Zane Randell is a FIMRC staff member who saw the before & after at Project Limón. While living in Nicaragua, he helped operate our clinic before our electronic medical record (EMR) system was introduced. He also saw the impact that system had on our operations. Below, you'll find his descriptive take on the realities of managing a clinic without EMR - challenges we no longer face thanks to our partners at EMR4DW!
Limón, Nicaragua is not a place where things ever seem to be organized. I have never seen a published bus schedule, vegetable stands seem to pop up randomly on unoccupied spots of grass, and the right of way rules between motorcyclists, pedestrians, cars and livestock are nothing short of entirely ambiguous. The marginally moderated maelstrom that is daily life in Limón, where FIMRC operates its project site in Nicaragua, is a wonderful thing to observe, navigate and ultimately embrace as a part of life in this little town. Although somewhat miraculous, most things seem to get done and everyone gets to where they need to go. This semi-functioning system, fueled by an enormous dose of patience of everyone involved, is as much a part of life in Limón as gallo pinto is present on a dinner-time plate.
When it came time to open a health clinic in Limón, this organizational system did not really seem like the best practice. We had meds to keep track of, patients with appointments, doctors to schedule, and medical records to maintain. We peered over at our friends next door at the local health post and quickly determined that they may have taken a page from the book of the Standard Operating Procedures of the area and, unsurprisingly, kept things up to the same level of general disarray as we saw everywhere else.
We walked into the pharmacy to discover medication mainly in piles and often times in mismatching boxes. There were no appointments as the doctor would follow no predictable schedule. And, perhaps most shockingly, was the record keeping. In a small room, 2 open sets of shelves stood with tattered folders, many of which were falling out. Inside some folders, we found the files of people entirely unrelated to the name on the front cover. There was no discernible system, no apparent method, and to me, a new transplant, the thought that there was absolutely no chance that this worked.
Somehow the nurses and doctors of the health post were entirely at home and comfortable with what was created. Gracefully and patiently navigating stacks of folders and piles of medications, not missing a beat as they cared for the people that would roll through the doors. They would calmly walk into the same room that could easily overwhelm the first-time observer, quickly snatch up what they needed, and carry on with their day entirely unperturbed without so much as slowing down to take a second look.
As we were relatively uninitiated in the system that our friends next door seemed to have mastered we did what we could be to be an oasis of order in the desert that was Limón. We started off by keeping all of our meds in labeled rows and making sure our doctors kept a more predictable schedule. Like our friends next door we too started off with a nice collection of red and blue folders to store all of our patient information on shelves in the bodega, confident we could keep our shelves precisely stacked. Despite our best intentions, our walls of folders turned out just like our neighbors quickly and inevitably turning into a tattered mess of misplaced, mislabeled, and altogether missing charts. We, however, lacked the requisite experience that they had next door to make any use of such a system. We had been bested; we were no match for the magnetic pull towards total disarray.
Perhaps it was the bodega itself: as much a home for scorpions, geckos, toads, snakes as our most important documents. Perhaps it was the unending humidity of the rainy season, that slowly ate through the once crisp height/weight graphs tucked into every chart. Maybe, as much as we hated to admit it, it was us, delirious and tired after a long day at the clinic, putting a folder in the wrong spot on the shelf allowing it to get swallowed up and disappear into the multi-colored wall. Whichever it was, this was not going to work.
As the internet in Limón got faster, and the power outages less frequent, the Electronic Medical Record arrived to us in our warm Pacific village, catapulting us into the 21st century. Promising to do away with folders and papers that were now overwhelming the last of our shelf space, we welcomed this innovation with open arms.
The transition was slow as we arduously transposed each and every file into the online system. Not perceptible at first, our shelves got less cluttered, inch after inch of valuable shelf space in our clinic freed up as the files seemingly disappeared to make our records more permanent, no longer as susceptible to the unending destruction of the environment in which they had previously lived.
Perhaps best of all, we no longer had to rummage around on critter-covered shelves risking bites and stings in search of an ancient file lost to Limón.
Our Partners at EMR4DW ("Electronic Medical Records 4 the Developing World") have integrated their database at a number of our project sites. The statistical trends we've seen as a result of using this system is very encouraging. Stay tuned for an update on how the quality of care we provide has transformed since adopting EMR4DW's services!