Over the last 3yrs, I have travelled across the world and looked at 100+ health facilities of different scales. My last encounter with a health facility in rural Bilaspur was very different. Having looked at systems of practice in a variety of health facilities including subcenters, private clinics, primary health centers, community health centers, district hospitals, tertiary hospitals and super-specialty hospitals, each of these places have different characteristics. What makes Jan Swasthya Sahyog (JSS), situated in rural Bilaspur in Chattisgarh special is the motivation levels among all the staff at the health facility. This includes clinicians, nurses, technicians and computer operators… And the motivation of these people stems from the fact that they still believe in care, rather than just providing health services. I use “still” because in my worldview of health facilities, most often I see people missing out on the “care” from the notion of health-care.
My visit to JSS was for volunteer work that I have been doing over the last few months to see an Electronic Medical Record (EMR) system to be setup at JSS. Over 100 volunteers across the world have come together in this pursuit to build an EMR system that is easy to use, suited to low-resource settings and can help improve work of the providers as well as help provide better services to patients. JSS was founded 15yrs back by post-graduates doctors of All India Institute of Medical Sciences (AIIMS), India’s most prestigious medical school and hospital to provide healthcare to people who are deprived from it because of poverty, neglect and lack of development. And when I visited JSS on Christmas 2011, I could see the savior work done by JSS for the many people who come from far-flung places because they are treated with dignity and care.
The EMR system broadly from interviews and discussions with some doctors, nurses, other staff and my interpretation of the context needs to do the following:
- Help to improve efficiency in use of resources and providing patient care
- Help to maintain correct medical practices through validations
- Help to understand who, what, why is being treated at JSS
EMRs or for that matter any computerization process advertises many-fold benefits. Technology is most often considered the silver bullet that will solve all problems. From my experience this is rarely the case. So these 3 points might provide a guiding path to decisions that we make in the design of the EMR. In the design of the EMR, just like JSS we have to put “care” at the forefront of our efforts rather than technology prowess. Thus, this system is envisaged to be a point-of-care systems where providers will look up records and use the system to provide “care”.
The other very unique thing about JSS is that is it rooted in the locale of the context. Having seen other health facilities setup by “change-makers-coming-from-the-outside”, JSS is uniquely very much part of the context. This is one of the reasons I see why people come from more than 100kms away to JSS for treatment. People view JSS as locals and one among their own. This is one aspect that I think the EMR system should incorporate. It should embody in itself the locale. By locale, I mean the local practices, language, usability… among other things.
I would say we have some lofty goals for the EMR. One that the project lead calls as “Linux of EMRs”, but in my opinion even if we achieve more humble ends, like not causing burden to providers and patients that would make me happy. It is this pursuit that drives me to work towards this cause. I call it a pursuit because I realize this is not something that is a stagnant phenomenon. It will change with every small change that we make. Every morning it is this pursuit of happyness that drives me to understand what an EMR system would be of use at JSS.