplished with the touch of a button,” Reddy said.
Reddy presented a breakdown of the timeline and process that Vecna Cares established to design and deploy their system. They began with an audit of existing onsite variables that included an evaluation of time constraints, budget, connectivity issues, and possible human resources. To determine user experience workflow of the software, the designers needed to gather and incorporate existing data gathering and reporting requirements of the IRC and Kenyan government. Once the software was written, it was put through a series of quality-assurance beta tests with select users in-house and in the field to reveal any issues. Updates based on those test results optimized the software for deployment.
“Depending on the size of the location, installation can take a day or as little as an hour. You really just need to plug it in and turn it on,” according to Reddy.
Amendola described the training methodology that Vecna Cares used in the field with users as a three-phase approach. First was to identify, and train super-users at the clinic level and the admin level. Second, the super-users trained the end-users, who were shadowed by trainers in phase three to solidify proficiency. Abi Beaudette, a Program Manager at Vecna Cares who arrived from Kenya a few days prior to the webinar, said, “At the heart of the training process is change management. Finding a champion, creating buy-in, creating sustainable support systems that will last when you are long gone–that is the point.”
The CliniPAK system is currently in the go-live phase of deployment at Kakuma. The main hospital and one of the clinics have implemented the system, and data collection is ongoing from those deployments in preparation to for a full roll-out to the remaining clinics in the camp. Data collected for evaluation includes user feedback and ICT indicators, such as efficiency gains and system uptake among the end-users.
Reflecting on the deployment thus far, Reddy stressed the importance of keeping the objectives of the system at the forefront of software development. “Due to the constraints of a low-resource environment, compressed timelines, and a compressed budget, trade-offs must be made. Keeping the goals of the system at the forefront can make those trade-offs much better,” he said. In closing, Reddy emphasized the importance of getting the solution in the hands of the user as much as possible during the process. “They are the ones who will be able to guide you; to give you the feedback that will make the system the best it can possibly be,” he said.
Note: In the WebEx recording, the presentation is interrupted by technical difficulties due to a severe winter storm. The presentation drops out at minute 10:45 and picks up again at minute 21:50. Also, due to technical difficulties, the connection was disrupted to Cosmas Opondo, Electronic Medical Records Manager at the Kaukuma Refugee Camp for the International Rescue Committee was lost. Mr. Opondo was unable to present as a result.