Article type
Abstract
Background: Data are needed to monitor the maternal and child health sustainable development goals (SDGs). Providers must deliver high-quality care in environments where task shifting and reporting demands are increasing. National and global guidelines and evidence must drive clinical practice for all providers, whether community health workers, midwives or doctors. Digitised tools can support adherence to evidence-based care, and improve monitoring of health practices from the national level to the frontline. An electronic health registry at the point-of-care can support these goals.
Methods: An eRegistry uses an interactive, electronic clinical registry backbone to support implementation of clinical guidelines by frontline health workers. The eRegistry is a point-of-care recording tool that accepts uniform data points, reduces free text and utilises instantaneous quality-control mechanisms. It facilitates delivery of routine care with checklists designed according to national guidelines. A next-generation clinical decision support system, integrated in the eRegistry, provides automated management plans based on the patient’s own health data.
Strategy: In Palestine and in Bangladesh, eRegistries for maternal and child health are being deployed. Three cluster-randomised trials are under way, with key outcomes relating to provider implementation of guidelines and improved health behavior of care providers and patients. In each setting, the eRegistry generates reproductive health indicators derived from the WHO essential interventions and is customised with local guidelines. Open-source systems are adapted for use in each setting and made available to the global community. The data are available in real-time to providers and also to policy makers, making monitoring and evaluation of guideline implementation feasible.
Conclusions: Systematic reviews inform national guidelines, but lack of awareness of and adherence to those guidelines hinder providers from providing the best quality of care. By explicitly incorporating global evidence into a free and open-source eRegistry, quality of care is enhanced and long-term monitoring and evaluation made central.
Methods: An eRegistry uses an interactive, electronic clinical registry backbone to support implementation of clinical guidelines by frontline health workers. The eRegistry is a point-of-care recording tool that accepts uniform data points, reduces free text and utilises instantaneous quality-control mechanisms. It facilitates delivery of routine care with checklists designed according to national guidelines. A next-generation clinical decision support system, integrated in the eRegistry, provides automated management plans based on the patient’s own health data.
Strategy: In Palestine and in Bangladesh, eRegistries for maternal and child health are being deployed. Three cluster-randomised trials are under way, with key outcomes relating to provider implementation of guidelines and improved health behavior of care providers and patients. In each setting, the eRegistry generates reproductive health indicators derived from the WHO essential interventions and is customised with local guidelines. Open-source systems are adapted for use in each setting and made available to the global community. The data are available in real-time to providers and also to policy makers, making monitoring and evaluation of guideline implementation feasible.
Conclusions: Systematic reviews inform national guidelines, but lack of awareness of and adherence to those guidelines hinder providers from providing the best quality of care. By explicitly incorporating global evidence into a free and open-source eRegistry, quality of care is enhanced and long-term monitoring and evaluation made central.