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Computer systems developed
at Children’s and Harvard Medical School helped Erilus (left)
recover from tuberculosis in 2001. He lives with his wife
(above) in rural Haiti. Enlarge
Photo: David Walton
electricity and tenuous Internet connections are not problems a
typical Children’s specialist must plan for. But those are some
of the considerations Children’s Informatics
Fraser, MD, faces in developing high-tech tools to manage deadly
infectious diseases in impoverished countries.
Fraser and his team from Harvard’s Infectious Disease and Social
Change program are using a Web-based information system to improve
treatment for over 1,500 tuberculosis
(TB) patients in Peru and Haiti. The system helps local health workers
develop complex management plans for individual patients, accurately
and efficiently maintain drug supplies, receive results from international
labs and monitor the spread and prevalence of the disease.
“Some people say that before you address these kinds of issues
in a poor area, you have to have clean water, better nutrition and
other basics,” says Fraser. “But really you have to have both. Medical
care is a necessity.”
|A clinician working with the international
health organization Partners
in Health takes patient histories at a shantytown clinic
outside of Lima, Peru. The data is later entered via the Web
and stored on a server at Harvard Medical School.
Fraser’s computer-based approach solves several problems in treating
TB. Interruptions to the long and cumbersome treatment process—whether
because a patient stops taking medications when he begins to feel
better or because of poor access to physicians and medicine—can
give rise to multi-drug resistant TB (MDR-TB).
This form of the disease is even more difficult to treat, requiring
physicians to try different combinations of several drugs at a time
over many months or years. Managing the disease in a single patient,
tracking it across a population and predicting what medications
must be ordered requires managing a vast amount of data.
In 2000, Fraser’s team began working with the Boston nonprofit
Partners in Health to implement the first community-based, individualized
treatment program for MDR-TB in an impoverished setting. They created
a Web-based electronic medical record (EMR) to provide clinicians
with up-to-date data on all drug regimens and lab results, developed
processes to ensure accurate data entry, and built the system so
that it would even work over slow, often unreliable Internet connections.
To protect the security of the equipment, the system’s database
server is located at Harvard Medical School. The servers communicate
with local sites in Lima, Peru, which in turn administer the work
of neighborhood clinics.
Conscious that the technology employed in Peru could be valuable
in many other settings, Fraser and his team have been careful to
give the technology the flexibility to adapt and grow. They are
now using a similar system to support the treatment of HIV
patients in rural Haiti who, like MDR-TB patients, require daily
administration of multiple medications and careful clinical monitoring.
Fraser expects the system to monitor the treatment of several thousand
Haitian HIV patients within the next five years, and hopes to share
the software with other health care programs once it is complete.—CM
Children's Hospital Informatics
Partners in Health
is multi-drug resistant TB?