While untreated HIV can lead to infection and death, antiretroviral therapy (ART) — a combination of medications that suppresses the virus, restores immune function, and reverses the progression of AIDS — is available to many people living with HIV (PLHIV) at no cost. But success depends on PLHIV adhering to regular treatment, and tracing those who have lapsed from care is expensive and time-consuming for clinics that are already understaffed.
To address this challenge, Baobab Health Trust, a nonprofit organization in Malawi, where 9.5% of the population is believed to have HIV, worked with the country’s Ministry of Health to migrate clinics from paper-based patient records to electronic medical records (EMRs) in 2005.
And now, in a study — “The Lifesaving Impact of Electronic Medical Records for HIV Patients” by Laura Derksen, Anita M. McGahan and Leandro S. Pongeluppe — that was published in The Review of Economics and Statistics, it has been established that electronically shifting the medical records can be life-saving.
In this study, the researchers particularly examined the impact of this change on patient outcomes in 106 HIV treatment clinics between 2007 and 2019. They found that EMR introduction led to an estimated 28% reduction in deaths after five years, with the greatest reduction among children.
It is estimated that, over time, EMR adoption prevented roughly 5,050 AIDS-related deaths.
“We are using management technology to help support the ones who are most vulnerable among the vulnerable,” Pongeluppe said. “We can save lives, especially the lives of the most vulnerable, and in a way that is very cheap. This hopefully will be a way for us to incentivize further implementation.”
The authors estimated that the cost of EMR implementation is about $448 per life saved in the first five years.
Sadly, as Pongeluppe noted, EMR usage is currently limited in other Sub-Saharan African countries, along with parts of Latin America, meaning there is great opportunity for nongovernmental organizations to expand this system across developing countries.
The EMR system allows staff to track scheduled ART visits, identify patients who are at least two months late for an ART appointment, and prompt for referrals to other services and screenings for tuberculosis — one of the leading causes of sickness and death for people with HIV/AIDS. In clinics without EMR, staff must examine thousands of paper records to identify lapsed patients.
Their findings suggested that these improvements in health care outcomes are the result of gains in efficiency rather than changes in medical care, and the reduction in deaths is driven by an increase in lapsed patients returning for care.
“The broad efficiency gains delivered by the EMR system enable clinics to manage higher patient volumes and retain patients more effectively without exceeding capacity limits,” the researchers stated. “We contribute to a broader literature on healthcare policy that goes beyond the provision of medicines by showing that managerial interventions such as EMR systems have important health impacts and can be implemented at scale in low-resource settings.”
