Zambia’s Electronic Medical Record – Version 2.0

Post Sequence

  1. Background
  2. Initial Release
  3. Patient Flow
  4. Reporting Server
  5. Version 2.0
  6. Continuity of Care
  7. (More on the way…)

These are a series of posts on the history of Zambia’s first national Electronic Medical Record or EMR. The EMR was known by a few names: PTS, PMRS, Continuity of Care and finally SmartCare. The EMR was originally targeted at supporting care and treatment of the estimated 17% of the adult Zambian population infected with HIV. The project was successful on a grand scale. It grew to serve the population of Zambia as a general EMR addressing other illnesses such as Tuberculosis, Malaria and general health. It is still in operation today has served millions of patients not just in Zambia but in other African nations as well.


By the Spring of 2005 it was clear that PTS was working. We were collecting an unprecedented amount of data and, more importantly, it was the right data. We were not only able to produce the required government reports easily and quickly but we were also quickly amassing a vast amount of information on the performance of the US Government’s PEPFAR AIDS Care and Treatment program in the nation of Zambia.

More Clinics

As a result of our success we were receiving a mandate to deploy the system at ever more clinics both in the capital city, Lusaka, where we started, but also in other cities and villages across Zambia. This challenged both our capacity for provisioning the systems themselves as well as our ability to ingest and process all of the data coming out of the systems.

In addition to the development of the software, we were now tasked with establishing a logistical supply chain for the procurement of PCs, monitors, printers and other equipment to be deployed at the various clinics around Zambia.

More Patients

At the same time, existing clinics were treating new patients and adding new records in the continuing treatment of existing patients. As a result, the amount of data coming out of each clinic was growing with time. All of this data was being used in the production of the various Zambian and US reports and also to perform analysis on the performance of each clinic in Zambia.

Enhanced Protocols

As we made our way through the initial phase of the Anti-Retroviral rollout, the US and Zambian clinicians administering the care and treatment were periodically reviewing the efficacy of the current clinical protocols as well as the standard of treatment. Each week we held a meeting with all department heads to evaluate how we could enhance care. With each enhanced protocol the application needed to be correspondingly enhanced to capture this new data.

More Form Fields

With the increase in data to be captured the forms were becoming ever longer and less wieldy. The solution to this was a redesign of the underlying layout engine. This allowed for multiple columns in the forms and also to have the electronic forms match closely the printed paper forms.

Version 2.0

Out of all of these needs, from the need to support more clinics, more patients, more complex forms as well as more complex analysis, Patient Tracking System 2.0 was born.

There were no major changes to the technology stack or the fundamental system architecture. However there were several important changes to the data capturing component, the databases and the back office server apps which powered the generation of reports and the massaging of the data for epidemiological purposes.

The resulting application was more performant, easier to use and captured vastly more data. This new data would, in later versions, enable the development of life-saving functionality.

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