When Secretary of State Hillary Clinton visited Zambia recently, she praised the government for its vision in deploying an electronic health record system that stores a person’s data on a pocket-sized plastic card. With the support of Jhpiego and other partners, more than 550 health facilities in Zambia are using the SmartCare system and more are expected to come online soon.
With funding from the U.S. Centers for Disease Control and Prevention (CDC) and in partnership with the Zambian Ministry of Health, Jhpiego has been supporting efforts to expand, refine and introduce the SmartCare card system nationwide. This collaboration has been made possible through comprehensive field coordination and active participation in SmartCare training, provision of training equipment, initial pilot testing, nationwide deployments, mentoring and further support to selected districts to clear system backlogs and strengthen health systems.
The project is led by the Ministry of Health and the CDC. Implementing partners, in addition to Jhpiego, include:the U.S. Agency for International Development; the Centre for Infectious Disease Research in Zambia; Zambia HIV/AIDS Prevention, Care and Treatment Partnership; Zambia National AIDS Network; the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF); JSI/DELIVER; Aids Relief/Catholic Relief Services; the Zambia Defense Force (ZDF) Medical Services; the Zambia Police Medical Services; the Churches Health Association of Zambia and Chreso ministries.
“SmartCare has tremendously, without a doubt, contributed to the improvement of provision of health care services in some areas to the Zambian people,” said Kwame Asiedu, Jhpiego Country Director in Zambia. “The easy and practical use of SmartCare by health care providers allows them to have patient records almost at their fingertips, and has improved the services these providers give to the patients. And, I am glad that Jhpiego is contributing to these efforts.”
In 2005 SmartCare began in Kafue District as a pilot project, supported by Jhpiego, to address uniquely African health care challenges in a resource-poor country with a mobile patient population. According to a SmartCare mission statement, the goal of this electronic health record system is to enable the delivery of cost-effective, confidential, high-quality health care for everyone, everywhere, every time, by improving health records and related health information systems.
Since 2005, SmartCare has been deployed in more than 550 clinics and hospitals, in all nine provinces and 72 districts in Zambia. Sites include public, private and military health facilities. As the electricity infrastructure develops in more remote areas of the country, SmartCare implementation will follow to strengthen health systems. Today, more than 600 users, support staff, managers and trainers are SmartCare certified. Eventually, all personnel who teach, support or use SmartCare will undergo this rigorous and demanding certification process.
SmartCare was developed to improve continuity of care and provide timely data on maternal and child health, HIV/AIDS, tuberculosis and malaria interventions for public health purposes, including Health Management Information System (HMIS) trend reporting and analysis for health officials and clinicians. SmartCare is now also required for any facility in Zambia desiring accreditation to dispense antiretroviral (ARV) drugs for HIV clients.
The software was designed to be simple, intuitive and friendly, even for the large numbers of the population who have limited computer knowledge. A touch screen interface mirrors the already familiar paper health card system. SmartCare interfaces well with “paper-based” clinics. This seamless interaction of data will facilitate the national rollout of the system and a smooth transition, over several years of implementation, from a paper-based system to an electronic one.
Health providers and patients have both benefited from the switch to an electronic record system.
Just ask Benedit Chewe, a maternal and child health care provider at Mikomfwa Health Centre in Luanshya, Copperbelt Province. As she attended to a mother and baby, Chewe entered the woman’s health information into SmartCare with ease. “We are now able to generate the Antenatal Card automatically from SmartCare,” she said, referring to the records of prenatal care visits. “It was tedious and time consuming in the past because we used to do it manually.”
A 24-year-old female client added: “It is easy and faster than paper files. Initially, we used to queue for longer periods to access services.”
A Key Component
The SmartCare card is a key part of the electronic health record system. This customized card carries an encrypted copy of a patient’s entire health history. It uses a SIM chip, familiar to those who use cell phones, to store the data. The $1.30 card is more durable and private than a paper record, and is easily replaced. It also serves as a low-tech, “just in time” communications alternative when the Internet, phones and faxes don’t work. Health records travel directly with the patient. A soft copy of the health record is saved in the SmartCare database of every facility the patient visits. These data are later de-identified, and pooled at the district, provincial and national levels for public health monitoring, evaluation and HMIS use.
Where cellular reception exists and costs are sustainable, a 3G cellular option can be used between SmartCare and providers, patients, facilities and managers to provide reminders, requests, warnings, updates and reports.
“SmartCare allows a client to access ARV drugs from anywhere as long as they have a Care Card,” said one clinician who works at a Jhpiego-supported health facility in Lusaka. “One client came from Chipata to attend a funeral in Lusaka. She was running out of drugs. But through her Care Card, she was able to access her drugs and continue with her medication while in Lusaka.”
The Zambian clinician added, “Data are never lost, even if the client has lost her card. Her data can still be accessed on the facility computer by searching her name, thereby ensuring continuity of care.”
For Zambia and other countries interested in an electronic health record system, SmartCare provides continuity of care for patients over time and place, as well as ownership of their personal health record. For clinicians, it provides quick and complete access to patient data, and powerful clinical decision-making support, along with monitoring and evaluation and quality assurance tools.
To ensure successful implementation of the SmartCare system, Jhpiego has procured and provided 34 SmartCare training laptops, organized SmartCare training courses for pilot testing in Kafue District and during national and provincial rollout, and offered quarterly technical support and supervision to SmartCare sites across Zambia.
Jhpiego is currently spearheading the rollout of SmartCare across public and private pre-service education institutions in Zambia.
In recognizing Zambia’s innovation and foresight, Mrs. Clinton said she had tried unsuccessfully for the past decade to get a similar system in place in the United States. “So I may need to send some people here to see how it is done,” Mrs. Clinton told a delighted audience at the University Teaching Hospital Paediatric Centre of Excellence in Lusaka.