E-health systems for management of MDR-TB in resource-poor environments: a decade of experience and recommendations for future work.

Introduction: Multi-drug resistant TB (MDR-TB) is a complex infectious disease that is a growing threat to global health. It requires lengthy treatment with multiple drugs and specialized laboratory testing. To effectively scale up treatment to thou- sands of patients requires good information systems to sup- port clinical care, reporting, drug forecasting, supply chain management and monitoring. Methods: Over the last decade we have developed the PIH- EMR electronic medical record system, and subsequently OpenMRS-TB, to support the treatment of MDR-TB in Peru, Haiti, Pakistan, and other resource-poor environments. Results: We describe here the experience with implementing these systems and evaluating many aspects of their perfor- mance, and review other systems for MDR-TB management. Conclusions: We recommend a new approach to information systems to address the barriers to scale up MDR-TB treat- ment, particularly access to the appropriate drugs and lab data. We propose moving away from fragmented, vertical systems to focus on common platforms, addressing all stages of TB care, support for open data standards and interopera- bility, care for a wide range of diseases including HIV, inte- gration with mHealth applications, and ability to function in resource-poor environments.