A LMIC-First Manifesto to Developing Electronic Medical Record Systems

Abstract

The inability to quickly design, develop electronic medical record (EMR) systems and deploy new clinical guidelines remain bottlenecks to successful scale up and continued use in low- and middle-income countries (LMIC). Significant gaps persist in EMR designs for LMIC settings. These gaps result from failure to understand how the environments, models and processes of delivering healthcare in LMICs are fundamentally different from high income countries. Additionally, EMRs are often planned in top-down fashion, driven by an implementers or external funder’s vision. EMR systems for LMICs model those used in the global north, requiring heavy text data entry, complex data models, and heavyweight hardware to support. We outline a “LMIC-First” approach to designing EMR systems intended for LMICs. This approach considers the EMR system, its environment and how these interact when the system is implemented by following six themes to EMR design.