Date of Award

Spring 1-1-2015

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

First Advisor

Alan Mickelson

Second Advisor

Zoya Popovic

Third Advisor

Frank Barnes

Fourth Advisor

Scott Savic

Fifth Advisor

Bruce Krogh

Abstract

This thesis proposes an implementation of smart phones as a data collection tool for medical record keeping in low-resource settings. Those devices would collect medical data and store it as an Electronic Health Record (EHR). In community care, EHR could be a bridge from untrained Community Health Workers (CHWs) to healthcare providers with timely and relevant data. Although CHWs are the backbone of health care delivery in developing countries, they often have little formal education and training. Providing CHWs with appropriate training and workplace tools could improve their ability to provide quality community based care. The field work for the thesis was carried out on site in Rwanda, a country with one of the world’s lowest doctor to patient ratios, where CHWs play an important role in healthcare delivery.

The analysis has a multidisciplinary approach, and it evaluates the feasibility and usability of a specific mobile health application. During the field study, CHWs were effective in data collection, collecting close to 2000 records from boys and girls under the age of five. The pilot project included only 24 CHWs but the scaling up estimates are encouraging for the whole of Rwanda as well as other developing countries with health systems similar to Rwandan.

Data analysis presents the evidence that these new electronic records are superior to the currently paper-based records, and demonstrates that electronic records facilitate the development of a country-specific model based on the collected data that is more accurate than the international standard provided by the WHO growth chart. In addition, the electronic collection of data allows real-time monitoring.

Comparing the cost and benefits of the suggested mobile application by calculating a benefit-to-cost ratio, for a present day Rwanda, results in a ratio that has seven times higher benefits than cost. That is a significantly high ratio, however, a concern is that the timing of the cost and benefits differ, and a business model is developed that offers a solution on how to fund costs at the present time without waiting for the future benefits.

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