Planning Notes

11/3/03 SUMMARY BY CARMELA RUBIN
10/28/03 RESPONSE FROM IAN RAWSON TO CARMELA RUBIN
10/21/03 RESPONSE FROM IAN RAWSON TO ED WARD
HAITI MAPS

11/3/03 SUMMARY BY CARMELA RUBIN:

Goals: 

1. Create a network (intranet) between the hospital and its 12 related health centers distributed throughout the Artibonite Valley in the upland regions.  The main goal of this network is to allow for increased communication between the main hospital and the health centers, including voice, data, and (ultimately) video, thereby establishing a common patient profile, improving treatment, and facilitating the task of referring health center patients to the main hospital.
2. Create an international capability between at least HAS and Pittsburgh for the sharing of medical information with U.S.-based specialists for research, epidemiological research and programs, and telemedicine (including at least telediagnostics and teleradiology).
3. Create a network capability for telemedicine between the HAS dispensaries and U.S. specialists for point-of-treatment telemedicine.

Hospital Infrastructure Information/Assumptions:

1.      The hospital is staffed by a local staff of doctors, nurses, administrative staff, and this staff is complemented by foreign volunteers.  The volunteers are English speaking.  The doctors speak English, Creole, and most likely French.  The administrators are Creole speaking and have the equivalent of a high school education.

2.      The hospital has its own power generator and is connected to the internet via satellite.

3.      Records keeping and documentation is all paper based.  However, charts and forms are similar to those used in U.S. medical facilities.

4.       Health Centers

a.       The health centers are open on weekdays and staffed by local Haitians.  They are literate, but the most educated of the staff has the equivalent of a high school degree.  The health centers may or may not have electricity.  Those with electricity have solar panels, but we don’t know how they work or how well they work.  We also don’t know how many or the centers have solar panels versus those that have nothing.  The main purpose of the health centers is to identify symptoms of patients and if needed, send them to the main hospital on a specific day or to specific clinic.  They also may do some acute primary care and preventive health.  The health center worker gives patients needing additional care at the main hospital a paper referral.  The referral contains their symptoms and a possible diagnosis.

5.      Technology

a.      So far, the most promising technology is the Alvarion wireless system.  However, we do not know how dense the foliage is, and if there are any radio frequency restrictions in Haiti. 

6.       Connecting the health centers

a.      In addition to buying the hardware and software, there are other issues that need to be resolved.  To implement any type of e-health, all health centers would need a reliable power source (intermittent okay).  They also would need to be secure enough to house a computer or laptop.  Should we consider moisture problems? 

7.      Electronic Medical Records

8.      Open Source vs. Commercially Available

9.      Language interface

 Next Steps:

1.      What happens now? 

2.      English is the language of the doctors, so do the staff members just file the charts alphabetically and never look inside? 

3.      What would happen if the records are electronic? 

4.      Would doctors type as they go, or would somebody transcribe them? 

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10/28/03 RESPONSE FROM IAN RAWSON TO CARMELA RUBIN:

Main Hospital

·        What is the existing system of paper based records keeping?  STANDARD US MODEL FOR MEDICAL RECORDS

·        What types of forms are used? ADAPTED FROM US HOSPITALS

·        What do they look like?

·        Where are they stored?  CENTRAL FILES REGISTRY AT ADMISSIONS DESK

·        Who files them?  ADMITTING AND MEDICAL RECORS CLERKS

·        What is the interaction between the doctors and the administrative (MEDICAL RECORDS) staff?  INDIRECT

·        What is the educational level of the administrative personnel?  HIGH SCHOOL EQUIVALENT

 Health Centers

• We also need to get a “day in the life” view of the health centers.
• Do they also have their own electric generator, or is power sporadic?  SOME HAVE SOLAR POWER SOURCES, OTHERS - NO POWER
• How much medical care does the health center employee provide?  BASIC PREVENTIVE AND PRIMARY ACUTE CARE - NOT DIAGNOSES, BUT SYMPTOM IDENTIFICATION
• What is their level of education?  VARIES - HIGHEST IS HIGH SCHOOL
• How secure are the health centers? FAIRLY
• Would equipment such as a laptop be safe there? POSSIBLY NOT
• Are these health centers open daily?  WEEKDAYS

• You mentioned that the health centers refer people to the main hospital.

·        How this system is structured?  A PATIENT WHO NEEDS ADDITIONAL CARE IS SENT TO THE HOSPITAL EITHER ON A SPECIFIC DAY, AS FOR A SPECIAL CLINIC, OR ON AN AS-NEEDED BASIS

·        What do the referrals look like?  PAPER – REPORT ON SYMPTOMS AND PRESUMED DIAGNOSIS

 Medical Needs

• Would it be possible to communicate with some doctors who have volunteered at the hospital, and/or with some of the staff who works there or has volunteered there?  CERTAINLY - THERE ARE A NUMBER OF THEM IN PITTSBURGH

• We think that they could uncover some needs that we may be overlooking Since at this time it is not possible to go to Haiti and do firsthand observation, it is critical to have a clear picture of the daily workings and infrastructure at the hospital.  Perhaps somebody familiar with the hospital operations could draw a diagram or flow chart to answer our process questions.  I think a short answer or a few sentences should suffice to resolve some of the questions.

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10/21/03 RESPONSE FROM IAN RAWSON TO ED WARD:

 In response to some of the points which you included in your recent email to John Whitehill:

 The national utility infrastructure of Haiti is very undeveloped.  There is no public electricity grid in our region, and we produce our own power for the hospital and its associated structures and residences.

 The national telephone system has recently installed connections at HAS, but the service is unpredictable.  We communicate internationally through our own satellite connection for voice and email.

 There are no telephone services at the outlying areas where many of our service population lives.

 Our 285,000 residents are served through 12 dispersed dispensaries, where they receive primary care and education and preventive care.  When a patient requires further care, he is referred to the hospital.  When the hospital finishes its care, it "counter-refers" the patient back to the local health center for followup.  This is all done by paper now, and is not timely or accurate or complete.

 We are interested in using the internet for clinical data storage and communications because this simplifies access to the data by researchers and consultants from Harvard, Columbia, Stanford, Johns Hopkins, and hopefully, CMU.  Having the data on an intranet would limit the benefits of these collaborative relationships.

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Haiti Maps:

University of Texas (the best so far, especially the JPEG relief map)

National Geographic (almost as good, with some elevation relief)

Encarta (focused on the Artibonite Valley, but none of the place names coincide with the Friends-of-HAS network illustration)

MapQuest (attractive relief map, but relatively small and undetailed)

Demis (choose Haiti from pull-down menu; zoomable map; nice, but suspect -- no Deschapelles shown in the Artibonite Valley, but shows a La Chapelle)

CIA (also on FreeGK, 1uptravel, et al.; stylized and not detailed)

Lonely Planet (also highly stylized)

Friends of HAS (stylized and not sufficiently detailed for network design, but does at least focus on the Artibonite Valley)

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