As a team of students and faculty at Duke University, we are working to create patient-centered electronic health records (EHR) to allow individuals to access and meaningfully engage with their health records at any time. This EHR is a longitudinal record of patient health information generated by one or more encounters in any care delivery setting. Our goal is to develop a mobile and cloud-based EHR system that provides the modularity and customization required to advance the concept of personalized health. Our EHR platform provides customized health information and services to patients, providers, and public health entities, respectively. We envision a health system where patients have real-time access to their health information and are equipped with tools effectively manage their health, directly through their mobile phones.

We believe that our EHR system will improve healthcare service delivery and outcomes across the globe, and most importantly in low-resource settings, thereby helping reduce global health disparities. We envision a unified country-wide adoption of this system, as everyone with access to mobile phones, regardless of their socioeconomic status, education, or location will be able to use this EHR to understand their health and take preventative measures or manage existing conditions to improve health outcomes. We have assembled an interdisciplinary team of engineering, global health, business, and medical students ranging from undergraduate to graduate and professional students with extensive knowledge in this field to develop the prototype and conduct a pilot test of this EHR system in Abuja, Nigeria. This city was chosen after conducting initial market research to understand where there was an immediate need for the introduction of an electronic health record system. Since Abuja does not currently use a standardized EHR, we believe it will make the perfect test case to pilot a patient-centered design. Additionally, the city has various communities with different socioeconomic status and education levels, and a high mobile phone penetration within the city to test this platform.

We are currently building the prototype, but have completed mockups of the EHR that is under development. Representational State Transfer (REST) is the architectural design style that we will utilize for our EHR Platform. The primary benefit of using a REST architecture is scalability. Because the server and client are loosely coupled, the server will not be overburdened when the number of concurrent users grows. Additionally, this architecture will enable developers and users will be able to perform Create, Read, Update, Delete operations on the API, which will facilitate the customizable, modular approach we hope to adopt for our platform. Data interchanging (sending data between the server and client) will be a core functionality of our EHR Platform. We will be using JSON because it is lightweight and transmits data more quickly than XML, and integrates well with our full JavaScript architecture. We have elected to initially build out the EHR platform using Angular.js and Node.js, both implementations of JavaScript.

Funding from AthenaHealth will be used to conduct this large-scale pilot study in urban, periurban, and rural areas in and around Abuja to test the efficacy of this system in improving health outcomes and patient’s perceptions of their health. In order to test feasibility of this pilot study, we have created several qualitative and quantitative measures that define “active successful,” “active,” and “initial interest” users based on their interactions with the mobile app to access and update their health information. We plan on conducting interviews and questionnaires every month throughout the pilot test with patients, physicians, community health workers, and other healthcare professionals to understand how they are using this EHR system and their general attitude towards having this information. Using this data, we will continue to iterate on this design until patients’ needs have been met. The initial health record module will focus on vaccine management, health vitals and information recorded during an annual physical exam, with the intent of explaining every test, number, or note the doctor records so the patient is able to keep track of their own health information. Other modules will be introduced over time to help with chronic disease management, medication management, etc., directed towards patient-driven use. Over time, this patient-centered EHR system will be sustainable as we aim to create a partnership with clinics, local governance, community healthcare workers, and private sector companies to understand how to make this system better and address healthcare disparities.

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