We have made some surveys during the last two years to find a Hospital Information System (HIS) for ELCT hospitals. There are no off-the-self systems and all programs must be customized to our needs and we need support during the implementation and in the long run. Some of our hospital started to use a locally made DOS based program 6 years ago but that time it was impossible to give timely support to district hospitals and most of them have stopped using the program. Now when we have the satellite system we can give remote support, which is crucial when we are using a system we are dependent on.
There are hundreds of proprietary programs available in Europe, America, South-America, India and some also in East-Africa. The problems with those we have evaluated is either they are far too expensive, poor quality or there are difficulties to organize support.
There are also a few free programs available. Out of those VISTA is the most advanced program, but need high-level IT-skill for implementation. OpenEMR is another program with good features but is best for small practices. There are others in their initial stages.
We have selected Care2x for several reasons. First of all it is open source program with good documentation and we can modify it freely to our needs. Even though it is free we still have to use money for customization, but we can also get the support from the community developing it. Care2x is made with known good tools: php, mysql and is run on Apache server. It is platform free, but we will install it on Linux server. The main reason is that remote administration is easier through our small bandwidth with Linux than with Windows and Linux is also more stable.
Care2x is a new program and the first deployment version was published in the beginning of 2003 but already now it is translated to over 20 languages and hospitals in Malaysia, India, France, Italy are using it and many more are working on it. There are also hospitals in South Africa, Kenya, Egypt working on it. So we are not alone.
But still there are risks when we have to make big modification to laboratory and pharmacy modules and build stock/inventory module, which does not exist yet. But out of the options we know about with this we have the best chances to succeed.
We started the pilot in Selian town clinic June 2004 using the original Care2x as it was, with only minor cosmetic changes. It has been very stable and the staff is motivated to use it. Local IT-company Arusha Node Marie, who also trained the staff, did this implementation.
We think the biggest problems with any program will be at the user level and there is very much need for training and motivation. Our goal is to make the program simple and user friendly so that it will not be a burden to our staff but helping in their daily routines.
In September Merotech IT-company from Germany made the requirement analysis with us in Selian hospital, which is still using the old HIS. We screened the manual routines in the hospital, took the features from the old HIS and we also used WHO manual “Setting Up Healthcare Services Information Systems” in our work. The programming was started in December 2004.
The work we have done has attracted interest in other hospitals in this area. Kijabe Mission hospital has joined to the project. There are two other teams in Tanzania and one in Uganda starting to work with Care2x.. Close co-operation is planned etween these teams. During 2005 we participated in national ICT workshops, which were supported by The International Institute for Communication and Development (IICD). New project propsal was made to further customize Care2x and roll out to hospitals. The project was officially accepted in March 2006. We have seen that the work routines are quite similar and our plan is to make East-African version of Care2x. Each hospital can make smaller modifications to it according to their requirements. We keep our work free for all, because we believe that is the way to build a strong African base for the program. We have small resources and we should not work parallel but together.
Our demo of Care2x is online at http://www.radiokili.org/public/care2x/care2002_tz_mero_vps/ and the progress of our work can be followed there. The planned modifications and our time schedule are seen there also.
More information about Care2x can be found in its homepage http://www.care2x.com