Evaluation of Clinical Impacts and Costs of eHealth in Rwanda

Summary

This study will estimate the impact of a suite of clinical decision-support tools on structural, process, and clinical outcomes related to HIV care. The "enhanced EMR" package under investigation will include EMR monitoring tools, data quality control procedures and support, patient reports, alerts, and reminders about patient care. This intervention will be delivered by the Ministry of Health and Rwanda Biomedical Centre and monitored by the study team led by University of Rwanda's School of Public Health and Brown University.

Conditions

• HIV/AIDS and Infections
• Electronic Medical Records
• Clinical Decision Support System

Interventions

OTHER

Experimental: Intervention 1 (Int1)

This intervention will consist of the following additions to the EMR package. A link on the clinician's homepage to enrol a new HIV+ patient in the EMR which will open a form for (1) entering patient demographics (2) adding the contact home address or description of area, phone number (if available), (3) the peer educator contacts (4) recording the HIV+ result and date. A report will be added that is run every week to identify HIV+ patients not linked to care. The patients identified will be checked with paper records to ensure they have definitely not visited, then contacted after one, 2 weeks and 4 weeks if he/she did not show up. After two attempted contacts, if the patient is not yet linked to care he/she will be visited at home by the health facility social worker using routine home visits by health care providers.

OTHER

Experimental: Intervention 2 (Int2)

The data on availability of VL results in the EMR will come from a SQL statement to query the OpenMRS database. An alert will be fired if the patient has been enrolled for 8 months or more and does not have a viral load result in the EMR. The alert will be displayed on the patient summary and on the consult sheets, with text requesting the clinician orders a VL.

OTHER

Experimental: Intervention 3 (Int3)

The data on VL results in the EMR showing detectable virus will come from a SQL statement to query the OpenMRS database. An alert will be fired if the patient has been enrolled for at least 12 months and the VL result in the EMR shows \> 1000 copies/mm3. The alert will be displayed on the patient summary and on the consult sheets requesting actions to address treatment failure (change first line medication, start second line medication, repeat VL, counselling on treatment adherence). A report will also be added to regularly check for patients with high viral load.

Sponsors & Collaborators

• Centers for Disease Control and Prevention

  collaborator FED

• Ministry of Health, Rwanda

  collaborator OTHER_GOV

• Rwanda Biomedical Centre

  collaborator OTHER

• Partners in Health

  collaborator OTHER

• Innovative Support to Emergencies Diseases and Disasters

  collaborator UNKNOWN

• University of Pittsburgh

  collaborator OTHER

• Jembi Health Systems

  collaborator UNKNOWN

• Brown University

  collaborator OTHER

• National University, Rwanda

  lead OTHER

Principal Investigators

• Fraser HAMISH, MBChB · Brown University: [email protected]

• Jeanine CONDO, MD, PhD · University of Rwanda

Study Design

Allocation

RANDOMIZED

Purpose

OTHER

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2018-09-15

Primary Completion

2020-07-15

Completion

2020-07-30

Countries

• Rwanda

Study Locations