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Dream–SE software is designed for HIV care and is being used in Portuguese, Italian, English and French. It is a client–server application, which is not an issue if users are connected through an LAN network to the server but can be problematic for remote users.

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Dream–SE is free software, but the software code is closed, which limits customisability. Hardware equipment requirements are minimal. These products also have recurring licensing costs. They must be carefully protected with updated anti-virus software.

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These are standard products, appropriate for most environments, and staff with basic skills to install them are ubiquitous. While other reviews have emphasised EMRs in the care of HIV and TB, this review also explores the availability of EMRs to support primary care.ĭream–Sant Egidio (SE) relies on Microsoft Windows, MS SQL Server and MS Access.

We attempted to take into account clinical setting and patient problems, cost of needed hardware and proprietary software components, technical skill needed for installation and maintenance, scalability, clinical functionalities and ease of reporting. Our emphasis is on EMR availability, cost, simplicity of installation and maintenance, clinical functionality, and reporting for monitoring and quality improvement. This study aims to address the needs of clinicians like us from resource-limited settings who are exploring options for adopting an outpatient point-of-care EMR but have unreliable internet access and limited financial and human resources. Computers on and off campus are plagued by viruses, which further degrade the performance and reliability of computers based on the Windows operating system. The setting has slow unreliable internet access and inconsistent electrical supply, but computers are widely used in the area and among the medical students. The motivation for this study came from the need to equip a new medical school teaching clinic with an EMR, both to improve medical care and to teach medical students about medical informatics.

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Recently, Kenya published standards and guidelines for EMR systems, 15 but it is impossible to determine, based on published reports, which products have the functionalities necessary to provide full clinical care. Potential adopters of a point-of-care EMR have a critical need to know the functionalities and limitations of existing systems in order to evaluate whether or not a given EMR is suitable for their clinical setting. 3–11 Reviews often mention a selection of EMRs under development but have not indicated why they chose to evaluate particular systems and to exclude others. 2 Authors of reports concerning individual EMRs often emphasise the strengths and potentialities of the system they have been developing, but fail to delineate actual functionalities and limitations. Non-communicable chronic diseases are also major causes of worldwide morbidity and mortality, but they have not received the emphasis afforded HIV/AIDS and TB, either in the Millenium Development Goals 1 nor in the development of EMRs for delivering primary care for patients.Ĭase studies and periodic reviews have provided potential users with information about various EMR implementations in resource-limited settings, but Mitchell's characterisation of the landscape as ‘a descriptive feast but an evaluative famine’ in 2001 continues unchanged. The HIV pandemic and increases in multidrug-resistant tuberculosis have provided much of the impetus for funders to support the development of point-of-care EMRs in resource-limited settings. They allow clinicians to evaluate and follow-up patients, prescribe medications safely, monitor laboratory and imaging results, allow for programme evaluation and provide ongoing data for quality improvement. Electronic medical records (EMRs) are important tools for safely managing chronic diseases.

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