Improving and Expanding Electronic Health Records in a Rural Setting

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IKP Center for Technologies in Public Health Future directions CDSS Decision-trees have been constructed for the respiratory and cardiovascular systems, but will need to be expanded to include other body systems. A panel of physicians--ideally physicians with knowledge of rural health issues— should review the decision-trees that have been created to ensure their accuracy and comprehensiveness. These decision-trees will need to be coded so that computer programmers may translate the yes/no options into CDSS software. Eventually, protocols for the management of certain diseases, as well as protocols developed to guide nurses during the physical exam will be integrated into the CDSS. PH-EHR The pilot environmental surveys created need to be verified and finalized by professionals with a more thorough environmental health background who are well versed in the factors that plague rural India specifically. Once needed individuals with appropriate backgrounds are assigned to the project an at-risk scoring system needs to be added to the decision tree that will link all answer choices to at-risk conclusions. Ultimately scores will need to be assigned to all responses in which higher scores will be assigned to factors that are more likely to cause individuals and communities to be at-risk for GI and URI. This will lead to each household and hamlet being assigned a single at-risk score. Once this step is taken ICTPH should conduct the surveys in the villages where they operate, both at the household level and community level. After which the data gathered would need to be entered into the EHR system. A module, more specifically, an algorithm that would translate the decision trees into risk scores needs to be created. The community level data will need to be quantified to discover the most prevalent environmental factors occurring in villages that will cause the population to be at risk for GI and URI. ICTPH can then began to brainstorm what effective and feasible policy changes they can reasonable work on to implement with the local governments. The hamlet survey will lead to an environmental profile of the hamlets which can be incorporated into the EHR system. So, for example, if multiple patients from Hamlet X present with GI/URI symptoms at the clinic the system will alert them to this increased incidence of GI/URI in Hamlet X. The clinic can then pull up the profile for Hamlet X on the EHR to see the prevalent community environmental risk factors there. This information will assist ICTPH in developing large-scale community level environmental interventions where needed. The organization should work to create individual interventions that will tackle the various environmental factors that are affecting households. These interventions need to be linked to responses to the individual surveys so once a patient enters the clinic, their household survey responses will be displayed on the screen and the necessary interventions will also be displayed. This will lead the nurses to conduct the individual interventions to patients. If ICTPH is able to change and implement environmental policy at a community level, testing will need to be conducted to document changes in water quality, water policy, sewage and waste practices, etc. Follow-up will also need to be conducted regarding patient compliance with the created initiatives. As such, evaluation of all initiatives need to be carried out to document changes in population health. 26 www.ictph.org.in
Improving and Expanding Electronic Health Records in a Rural Setting: Clinical Decision Support System & Public Health Component Annex 3 Community-Level Environmental Survey Pilot Survey By: Urmi Cholera & Jessica Wolff Community-Level Environmental Survey: WATER 1. Where do most villagers obtain drinking/ cooking water from? Surface Water (River/Lake/Pond) (GO TO Q2) Piped Water in yard/home (GO TO Q4) Outdoor community water pump (GO TO Q4) Well (GO TO Q8) Other 2. Is this surface water used for anything else? NO (GO TO Q3) YES (Check relevant boxes below then go to Q3) Defecating Bathing Clothes Washing 3. Are there any trash piles located near the surface water source? NO YES 4. What is the source of the piped water? Surface water (River/Pond/Lake) (Answer Q2-3) Treated well water (GO TO Q5) Untreated well water 5. How is well water treated? Chlorine tablets/powder Bleach Water filter (ceramic/sand/composite) Electric purifier Other (GO TO Q6) 6. How often is water treated? Once a day Once a week Once a month Longer Unsure (GO TO Q7) 7. Is well water quality checked by an official? NO YES-How often? (Mark answer below) Once a week Once a month Longer 8. What is the status of well? (Check all boxes that apply) Protected/Covered Unprotected Treated water (GO TO Q5) Untreated water Trash thrown in well Clean/Well maintained www.ictph.org.in 27
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