Addressing the information deficit in global health: lessons from a digital acute care platform in Sri Lanka

Abstract

Lack of investment in low-income and middle-income countries (LMICs) in systems capturing continuous information regarding care of the acutely unwell patient is hindering global efforts to address inequalities, both at facility and national level. Furthermore, this of lack of data is disempowering frontline staff and those seeking to support them, from progressing setting-relevant research and quality improvement. In contrast to high-income country (HIC) settings, where electronic surveillance has boosted the capability of governments, clinicians and researchers to engage in service-wide healthcare evaluation, healthcare information in resource-limited settings remains almost exclusively paper based. In this practice paper, we describe the efforts of a collaboration of clinicians, administrators, researchers and healthcare informaticians working in South Asia, in addressing the inequality in access to patient information in acute care. Harnessing a clinician-led collaborative approach to design and evaluation, we have implemented a national acute care information platform in Sri Lanka that is tailored to priorities of frontline staff. Iterative adaptation has ensured the platform has the flexibility to integrate with legacy paper systems, support junior team members in advocating for acutely unwell patients and has made information captured accessible to diverse stakeholders to improve service delivery. The same platform is now empowering clinicians to participate in international research and drive forwards improvements in care. During this journey, we have also gained insights on how to overcome well-described barriers to implementation of digital information tools in LMIC. We anticipate that this north–south collaborative approach to addressing the challenges of health system implementation in acute care may provide learning and inspiration to other partnerships seeking to engage in similar work.

Real-time assessment of COVID-19 impact on global surgical case volumes

“…29 The benefits and challenges associated with collection of healthcare data using mobile technology have been previously discussed. 30,31 Benefits include a decentralized approach to collection of data from the 95% of the global population living in an area covered and subscribed to mobile cellular service. 32 Specifically in LMIC, there were 5.5 billion mobile phone subscriptions, representing nearly 92 subscriptions per 100 inhabitants.…”

Quality evaluation and future priorities for delivering acute myocardial infarction care in Sri Lanka

“…This study uses a recently implemented electronic AMI registry, codesigned by clinicians of the Sri Lanka STEMI Forum, with the purpose of enabling prospective systematic evaluation of care for patients with AMI. Using the Network for Improving Critical care Systems and Training (NICST) methodology, the registry uses a mobile platform with capacity for real-time visualisation of routine information (including referral, diagnosis and management) 5 10. The same platform facilitates evaluation of patient-reported outcomes: satisfaction, functional recovery and burden of symptoms following discharge.…”

“…Digital surveillance systems capable of replicable and continuous evaluation of care that can be embedded within healthcare delivery remain notably absent in many LMICs. However, recent efforts have shown that such systems are both feasible and can help guide priorities for care improvement 8–10…”

What is ‘global surgery’? Defining the multidisciplinary interface between surgery, anaesthesia and public health

“…In addition, the rapid spread of internet-enabled mobile devices has facilitated data collection and allowed for the expansion of clinical registries, providing clinicians with data to drive local quality improvement and researchers with aggregated data to inform policy. Future work needs to concentrate on ensuring consistent definitions and data fields to limit redundancy and to maximise collaboration 28 29…”