As of March 2010, the OpenEMR system was receiving an average of 150 patient records per day, and 3-5 cases were week were being shared with APPNA-affiliated doctors providing consultative services free of charge. By analyzing the data gathered through the system, project staff have been able to track disease trends and launch preventive efforts. For example, when the data showed a high prevalence of waterborne diseases among patients from Mardan, project staff requested water purification tablets from local sponsors and began distributing them to patients, a simple and inexpensive solution that has helped to reduce the burden of waterborne disease in the area. 

After the software was designed and most of the equipment is in place on the Pakistani side, the focus was shifted to providing training and consultation to LHWs. Mobile modules for processes were designed and implemented to assist LHWs in registering new patients and obtaining information on the definition, symptoms, and treatment protocols for specific diseases, with data being transmitted in text, photo, and video format. These services are being modified and upgraded in response to comments from beta testers, including nurses at the UM Healthcare Trust who are currently using them to register and assess patients. The project directors had planned to offer a training course for LHWs in 2009 to launch the SMS and MMS services to a broader group of users, but that course had to be delayed until the spring of 2010 because local healthcare agencies were so busy dealing with the health impacts of the refugee crisis. The training manual and curriculum have been developed and it is hoped that the first group of 50 LHWs will be trained by the end of March.

Three Pakistani participants in the project—Mr. Atif Mumtaz, Dr. Mian Qasim Nasr ud Din, and Ms. Shamila Kyani—visited San Francisco to participate in the APPNA annual conference July 1-5, 2009. This visit and the ongoing efforts of US project director Dr. Naeem helped to build the network of Pakistani-American physicians in various specialties who are serving as volunteer consultants on the project. After the conference, Dr. Nasr ud Din completed a 2-month internship with APPNA consultants from July to September 2009.

Despite the funding problems and the massive influx of Swat and Buner refugees into the Mardan area in the spring of 2009, which strained the area’s already inadequate healthcare system, the medical camps and new telemedicine consultation capabilities partially supported by this project were helpful in serving these very needy patients.  In addition, an electronic medical records (EMR) management system developed as part of this project was established at the Zahidabad clinic, and it was used to manage records created in free medical camps for rural residents organized by UM Healthcare Trust.

The primary partners on this project worked with the University of Mardan Healthcare Medical Facility in the village of Zahidabad, in Mardan District of Pakistan’s Khyber Pakhtunkhwa. Activities on the project began in late August 2008, when Dr. Rizwan Naeem traveled to Zahidabad and with his local colleagues presented a one-day training course on basic life support skills for 24 healthcare workers, the first such training program even held in rural Mardan District. Two medical doctors, two research assistants, and one network administrator were hired to staff the project on the Pakistani side. Due to budget cuts on the Pakistani side, some needed pieces of equipment could not be purchased, planned travel had to be cut, and some administrative positions could not be filled with employees of the desired skill level. Fortunately, Dr. Naeem reports that this project has received supplemental funding from the Information Society Innovation Fund, which is helping to support the purchase of additional laptop computers and the organization of more LHW training workshops.