EHACare is a comprehensive and workflow-driven Electronic Medical Records (EMR) application that aims to transform healthcare practices and supports clinical decisions.
EHACare's major goal is to to optimize the entire care process by lowering administrative work, minimizing mistakes, and increasing patient care results.
Background
EHA Clinics, a primary Health Care provider located in Nigeria, on a mission to deliver quality health care that is accessible, effective, and affordable.
In 2018, the NGO eHealth Africa, where I was working as a Design Lead, was setting up EHA Clinics, a new venture whose formation was partly a result of trying to improve the welfare of their own staff.
Today in 2023 there are five EHA Clinics that serve as a one-stop shop for consultation, diagnosis and pharmacy services backed up by onsite labs, underpinned by sophisticated technology that enables the safe and secure flow of patient data to enable providers to make the right medical decisions.
After the establishment of EHA Clinics in multiple locations and following the challenges that were faced during the Covid-19 Pandemic, it became evident that the existing EMR (Electronic Patient Management) Software had reached its limitations in terms of scalability, extensibility, and the ability to tailor specific workflows.
Other available patient and clinic management solutions in the market also did not align with our needs of a primary health care provider in Nigeria.
The solution for EHA Clinics was a strategic partnership with Better, who provided a digital health platform, that empowered the EHA Clinics software team to develop a customized Patient Management System that met their exact requirements while adhering to international clinical data standards and ensuring interoperability with other systems.
It was super promising: We, the team, had the freedom to design our own interface and workflows on top of the Better infrastructure.
The Challenge
Creating a comprehensive patient and clinic management system from the ground up is undeniably thrilling, but it's also a formidable challenge. The clinical team's excitement and expectations were substantial, given their ongoing struggles with poor and missing digital workflows. There was a collective eagerness for our new solution, necessitating a swift and efficient implementation process.
To rapidly acclimate ourselves to the Better ecosystem, we opted to create a fundamental workflow as a proof of concept. This workflow encompassed all interfaces with the Better platform, involving the creation of a patient record to establish connectivity with the demographic server and the development of a patient evaluation, primarily focusing on vital signs data, to link with the clinical data storage.
We chose to leverage the Better form builder for crafting our clinical forms, a decision that brought forth numerous advantages. This approach allowed for instant form updates without the need to make changes to the core application. Moreover, it empowered clinicians to autonomously manage their medical data fields.
In our application, we only needed to embed the final forms. The key challenge lay in ensuring the integration was seamless, preventing any disruptions to the workflow.
Looking back, managing medical data collection forms in a separate tool saved the development team a considerable amount of valuable time.
As a matter of fact, the clinical team needed to go through numerous iterations concerning the data points they wished to capture: What information is mandatory, what else do we want to capture, do we need an extra comment field, should we use a list of options or just free text?
This parallel process allowed the developers to maintain their focus on constructing the workflows without disruption.
Visual Design
Every member of the clinical team, whether it's the front desk staff, doctors, lab scientists, or pharmacists, spends a significant amount of time using our application. My aim was to create a visually appealing and tranquil interface.
I envisioned an interface that strikes a balance between cleanliness and warmth, in contrast to some other medical and clinical management software that can be overwhelming due to technical jargon and complexity.
The elements on the screen should feel tangible and approachable for both medical professionals and those without a medical background.
EHA Clinics staff adheres to the belief that patients should feel at home, and my goal was to reflect that sentiment in our application's design.
Workflows
In the two years leading up to the project's commencement, I had the privilege of gaining an in-depth understanding of various clinical workflows through direct experience. Being part of an in-house informatics team situated within the clinic made it convenient to engage in discussions, make observations, and acquire valuable insights. Additionally, our team had been responsible for maintaining the previous software, which allowed me to pinpoint pain points and understand the challenges that kept clinicians awake at night.
Being said, as we embarked on the development of the new app, we were fortunate not to start from zero. To ensure that we covered all bases, we conducted a series of workshops to meticulously define the most critical patient and administrative workflows.
Our analysis revealed that the pivotal aspect was the seamless transition of patients through various stages within the clinic, encompassing everything from appointment booking and front desk interactions to doctor consultations, laboratory tests, pharmacy services, and the check-out process.
Enhancing this patient journey became the central focus of the project, with the understanding that such improvements would bring benefits to every member of the clinic's team.
The dashboard
Utilizing a Kanban board to oversee the patient journey brings a digital and tangible presence of the patient to all clinical staff. This board functions as a central hub for daily operations, facilitates communication, and provides a real-time snapshot of the clinic's current status.
The board features a "backlog" of all appointments for the current day, providing advance knowledge to the front desk about each patient's purpose of visit.
After welcoming the patient, the patient's ticket on the board can be moved to the corresponding room and assigned a status (e.g., "waiting room - waiting for nurse").
When a nurse collects the patient from the waiting room for vital sign assessment, she can use the board to update the room and status and easily access the patient's record from the ticket to record vital signs.
The patient ticket consolidates vital information for each visit, serving as a central access point to the patient's record and all encounter-related documents, including lab test orders and prescriptions. This streamlined access benefits all clinicians. Moreover, it includes a messaging system, enabling communication with the front desk, such as requests for follow-up appointments before patient checkout.
The introduction of the dashboard has vastly enhanced communication between front desk and clinicians - for the benefit of the patient. It has also significantly reduced the administrative workload for front desk personnel. Consequently, patient waiting times have been substantially reduced.
The process
In our MVP (Minimum Viable Product), we initially focused on essential clinical workflows, providing a minimal feature set suitable for a pilot rollout. However, it quickly became evident that sustaining a functioning clinic required a more comprehensive solution. Moreover, we recognized that, contrary to our initial plan, we needed to develop our own appointment booking and laboratory management system.
Consequently, we adopted an incremental approach, introducing new features week by week. Over time, EHA Care evolved into a comprehensive tool encompassing various workflows, including those for the front desk, nursing, clinicians, laboratory, pharmacy, and community health programs.
From the outset, we established an iterative process that engaged not only the development team but also clinicians and other clinical staff.
Every week, we convened a prioritization meeting, involving representatives from all clinical departments. During these sessions, we openly discussed requested features as well as those suggested by our team. Given the numerous requests, we collaboratively set priorities, ensuring transparency in the delivery timeline. This approach fostered meaningful discussions and, most importantly, empowered our clinicians by putting them first.
Every two weeks, the development team conducted feature demonstrations for all staff to gather feedback and engage in discussions to refine and enhance the system further.
The product
EHA Care covers front desk, nursing, clinicians, laboratory, pharmacy and community health program workflows. Furthermore it provides a booking system and reporting, monitoring and quality assurance features, that are being developed as separate modules. EHA Care is used in 5 clinics that serve over 33.000 patients.
Case study by Better:
EHA Clinics developed an EHR using Better Platform in just 12 months
Webinar by Better and EHA Clinics:
Nigeria:
The EHR journey of EHA Clinics
EHA Clinics in Nigeria
clinical personnel
patients