History

Origin of Zcore: ZEPRS

The Zcore platform had its genesis in Zambia. The Zambian Electronic Perinatal Record System (ZEPRS) is a web-based Electronic Medical Record (EMR) system designed for public obstetric clinics and the University Teaching Hospital (UTH) in Lusaka. RTI International (RTI) has developed ZEPRS under contract to the University of Alabama at Birmingham (UAB) with funding from the Bill & Melinda Gates Foundation. A team of UAB and Zambian doctors conceived the idea based on the very successful model of a perinatal records system that the UAB had built in Birmingham, Alabama, that had improved patient outcomes there.

This project was designed to improve the quality of perinatal care in 24 participating clinics and the UTH in the Lusaka Urban Heath District (LUHD) by:

•  allowing better and more timely access to patient records;
•  implementing patient-care prompts into the system to make sure critical care issues are addressed during each pregnancy and from pregnancy to pregnancy;
•  enabling health administrators and researchers to access data to help design interventions to further improve perinatal patient care; and
•  providing health researchers with data needed to target and design interventions to improve public health.

The project began by designing and developing a wireless network interconnecting 24 clinics, the UTH, the Lusaka District Health Office, and the Centre for Infectious Disease Research in Zambia (CIDRZ). This network expanded to connect multiple buildings at delivery clinics and to network all relevant departments within the UTH using a combination of fiber-optic, wired, and wireless networking technologies.

Starting in July 2004, the connected clinics and the UTH used a web-based electronic patient referral system developed by this project. This application proved the functionality of the ZEPRS wireless network and the ability of Zambian medical personnel to use such a web-based application effectively.

ZEPRS Version 1.0 was released officially by RTI on November 21, 2005. Three clinics and two departments at UTH are now using the fully integrated ZEPRS Version 1.0 Electronic Medical Record (EMR) and patient referral system. By March 9, 2006, Chipata Clinic, the longest running site, was managing 617 perinatal patient records using ZEPRS. During the rollout, which was completed in August 2007, an average of one clinic was added to the system per month. More than 277,000 patients (June 2009) are now being managed using ZEPRS at 24 clinics and UTH.

Prolonged electric outages at a few clinics and network damage due to lightening pose challenges, but progress to date has been very encouraging. RTI added the capability to print patient record summary cards that can be used for reference and recordkeeping during extended electrical outages. RTI is currently testing enhancements that enable ZEPRS users to continue using the system during network outages. This feature caches data off-line and resynchronizes with central databases when network connectivity is restored.

RTI developed ZEPRS using open-source components and best-of-breed extensible web-based layered architecture. This minimizes operating costs and makes it easier to expand usage within Zambia and to transfer and adapt the application to other countries.

Zcore Platform Evolves

2006:

Zephyr tech demo uses the Eclipse RCP framework to render ZEPRS forms, fields, and problems. Form fields are rendered dynamically as SWT widgets. Data is stored in the embedded database Derby.

2007:

RTI created a proof-of-concept project called IRSA, a data entry client that used some of the ZEPRS concepts and code. IRSA uses the Eclipse RCP framework for the user interface. Reports are provided by BIRT, which is embedded in IRSA. Data is stored in IRSA using the embedded database Derby and can be easily exported (using .csv files) into MySQL database. The Eclipse RCP "container" plus the embedded database enabled a single, easy-top-install application for PC's which could solve some of the deployment issues experienced with the complicated installation requirements for ZEPRS.

2008:

RTI began work on a data entry client for the Nairobi Provincial Medical Office called the Daily Activity Register. This integrated ART patient and ARV pharmaceutical supply management system improves upon the IRSA concept by using an embedded web server to render the user interface. This change enables Zcore developers to use common HTML/JSP skills instead of having to learn Eclipse SWT code.

2009:

Platform Improvements: RTI added multilingual capabilities and OpenMRS integration to the Zcore platform.

TIMS: As part of the Women’s Justice Empowerment Initiative (WJEI) project in South Africa, RTI is working with the Sexual Offences and Community Affairs (SOCA) unit of the National Prosecuting Authority to build a case management system. The Thuthuzela Information Management System (TIMS) will be used to manage the legal, medical, and psycho-social cases at the Thuthuzela Care Centres (TCC's). This Zcore implementation features a data syncronisation scheme that is well suited for remote sites with intermittant access to the internet.