How Things Work (and Don’t Work) in the Clinic

The Botswana-Baylor Children’s Clinical Center of Excellence is fortunate in that it is equipped with a level of technology not often seen in other African clinics. I’m sitting here typing on a Proline computer with a flat-screen monitor and reliable Internet access. These computers have been instrumental in patient care and recordkeeping and are a primary tool of the doctors. However, the Botswana government has legislated that all clinics in Botswana must use the same recordkeeping system–Meditech. This seems like a great idea, as it would be possible to create a national database and would facilitate communication between clinics. The idea is that the doctors enter all the patient’s information into the database and then update the patient’s file after their exam. The labs which do all the bloodtesting are hooked into Meditech as well, so that they can input the values from each test directly into the database, which can then be accessed by the doctors.

This seems like a great idea and is very progressive, but it simply doesn’t work. Most days in clinic are punctuated by a “Meditech is down again!” call down the hall to alert the doctors. During these downtimes, doctors are unable to input anything into the system and are also unable to acquire the results of any lab tests. These results often determine the┬ároute of care the doctor wants to take, so the patient often has to come back to clinic on another day or be contacted by phone by the doctor about any problems. Also, the program itself is not user-friendly. Time-pressed doctors are forced to enter in the same values multiple times, which often leads them to simply input ‘0′ for every value just so they can access the part of the record they need. Each patient in the clinic has a Microsoft Word file which serves as the backup for Meditech–each doctor just tacks onto the Word document any changes and revises as necessary.

What has sent me on this rant is yet another consequence of Meditech’s malfunctioning: we are not able to look up patients’ paper files, as the system of organization is found on Meditech. The project Rachel and I are working on requires us to go through the paper copies of patients’ files to find the data we need. But if we can’t find the paper files, we’re stuck in the lab writing blogs and otherwise being unproductive. I had set the goal of tomorrow for finishing our spreasheet, but that’s not going to happen.

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