Implementation of Electronic Health Records During Global Outreach: A Necessary Next Step in Measuring and Improving Quality of Care

Published:October 27, 2021DOI:
      There has been a marked improvement in health outcomes in low- and middle-income countries (LMICs) throughout the past several decades. Although access to care has increased, evidence demonstrates that over 8 million lives could be saved annually with high-quality health systems. Traumatic injuries that are often treatable by surgical services are a leading cause of global mortality. As such, increased efforts toward improving quality of care in addition to access are needed for surgical services in LMICs. Electronic health records have become standard in high-income countries, given their demonstrated ability to improve clinical care, prevent complications, and inform quality improvement. Electronic health records are not frequently used in LMICs and represent an opportunity to address the quality gap in these health systems. This review highlights the benefits of electronic health records in high-income countries, their potential benefits in LMICs, their current role in supporting surgical outreach, and their implementation on outreach trips to measure and improve quality of care.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kotagal M.
        • Agarwal-Harding K.J.
        • Mock C.
        • Quansah R.
        • Arreola-Risa C.
        • Meara J.G.
        Health and economic benefits of improved injury prevention and trauma care worldwide.
        PloS One. 2014; 9e91862
        • Alonge O.
        • Agrawal P.
        • Talab A.
        • et al.
        Fatal and non-fatal injury outcomes: results from a purposively sampled census of seven rural subdistricts in Bangladesh.
        Lancet Glob Health. 2017; 5: e818-e827
        • Lozano R.
        • Naghavi M.
        • Foreman K.
        • et al.
        Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.
        Lancet. 2012; 380: 2095-2128
        • Elias A.
        • Tezera C.
        Orthopedic and major limb trauma at the Tikur Anbessa University Hospital, Addis Ababa, Ethiopia.
        East Cent Afr J Surg. 2005; 10: 43-e50
        • Chao T.E.
        • Sharma K.
        • Mandigo M.
        • et al.
        Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis.
        Lancet Glob Health. 2014; 2: e334-e345
        • Meara J.G.
        • Leather A.J.M.
        • Hagander L.
        • et al.
        Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development.
        Surgery. 2015; 158: 3-6
        • Maki J.
        • Qualls M.
        • White B.
        • Kleefield S.
        • Crone R.
        Health impact assessment and short-term medical missions: a methods study to evaluate quality of care.
        BMC Health Serv Res. 2008; 8: 121
        • Kruk M.E.
        • Gage A.D.
        • Arsenault C.
        • et al.
        High-quality health systems in the Sustainable Development Goals era: time for a revolution.
        Lancet Glob Health. 2018; 6: e1196-e1252
        • Institute of Medicine (US)
        Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press; 2001.
        (Accessed December 22, 2020)
        • Menachemi N.
        • Collum T.H.
        Benefits and drawbacks of electronic health record systems.
        Risk Manag Healthc Policy. 2011; 4: 47-55
        • Miller A.R.
        • Tucker C.E.
        Can health care information technology save babies?.
        J Polit Econ. 2011; 119: 289-324
        • Courtemanche C.
        • Garuccio J.
        • Le A.
        • Pinkston J.
        • Yelowitz A.
        Strong social distancing measures in the United States reduced the COVID-19 growth rate.
        Health Aff (Millwood). 2020; 39: 1237-1246
        • World Health Organization
        Global diffusion of eHealth: making universal health coverage achievable. Report of the third global survey on eHealth.World Health Organization; 2016.
        (Accessed October 31, 2020.)
        • Saluja S.
        • Mukhopadhyay S.
        • Amundson J.R.
        • et al.
        Quality of essential surgical care in low- and middle-income countries: a systematic review of the literature.
        Int J Qual Health Care. 2019; 31: 166-172
        • Shapiro L.M.
        • Park M.O.
        • Mariano D.J.
        • Welch J.M.
        • Kamal R.N.
        Candidate quality measures for orthopaedic surgery outreach trips: a systematic review.
        J Am Acad Orthop Surg. 2020; (10.5435/JAAOS-D-20-00263)
        • Shapiro L.M.
        Global Quality in Upper Extremity Surgery and Training (Global QUEST) investigators. Quality measures to deliver safe, high-quality care on hand surgery outreach trips to low and middle-income countries.
        J Bone Joint Surg Am. 2021; 103: e32
        • Operation Smile
        Using Technology to provide better care.
        (Accessed November 5, 2020.)
        • Quinn J.W.
        • Barnard Q.
        • McKone-Sweet K.
        • Schlesinger L.
        Surgical Quality Assurance Database (SQUAD) in Uganda, Part A and Part B.
        (Accessed November 4, 2020.)
        • Cancedda C.
        • Farmer P.E.
        • Kerry V.
        • et al.
        Maximizing the impact of training initiatives for health professionals in low-income countries: frameworks, challenges, and best practices.
        PLoS Med. 2015; 12e1001840
      1. Innovations for Poverty Action. Poverty probability index.
        (Accessed April 19, 2021.)