Research Award Details

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Implementation of an Electronic Medical Record for Medical Missions Care

Grant Recipient: Walter Truong, MD

Gillette Children's Specialty Healthcare
Presentations & Publications:
Further Funding:
Additional Information:
POSNA Microgrant Final Report - Fall 2018 
Implementation of an Electronic Medical Record for Overseas Medical Mission Care

  • The team at Gillette Children's Specialty Healthcare has been going to Ecuador for 2 decades, providing complex pediatric lower extremity reconstructions in the Quito area. Some are for post-traumatic sequelae but most are issues secondary to neuromuscular conditions or congenital anomalies. This was initiated by Dr. Jim Gage in collaboration with a local surgeon named Dr. Eckehart Wolff over 20 years ago. The format has changed over the years but currently, about 50 patients are seen in clinic and surgical cases are prioritized and scheduled over the subsequent week. This is repeated again at the end of that week, thus 2 clinic days and 8 operative days. The issue is that medical records are currently kept on word documents that are updated and maintained by Dr. Wolff on a flash drive. Xrays are printed and the family carries these to clinic and the OR. The surgeon that saw the patient in clinic is not always the surgeon that is operating on them the following week. Patients also come back year to year, at our request, for subsequent follow-up and often, further surgeries. All of these factors make record keeping essential to optimal care and the records may be incomplete and prior images are carried by families with varying degrees of completeness.
  • Backpack EMR is a company that has developed an electronic medical record (EMR) specifically designed for medical mission work ( We wish to use this system to enter clinical notes, take photographs and videos, store xray images and gait lab reports. Surgeons will be better able to review ahead of time for upcoming cases and have the complete record. Charts are accessible remotely, if needed, to assist with preoperative optimization and postoperative care.
What worked: 
  • We were able to take pictures of the patient and the extremity for reference at time of surgery and preparation for surgery. The notes were more complete and helped with continuity of care.
  • The software was not designed for non-traumatic encounters but they had the required elements.
  • The router and updates worked fine.
What didn't work: 
  • One of the clinic rooms could not keep up with the data entry on the iPad, so they reverted to the Word version. We then, had to input all the data in the evening. Making the work redundant.
  • The template was okay but had extra tabs and sections that we didn't use. Made it harder to focus on the information of interest.
  • There is not a web-based way of accessing and sharing the files for consultation remotely.
Primary Outcome: 
  • Continuity of care for patients from clinic to OR and for subsequent trips.
    • This was achieved as we had images and notes available. An improvement.
    • We will have these easily accessible for the trip planned for this fall.
    • This included Xrays that we took pictures of throughout.
Plans for the future: 
  • There are no plans for a publication but we will likely trial the platform again this fall. With hopes to get a better workflow to avoid pitfalls encountered last year.
  • Still exploring options to mitigate costs, including fundraising. Considering our own internal version as well.
Final Expense Report: 
  • Software Subscription $2500 per year x 1 year trial = $2500 = $1000 POSNA micro grant (see receipt attached)+ $1500 from Surgeons providing care (divided by 4 surgeons; Steve Koop, Michael Healy, Tom Novacheck, Walter Truong)
  • Devices iPad version 5 with128GB - $370/each x 2 = $740 Surgeons to bring from home
  • Router $400/each xl = $400 BackpackEMR to allow us to trial for free
  • Battery Pack $50 xl = $50 BackpackEMR to allow us to trial for free

View the PDF here