A demographics data exchange for continuity of care: Is it feasible in low-resource settings?

Introduction: Continuity of care is critical in the delivery of health care services between health departments in a health facility and across different health facilities. It is mostly achieved through the use of unique patient identifiers, electronic medical record systems (EMRs), and data connectivity services, which promote access to and exchange of data of patients who seek care from multiple providers. While such systems have supported improved continuity of care in developed countries, most low-resource countries such as Malawi are still in their infancy stages. The demographic data exchange (DDE) has been used as a master patient index in Malawi to realize continuity of information for patients who visit different departments at a health facility or move across different facilities. Objectives: To assess how the demographic data exchange has performed since its deployment in the year 2012 at few selected pilot health facilities in Malawi in facilitating continuity of information. Methods: We carried out a preliminary assessment of the DDE between August 2012 and December, 2014 in order to explore the extent to which it facilitated exchange of patients information across health facilities or across departments within a facility. Logs of patient identifiers saved at the facilities were analysed. Results: By December 1, 2014, 450,164 had been served with unique patient identifiers. Out of these, 4,448 ( 1%) were reported to have visited other health facilities and had their demographic data exchanged transferred between the health facilities they visited. 30,697 (7%) patients had been registered in more than one module of EMRs within each of the selected facilities using the same unique identifiers. Conclusion: The DDE has facilitated linkage of patient demographics records across health departments and facilities, thereby improved continuity of health information, despite challenges of network connectivity and a robust distributed architecture. Recommendation: Exchange of demographic data using nationally unique health identifiers and a robust distributed architecture should be piloted to strengthen information continuity. However, the quality of data connectivity services outside urban areas needs to be improved.