When Work Doesn't Feel Like Work

I’m not a software developer. To build our electronic medical record (EMR) software we used an open source platform called OpenMRS which you can build upon and customize with the fundamentals of HTML and MySQL coding. When we implemented these systems, I was not confident that they would be long-term solutions. I felt our EMR was certainly better than the paper based record systems most clinics in Ghana use, but I believed our implementations to be a temporary solution until someone legit like EPIC decided Ghana was worth investing in. Five years later however, most of Ghana is still using paper records. I read recently that providing healthcare without an EMR in the 21st century is like being a surgeon without a scalpel. I agree, from what I’ve seen at Harvard and during my time in the industry, people are using EMR data as the fuel for many technological innovations in healthcare. We can’t let Ghana fall behind.

Old paper folder record system at the CPMR

Myself and five colleagues have registered a company here, MedData Consulting Inc., that implements EMR software for clinics. I’m not really a fan of charity, I believe social entrepreneurship is a better way to make a difference. I could implement these systems for free, but there’s no sustainability in that. I wouldn’t be employing 5 people. Buying the software makes the hospitals more invested in the EMR. Our company has completed implementations for 4 hospitals so far. We’ve got some business objectives during my time here too. The first is a technical one. There is a new opensource EMR that builds upon our current platform of OpenMRS called Bahmni. It’s linux based, which is unfamiliar to most of us, so we’re going to do some research to see if we can begin implementing this tool. This will involve playing around with an old dell console in one of my coworkers apartments on the weekends. Honestly this work is a lot of fun. These guys are smart, tech savy, and a joy to work with. 

I’m a nerd, I love playing with these computers, writing code, especially when it contributes to something meaningful. This work is my hobby. I remember when I was working in New York, the only vacation time I took was two weeks to travel to Ghana for an EMR contract we had. I remember I never understood why my Uncle Tony would take his vacation time to run a Taco stand to fundraise for his church. But it was his passion. This is my passion. It doesn’t feel like work at all. It makes me feel alive. It gives my life meaning. 

This past week, I visited two of the clinics that have implemented our EMR software. For these two clinics, the software has been running for 5 years and 4 years respectively without any major problems. The staff at the CPMR, whom I trained to manage the system, told me that the government recently did a review of various EMR systems in the country, and OpenMRS came in 3rd. I don’t know if this is good press for us or bad news for the EMR situation in Ghana, but I’m happy that our work is improving the quality of care to patients at both these clinics.

Things have been slow for the past few years, mainly because our main programmer had gone back to school, but just completed in May. Actually, 5 out of 6 of us, including myself, have decided to further our education and obtain higher credentials. One has just graduated, three are in progress, 

and one of them recently got accepted and needs some extra income to pay his tuition. He is hungry for another EMR contract. We’ll be hunting for one of those during my time here as well. My Twi definitely helps in securing these contracts. 

I also see the future of the company as moving into data analysis of the EMR data. There are plenty of pharmaceutical companies as well as technology companies like Flatiron, doing this in the states. Once Ghana gets more and more data they will need statisticians to make sense of this data. Such a venture is generally even more lucrative than installing systems. 

Again, I’m not a software developer, but a statistician. I’m very interested in the data we are producing.

Discussing research projects with Mavis Boakye and other clinicians at the CPMR

Mavis Boakye, the head of the clinic at the CPMR, has published a string of academic papers on the herbal medicines she prescribes using the data from the EMR. For me this is a dream come true, as my original goal with the EMR was to empower the clinic to conduct research into the plant medicines. Mavis is quite statistically literate, a rarity for a clinician in the US let alone Ghana. This makes her an ideal collaborator for me. We’re going to start conducting more retrospective studies on the medicines together with her providing the clinical knowledge and myself the statistical knowledge.

The second clinic, International Health Care Center (IHCC), is the oldest HIV clinic in Ghana. It’s run by Dr. Naa Vanderpuye-Donton who is half Ghanaian and half Dutch, and obtained her medical degree in the Netherlands. She is extremely dedicated to the fight against HIV in Ghana, and she wears this dedication on her sleeve. In addition to her clinic, she’s has an NGO called the West African AIDS Foundation (WAAF) which is out in the community for outreach and HIV screening initiatives. She’s often on TV for health education segments. For IHCC, implementing an EMR is even more important than your typical clinic. External programs run by PEPFAR and the Bill and Melinda Gates Foundation provide donations to reduce the costs of antiretroviral drugs that allow people living with HIV to live normal lives. Because of this, they often want to see data on how their $$ is being put to use. The EMR allows IHCC to quickly report these figures to external funders. This summer, we’re writing a paper together studying

loss to follow up among the HIV patients she cares for.

Thank you for reading. I’ll post again next Wednesday.