Sustainable Technology for Surgical Referrals: Pilot Implementation of an Electronic Referral System for Short-Term Surgical Missions

We present an investigation into the feasibility of implementing an electronic medical referral application for short-term surgical missions in rural Guatemala, where the local infrastructure does not support the demand for the surgery. An electronic referral application was implemented for Android smartphones and tablets which allowed the input, aggregation, and secure transmission of patient information that is currently collected on paper forms during surgical missions. The user interface and SMS text message-to-database feature allowed case management data to be entered and transmitted in real time. The referral application was piloted over a 3-day period with a collaborating NGO during a short-term surgical mission in rural Guatemala and was compared to the current standard-of-care paper medical record. This study also assessed the cell phone access and use of community attendees to identify the potential for communication with patients in an integrated electronic referral system. Participants in this study included nine medical mission staff members who used the referral application during the pilot, eight of whom took an end-user survey, 53 patients whose medical information was entered into the referral application, and 93 local attendees who participated in a community survey on cell phone usage. Overall, end-users expressed positive opinions of the application, which they found relatively easy to use. Data loss using the application was minimal in comparison to a 17% permanent data loss of paper records, and the electronic medical records had high internal validity. Widespread cell phone use among community attendees suggests an opportunity to expand the referral application to further improve the surgical referral process.