by Brendan Smith
Historically a term that prompts more eye glazing than heart throbbing, medical informatics is suddenly a hot topic. This is in part because of President Obama’s decision to include $19 billion in the economic stimulus package to digitize American health records, which health experts hope will result in increased efficiency in the notoriously wasteful American health care system. But the idea of creating electronic medical records (EMR) has also gained traction in the developing world, where it is hoped that they could improve the continuity of care for patients while giving health officials a clearer picture of the health trends and problems in their countries.
Against this backdrop the American Medical Informatics Association’s (AMIA) Spring Congress took place last week in Orlando. While much of the activity centered on the role of informatics in the US health system, a global health track focused on health information systems in the developing world and the need for better coordination among donors and US-based organizations such as AMIA in helping poor countries to deploy and operate such systems. In her keynote address, Sally Stansfield, the executive secretary of the Health Metrics Network (HMN), noted the plethora of disease-specific and donor-driven systems and requirements that proliferate across the developing world and the negative consequences they have for developing unified, comprehensive systems.
One of the most interesting and provocative points Stansfield made in her talk is that developing country governments are now often in a position to say “no” to donor projects that don’t fit into the country’s master plan for development, and that they need to do exactly that, because, in her words, “the donors sometimes need the countries more than the countries need the donors”. This point illustrates a larger one about development aid. While well-intentioned, donor aid often works at cross purposes with countries’ larger development goals, furthering the agenda of individual donors rather than that of the nation at large and leaving countries with a welter of unconnected projects. While country governments surely need to put together comprehensive, unified development plans, donors must ask themselves how the initiatives they fund fit into those plans, rather than simply how these initiatives dovetail with their own agenda. The development of health information systems over the next several years may demonstrate just how effectively they are doing that.