Electronic Medical Record for Clinic Growth in Rural Guatemala

Medical Student Ben Li working in Guatemala.Medical Student Ben Li working in Guatemala.

By Benjamin Li, MD/MBA expected 2018

Purpose: Describe the Primeros Pasos clinic and provide context for its current growth strategy: developing an electronic medical record system.

In 2004, a Vanderbilt medical student founded a non-profit primary care clinic to address health disparities in his home country, Guatemala. Like many developing countries, Guatemala struggled to provide access to health care throughout many parts of the country, especially rural areas. Located outside of Quetzaltenango (the second largest city in Guatemala), the Palajunoj Valley is an agricultural community of 18,000 inhabitants. Though situated in a beautiful landscape, it struggles with no access to clean water, heavy ash from the nearby active volcano (volcán Santa María), and poor education and nutrition. The Primeros Pasos Clinic provides care for this population.

Each year, Primeros Pasos has continued to grow through the collaboration of medical students, volunteers, and professionals. In its inception, the clinic served children from local schools. It expanded to include adult services in 2007, laboratory services in 2009, dental care in 2010, and a nutrition program for health and education in 2012. It is currently staffed with a clinic coordinator, a dentist, a pathologist, two Guatemalan physicians, six to eight rotating Guatemalan medical students, and a host of international medical volunteers who come and go throughout the year, usually one to three months at a time. It has established several partners, including local businesses, Spanish schools that provide education and lodging for volunteers, and global health alliances. The clinic treats four main conditions: intestinal parasites, respiratory illnesses, skin lesions, and malnutrition.

Like many developing clinics in poor regions, Primeros Pasos provides most of its care at low or no cost, so it relies heavily on outside funding. The clinic coordinator is responsible for applying for numerous outside grants throughout the year. In addition, each international volunteer is expected to fundraise $300 for the clinic. Vanderbilt Medical School organized a “Miss America” style event called the “Dr. Vanderbilt Pageant” to fundraise $2000 for the clinic in 2016. The clinic currently hopes to use this funding to acquire a new electronic medical record system (EMRS).

The new system, OpenMRS Software, is an open source EMRS platform commonly used to improve health care delivery in the developing world. It is designed to be adaptable for different sites, languages, and types of diseases. First implemented in Kenya and Rwanda in 2006, it is now used throughout the world.

As the clinic coordinator explained, this new system would open a whole new pathway for Primeros Pasos. Currently, the clinic operates with a handwritten paper/Microsoft Excel hybrid system in which patient records are kept in color-coded folders (pink for females, blue for males) stored alphabetically in three large filing cabinets in the clinic. The new system improves difficulties that range from illegible handwriting to providing unique patient identifiers (many people in the valley share identical names), and creates an organized way to streamline care, track patients, and collect information. Improving efficiency allows the clinic to see higher volumes of patients. This will encourage patients to return to the clinic for routine healthy check-ups, instead of just when they are ill.

On a significant note, the new EMRS opens avenues for greater funding. Many large grants require data and metrics to support program efficacy. Primeros Pasos will be able to use OpenMRS to collect, centralize, and report patient data (health demographics, diseases, treatment, outcomes, and more), allowing it to access this pool of funding. Furthermore, statistical reports can be used to evaluate and improve medical program design, approach, and policies to most effectively optimize patient care and outreach.

The steps towards this growth would not have been made possible without the interest and contribution of student volunteers and Global Health programs. Though short-term visits may appear to offer limited impact, Primeros Pasos is an example of a clinic that has benefited steadily through the years with continued support. A key component to its success has been establishing a long-term vision and a diverse board of members to oversee its growth and operations. Particular credit should be given to the clinic coordinator, who has been able to track the progress of the clinic, develop partnerships, spearhead finances, and update goals and initiatives while managing its volunteers. The clinic imparts a lasting impression on its volunteers, which serves as a testament of its collaborative success.

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