Open-source point-of-care electronic medical records for use in resource-limited settings: systematic review and questionnaire surveys

BACKGROUND: Point-of-care electronic medical records (EMRs) are a key tool to manage chronic illness. Several EMRs have been developed for use in treating HIV and tuberculosis, but their applicability to primary care, technical requirements and clinical functionalities are largely unknown. OBJECTIVES: This study aimed to address the needs of clinicians from resource-limited settings without reliable internet access who are considering adopting an open-source EMR. STUDY ELIGIBILITY CRITERIA: Open-source point-of-care EMRs suitable for use in areas without reliable internet access. STUDY APPRAISAL AND SYNTHESIS METHODS: The authors conducted a comprehensive search of all open-source EMRs suitable for sites without reliable internet access. The authors surveyed clinician users and technical implementers from a single site and technical developers of each software product. The authors evaluated availability, cost and technical requirements. RESULTS: The hardware and software for all six systems is easily available, but they vary considerably in proprietary components, installation requirements and customisability. LIMITATIONS: This study relied solely on self-report from informants who developed and who actively use the included products. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Clinical functionalities vary greatly among the systems, and none of the systems yet meet minimum requirements for effective implementation in a primary care resource-limited setting. The safe prescribing of medications is a particular concern with current tools. The dearth of fully functional EMR systems indicates a need for a greater emphasis by global funding agencies to move beyond disease-specific EMR systems and develop a universal open-source health informatics platform.