A peer-2-peer electronic health record system streamlining healthcare delivery during short-term medical mission clinics

Short-term medical missions (STMMs) provide resource-limited regions with immediate healthcare services and can play a helpful role in bridging critical gaps in healthcare access, providing essential services, and contributing to capacity building in underserved communities. However, STMM teams have the potential to cause harm due to unfamiliarity with the patient population, culture, and disease epidemiology. Specifically, mobile primary care clinics run by STMMs are run in isolation and are not linked with any existing electronic health record (EHR) system, creating room for potential medical errors. To date, there have been limited attempts to tailor EHRs to STMM mobile clinics and existing systems remain in early developmental stages. We aim to develop an EHR system suited for STMMs that does not depend on internet connectivity, improves patient safety and patient care processes, and has longer-term sustainable applications. Traditional STMM clinic processes are described, and historical post-trip feedback were retrieved. Brainstorming with stakeholders was conducted to determine the essential features of the EHR system. A solution was chosen which involved the decentralisation of data over a peer-2-peer network functioning over a local area network (LAN) provided by any portable router. The process of development, implementation, troubleshooting of this EHR during an STMM in Timor-Leste over 5 days in both urban and rural locations is described. Post-implementation qualitative feedback has been encouraging especially in the aspect of clinic process, medication safety and ease of data access, analysis, and sharing. While this EHR has been useful, there are limitations such as the need for a stable power supply to the router and the lack of unique identifiers for patients in some settings that prohibits the linking of data across databases. Nonetheless, the development of our EHR is an important step in the right direction.