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Botswana Hospital Takes A Digital Leap Forward

A digitized and networked African hospital provides care based on U.S. best practices for electronic medical records and clinical systems.

As many U.S. hospitals move to electronic medical records and other clinical systems in response to the American Recovery and Reinvestment Act's $20 billion-plus incentive programs for the meaningful use of health IT, a handful of state-of-the art hospitals are opening up in places that don't generally get a lot of attention for innovation.

That's the case in Botswana where the non-profit Bokamoso Private Hospital opened in January. The hospital project took just 20 months and cost $100 million. The $6 million budget for all IT systems, included the hospital's e-medical records system, computerized physician order entry, and other clinical systems, as well as business-related systems such as supply chain software.

The project was funded by two major health plans in Africa -- Botswana Public Officers Medical Aid Scheme (BPOMAS) and PULA Medical Aid Fund -- which provide services to about 15% of Botswana's population, said Jonathan Weiner, CEO of OR International, a New York-based hospital developer and management company that led the Botswana project.

The 200-bed (soon 300-bed) Bokamoso Private Hospital is staffed by 200 nurses and 80 doctors, including 30 from Botswana and 50 expatriates from the U.S.

Most of them had previously worked at organizations that were mainly paper-based. A few, including Bokamoso's chief medical officer, formerly a medical leader at Vanderbilt University Medical Center, had familiarity with electronic medical records and other clinical information systems, said Guy Scalzi, a principal at Aspen Advisors, a health IT consultancy firm in Colorado which provided a variety of IT services to the Bokamoso project.

A big advantage to building digitized hospitals like Bokamoso from scratch is that there aren't legacy systems involved, and electronic processes start fresh, said Scalzi.

"There is no legacy data, and no anchors," hampering efforts to be paperless and filmless, he said. That also means hospital staff, doctors, and other clinicians are trained from the start that processes, such as ordering lab tests and documenting patient care are done electronically.

"When you do it in the U.S., existing medical staff need to learn [the electronic systems] but they don't mirror the [paper-based] processes," said Zal Sarkari, an OR International director and project director at Bokamoso. "You change the way people work and no one wants to do that," he said.

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