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. 2018 Sep;6(3):197-204.
doi: 10.1016/j.hjdsi.2018.05.002. Epub 2018 Jun 5.

Developing and deploying a community healthcare worker-driven, digitally- enabled integrated care system for municipalities in rural Nepal

David Citrin  1 , Poshan Thapa  2 , Isha Nirola  2 , Sachit Pandey  2 , Lal Bahadur Kunwar  2 , Jasmine Tenpa  2 , Bibhav Acharya  3 , Hari Rayamazi  2 , Aradhana Thapa  2 , Sheela Maru  4 , Anant Raut  2 , Sanjaya Poudel  2 , Diwash Timilsina  2 , Santosh Kumar Dhungana  2 , Mukesh Adhikari  5 , Mukti Nath Khanal  6 , Naresh Pratap Kc  7 , Bhim Acharya  8 , Khem Bahadur Karki  9 , Dipendra Raman Singh  10 , Alex Harsha Bangura  11 , Jeremy Wacksman  12 , Daniel Storisteanu  13 , Scott Halliday  14 , Ryan Schwarz  15 , Dan Schwarz  16 , Nandini Choudhury  2 , Anirudh Kumar  17 , Wan-Ju Wu  18 , S P Kalaunee  19 , Pushpa Chaudhari  5 , Duncan Maru  20
Affiliations

Developing and deploying a community healthcare worker-driven, digitally- enabled integrated care system for municipalities in rural Nepal

David Citrin et al. Healthc (Amst). 2018 Sep.

Abstract

Integrating care at the home and facility level is a critical yet neglected function of healthcare delivery systems. There are few examples in practice or in the academic literature of affordable, digitally-enabled integrated care approaches embedded within healthcare delivery systems in low- and middle-income countries. Simultaneous advances in affordable digital technologies and community healthcare workers offer an opportunity to address this challenge. We describe the development of an integrated care system involving community healthcare worker networks that utilize a home-to-facility electronic health record platform for rural municipalities in Nepal. Key aspects of our approach of relevance to a global audience include: community healthcare workers continuously engaging with populations through household visits every three months; community healthcare workers using digital tools during the routine course of clinical care; individual and population-level data generated routinely being utilized for program improvement; and being responsive to privacy, security, and human rights concerns. We discuss implementation, lessons learned, challenges, and opportunities for future directions in integrated care delivery systems.

Keywords: Biometric identification; Community health workers; Delivery of healthcare, integrated; Electronic health records; Health information systems; Nepal.

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Figures

Figure 1:
Figure 1:
Data architecture for a biometrics-enabled, integrated, home-to-facility electronic health record
Figure 2:
Figure 2:
Pregnancy and child screening workflow
Figure 3:
Figure 3:
Diarrhea screening workflow and decision support
Figure 4:
Figure 4:
Map of institutional births recorded after household enrollment and via population health management (February 2014 – June 2016)
Figure 5:
Figure 5:
Example of customizable DHIS2 dashboard integrated with the electronic health record
See this image and copyright information in PMC

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MeSH terms