Development and implementation of a loosely coupled, multi-site, networked and replicated electronic medical record in Haiti

Since 2005, we have been developing and implementing an electronic medical record (EMR) that supports both individual and population health care for HIV-infected patients in Haiti. The need to support countrywide monitoring and evaluation drove early architectural decisions to support linking systems under conditions of network uncertainty. Despite numerous challenges including frequent power outages and inadequate Internet access and support, the system (iSante) is currently implemented in 55 clinic sites nationwide, tracks over 41,000 patients, and synchronizes patient data between in-country sites and the central site databases on a daily basis.