Here is why we need electronic medical records for maternal and newborn care
Health care in sub-Saharan Africa and particularly Uganda continues to struggle and suffer with poor and unreliable data. Policy makers at a national level have challenges with reliable population level data to effectively plan for health services particularly in the area of maternal and newborn. It is increasingly becoming visible that without high quality and reliable data, Uganda might continue to struggle with poor indicators through the Sustainable Development Goals.
Recent estimates released by the Uganda Bureau of Statistics for maternal and neonatal mortality indicated Uganda could only reduce its maternal mortality ratio from 438 to 336 per 100,000 live births. However the neonatal mortality rate remained stagnant at 27 deaths per 1000 live births. This lack of movement could be as result of poor quality data.
Uganda Demographic Health Surveys (UDHS) have for long been the main source of data for maternal and new-born outcomes. However, these surveys report information dating as far as five to ten years prior to the survey. The UDHS takes a random sample and suffer from inaccurate reporting by the respondents due to recall bias among others.
Most of the health facilities are still using manual data collection systems or paper based records inform of registers, patient charts which suffer greatly with issues ranging from completeness, timeliness, accuracy and validity plus the increased burden on the health worker. These could be mitigated through introduction of EMRs.
Electronic health information systems have been successfully implement in HIV/AIDS control programmes such as PMTCT/EMTC. Why not MNCH? Many of the maternal deaths, neonatal and stillbirth could be prevented if data was available in real time to the resource controllers and policy makers. Through targeting pockets in the country that register high deaths in addition addressing causes of these deaths, plan for and manage emergencies. I think borrowing from the HIV/AIDS experience, electronic medical records for maternal and new-born health should be a matter of urgency.
The Ministry of Health and other development partners developed a health management information system (HMIS) to bridge the data gap in the health sector. And this was a good initiative. However, this system suffers from lack of controls on the quality of data reported. Data collected through the HMIS is aggregated or monthly summaries by HMIS/Records officers. This exposes it to a lot of human errors. Secondly, because the system is managed centrally at MOH, in the health facilities where data is mostly collected do not view it as important but rather as a Ministry requirement. This in away hinders data use by the health workers to drive provision of good quality services. Electronic medical records (EMRs) become very handy in eliminating these steps, ensuring an easy and faster way of recording data through clicking as opposed to recording using pens and pencils in long maternity and new-born registers. In addition, EMRs protect patient safety and confidentiality, increase data quality, promote data integrity, faster information exchange, summary and transmission to the national system (HMIS) and finally data use.
To this, I reiterate that electronic medical records for maternal and newborns will improve quality of data reported in the short and long term. It eliminates relying on HMIS record officers from extracting and summarising data and delays in reporting to the national system. Data reported in the national system will greatly become more reliable hence improving planning, focusing resources to regions/ areas where mortality is highest at a given point in time. This way, we shall go a long way towards achieving the Sustainable Development Goal 3 target of reducing the maternal mortality ratio to less than 70 per 100,000 live births.
***Blog by Paul Mubiri, the Preterm Birth Initiative (PTBi) Study Data Manager for Uganda.