Project Background & Justification

In developing countries, Primary Health Care is of utmost importance to provide the first line of preventive and curative medical services to the individual, the family and the community. But the effectiveness of Primary Health Care is often hindered by poor patient, clinical, informational and statistical data management.

In 2000, under the auspices of PCDOM and with the general mission of improving the delivery of Primary Health Care in developing countries, we embarked on developing an innovative solution: PCDOM PrimaCare. PrimaCare is a medical software that focuses on the clinical and operational aspects of the medical practice from the perspective of a multi-dimensional and multi-disciplinary approach.The project was supported by the Malaysian Government's Ministry of Science, Technology and Environment's Demonstrator Application Grant Scheme (DAGS) under the Intensive Research in Priority Areas (IRPA) projects. Even though commercial software solutions to facilitate clinical management are available, they are too often unaffordable for developing countries and not adapted to the context of our regional specificities. This is the reason why we have been developing PrimaCare, an original, user-friendly and open source software that integrates ICT and medical knowledge into a system able to address the following challenges from the perspective of developing countries:

* Replace the process of manual recording with electronic health records (EHR). The EHR will help improve the general process of patient and clinic care (e.g. shorter turnaround).
* Offer a timely and easy access to patient information (e.g. laboratory tests, current and past medicines, previous encounters and diagnostics).
* Improve the quality of Primary Health Care (e.g. access to updated electronic medical information and treatment guidelines, including literature related to regional pathologies).
* Offer health information and education to the patients (e.g. promotion of preventive care by distributing print-outs related to the patient’s reason for consulting).
* Provide epidemiological data for better patient monitoring and intervention (e.g. immunization status, cancer screening).
* Bridge the current islands of information within the clinic and among the related clinics to provide more flexibility and security regarding the access to patient medical record.
* Reduce administrative costs by better managing resource and minimizing duplicated efforts within the clinic and among the related clinics.

At this stage of PrimaCare, we have developed a general cross-platform using open source resources including Apache Server, PostgresSQL database and PHP 5 scripting for interactivity. The current system consists of nine modules listed hereafter:

* system administration,
* clinic management,
* financial management,
* patient management,
* prescription management,
* billing management,
* schedule management,
* asset and supplies management,
* medical resources.

PrimaCare has been successfully field tested by local Primary Care Doctors in Malaysia. It was presented to international FOSS conferences in UCLA, the ICT4D platform at the World Summit Information Society (WSIS) in Geneva, as well as to some interested countries, such as Vietnam, Cambodia and Mongolia. Their feedback provides the substance for ongoing enhancements of the basic program. Now that we have developed a common platform addressing the general aspects of Primary Health Care, which mainly deals with the issues of Adult Medicine, there is a joint agreement among our medical users and ICT programmers that we need to move to our next enhancement. This enhancement consists of developing specialized modules to attend to the other important areas of Primary Health Care, such as General Pediatrics, General Women’s Health and Basic Epidemiology. By including tools to monitor key parameters, the creation of these specialized modules will help each clinic setting to not only serve more comprehensively its patients population, but also to work towards the achievement of the Millennium Development Goals (MDGs) 4, 5 and 6 as set by the United Nations1 (reduce child mortality, reduce maternal mortality and combat HIV/AIDS, malaria and other diseases).

For so doing, the most effective solution is the development of a Generic Engine for Modules (GEM), which is the specific subject of our grant request. A GEM is the underlying engine of the software application that, once developed, will allow us to create modules faster and with more ease. Instead of writing each module from scratch, including the needed databases, business logics, user interfaces, report templates, etc, we will just develop a core application containing all these features. This core application is the GEM. Once created, it will help us overcome the tedious process of writing each module from scratch, including its related database. In the framework of this grant application, we want to develop the three modules of General Pediatrics, Women’s Health and Epidemiology based on the technology of the GEM. But as the GEM will make the writing of new modules not only simpler but also more accessible to non-programmers, medical expert developers who are non-programmers will also be empowered to build or expand their own modules based on their needs, instead of relying on programmers to perform the hard coding.