The work of Wayne State University College of Engineering students is having an impact on underserved patients being cared for by WSU School of Medicine students thousands of miles from Detroit.
On a December 2012 trip to Haiti, the School of Medicine's World Health Student Organization was the first group to test the EasyEMR program, an open source electronic medical record software designed as a class project by a group of Computer Science seniors.
School of Medicine student Erik Brown and recent WSU Biology graduate Sarah Draugelis initiated the creation of EasyEMR after experiencing the challenges of pop-up clinics set up on mission trips by organizations like WHSO. Both have volunteered on medical mission trips, including those organized by the WHSO and Africans in Medicine, another School of Medicine student organization.
"What we lacked is the ability to easily record, retain and access any data about the people we see when we visit these places," said Brown, a sixth-year M.D./Ph.D. student completing his dissertation in Translational Neuroscience before beginning his third year of medical school in July. "Currently, we often use paper forms that help us on the day of the clinic but, at the end of the day they get discarded because we often have no effective method to organize them. If we could do this electronically, organization would be massively simplified."
"The two things that our patient population really needs are preventative care and continuity between visits, both of which are pretty much nonexistent," Draugelis said. "We see close to 1,000 patients in under a week. Often, the people on the medical team are working together for the first time, which can be a hurdle in itself. The EMR system needs to be as error free as possible to keep the clinic running smoothly."
The initial software was designed by students in a Fall 2012 senior project and computer ethics course taught by WSU College of Engineering Associate Professor of Computer Science Andrian Marcus, Ph.D. Additional testing and debugging will continue each class semester to improve essential functionality.
"My goal is to expose students to an environment where they can learn by doing, rather than by listening," Dr. Marcus said. "In addition to the learning outcomes, and equally important, I want the students to work on real projects that are useful to organizations and companies from the Detroit area and beyond. It is one way for us to give back to the community."
Building the software was a challenge, and came with plenty of specs from the medical students who would use it. It had to be easy and fast to use. Only the bare essentials were needed: vitals; history of present illness; a brief medical, social and family history; and past and present medication. Everything needed to be on one easy-to-use screen with as few clicks as possible. The system also needed to fit into the chaotic flow of the transient medical clinics, where hundreds of patients line up, often early in the morning.
Brown and Draugelis initially sought donations for existing EMR software more than a year ago, but "quickly realized that this system didn't exist and needed to be built from the ground up," Brown said.
For December's pilot trip to Haiti, the computer science students who designed the software were available nearly 24/7 for virtual troubleshooting. They included WSU Computer Science senior Tom Hickman, the student team representative, who remotely signed in to make modifications on the fly.
"Our first impression of this project was very bittersweet," Hickman said. "On the face of it, it appeared to be a set of very daunting requirements, but would give us the ability and experience of helping real people with the potential of saving lives. It seemed like a lot of pressure as well as being a great opportunity."
The biggest challenge, he said, was deploying the software to computers with poor system configurations and old hardware. The new class goal is to restructure the system to a central database on a server, so all computers remain in sync from the creation of each patient record, update of patient information and update of user information, Hickman said.
"We were very impressed with the students' ability to take on a very difficult project with limited resources," Brown said. "They were a force. Indeed, in the final week, the night before the medical students were to leave for Haiti, we discovered that only one of the eight (donated) computers was working. Several of the (computer) students worked very late into the night and got three more computers up and running just in time to make the flight. The medical team left with four laptops running the software."
Their hard work was appreciated, said Samantha Bruni, a second-year medical student and the Haiti trip's lead organizer. "I think that having the ability to look back on the patient population that we saw and being able to evaluate the prescriptions that we filled is invaluable for WHSO. Bringing EMR on a trip is a huge step toward the future of WHSO providing more sustainable medical care," Bruni said. "On future trips, the patients will receive better care, as we have records of their previous treatments and past medical history. Also, the EMR can be used for research purposes, as we have the ability to analyze our past care, which can enable us to provide better care on future trips."
The system served its initial purpose: collecting basic medical data on patients in Haiti that can be later retrieved and utilized to improve continuity of care between the transient clinics, Brown said.
"I appreciate everyone who thought it was a cool idea and wanted to try it," Brown said.
He hopes to secure new laptops, netbooks or tablets with longer-lasting batteries, a must because electrical outlets aren't always available in the remote clinics. "Clearly, this costs money. We are looking into grants and searching for donors to help fund the purchase of the necessary hardware," Brown said. "As long as it has a web browser, it will work."
If interested in supporting the project, contact Brown at ecbrown@med.wayne.edu.