ICT Improves Patient Care in Africa: ZEPRS -- An Electronic Perinatal Record System in Zambia

A midwife in a health clinic in Lusaka, Zambia, works on a PC while a colleague looks on.

In July 2004, for the first time, nurses and midwives in the Chawama, George, and Chipata health clinics in Lusaka, Zambia referred patients for treatment to the University Teaching Hospital (UTH) by entering patient information into a computer. The computer transmitted the information to the hospital over a high-speed wireless network. The system instantly alerted medical staff in the appropriate UTH department and provided vital information, including the appointment date and time, the reason for referral, and the patient's condition. This allowed medical staff to prepare for patients' visits so that when referred patients arrived, medical staff were ready. The hospital then used the same system to notify the referring clinic when their patients had arrived and what action had been taken. Historical information on referrals remains accessible to authorized medical personnel over the wireless network.

Improving Perinatal Care

The Zambian Electronic Perinatal Record System (ZEPRS), an electronic-first medical records and referral system, is one of the first of its kind in sub-Saharan Africa. ZEPRS is helping medical personnel to improve care, combat the spread of HIV/AIDS, and manage records for perinatal patients and infants (antenatal through 6 weeks after delivery) in clinics, the UTH, the Lusaka District Health Management Team, and the Ministry of Health over a high-speed wireless voice and data network. ZEPRS was developed by RTI International, the University of Alabama at Birmingham (UAB), the Center for Infectious Disease Research in Zambia (CIDRZ), and the Lusaka Urban District Health Management Team (LUDHMT) with primary funding from the Bill & Melinda Gates Foundation.

How ZEPRS Works

Lusaka data transmission tower

ZEPRS operates over a 27-km diameter high-speed point-to-point wireless voice and data network that interconnects 24 clinics and the UTH. A lower speed wireless network in each clinic connects at least one printer and three to nine mobile cart-mounted computers located strategically throughout the facility to support patient care. Using these computers, clinicians display and update patient records as they register and provide care to patients. Patient records are maintained in a central database at the ZEPRS data center maintained by CIDRZ.

Zambian medical personnel have been very receptive and enthusiastic about the system. Clinicians in all 24 clinics used the electronic referral module for 18 months prior to release of the fully integrated electronic perinatal patient records system. The completely integrated system was launched in four clinics in February 2006, and was then introduced to new clinics at the rate of one each month until reaching full deployment in August 2007. RTI has continued to work closely with CIDRZ to refine the ZEPRS software based on feedback from clinicians and emerging needs.

Achieving Results

ZEPRS is now being used by 24 clinics and the UTH to improve health care for over 155,000 patients. More than 5,000 new antenatal patients are added to ZEPRS each month. The ZEPRS intelligent coaching and problem-based care system helps clinicians follow standard procedures, reminds them of needed follow-up, and alerts them to potentially critical conditions through a system of automated and manual triggers that highlight a list of patient issues to system users. This software-based coaching and careful supportive supervision is having a measurable impact on the quality of health care. For example, real-time data provided by the system showed the supportive supervision resulted in a 10 percentage point increase in the HIV testing rate for new antenatal patients in one clinic. The system also provides accurate current HIV prevalence by clinic, which can be used to help target and monitor interventions geographically within the city.

ZEPRS is achieving results by

  • Improving access to patient records 24 hours a day, seven days a week via the ZEPRS wireless network
  • Helping clinicians follow standard procedures, complete necessary follow-up, and recognize critical conditions through automated task and problem lists
  • Providing critical information to health care supervisors engaged in coaching medical teams and health surveillance activities
  • Enabling health researchers to prioritize, design, monitor, and evaluate interventions to improve public health by providing detailed longitudinal data

Making It Open

RTI built ZEPRS using open-source components and best-of-breed Web-based application architecture. RTI has released the software and documentation under open source and open documentation licenses. This eliminates licensing costs and makes it easier to transfer and adapt the system to other countries. The RTI ZEPRS development team continues to learn from and contribute to other open-source electronic medical record systems to advance the state of the art in locally sustainable systems for the developing world.

Making It Flexible

The ZEPRS open-source software architecture is flexible enough to accommodate the addition of new fields, forms, and reports without requiring changes in the underlying code. The architecture RTI developed for ZEPRS may also be customized for different applications. For example, in 2004, ZEPRS provided the foundation for a patient tracking system to manage antiretroviral (ARV) treatment for HIV/AIDS patients (ART/PTS). RTI worked with the UAB and CIDRZ to develop ART/PTS. This software became an integral component of CIDRZ groundbreaking ART treatment program in Zambia. RTI has also used the ZEPRS architecture to develop open-source software for managing ARV pharmaceutical records in Nairobi, Kenya, prototype software for critical care for rape survivors in South Africa, and for managing Malaria Indoor Residual Spraying (IRS) operations in several African countries.

Continuing Innovation

RTI continues to incorporate new standards and technologies into ZEPRS. Recent work in 2008 includes an interface that transfers lab test results to patient records automatically twice a day. Current work is focused on completing a version of the software that will enable facilities to work independently off-line, transmitting data automatically only when network connectivity is available. This will enable the system to meet the needs of facilities with no connectivity, and to use existing mobile phone networks to transmit critical data.

Visit www.ictedge.org/zeprs to use a live demonstration of ZEPRS, to take a quick tour of ZEPRS features, and to find out more about the ZEPRS project.

More Information

For more information, contact
Information and Communication Technology Program
Gordon Cressman, Senior Director
RTI International
3040 Cornwallis Road
Research Triangle Park, NC 27709-2194 USA
Phone: +1 919 541 6363
Fax: +1 919 541 6621
E-mail: ict@rti.org
Web site: www.rti.org/ict