In 2011, health officials in Ho Chi Minh City (HCMC) initiated the implementation of eClinica, an offline database based on an open-source Electronic Medical Record system, OpenMRS, at outpatient clinics (OPCs) to streamline HIV patient registration and treatment monitoring. However, this version faced challenges, such as the inability to share data between OPCs, which led to duplicative patient records as patients visited different OPCs. Also, with no centralized database, health officials faced challenges with accurately monitoring and analyzing citywide HIV care and treatment trends.

Data in the offline, disconnected databases continued to grow annually. With more than 45,000 people living with HIV receiving antiretroviral therapy (ART), HCMC health officials needed a connected, advanced data system to facilitate efficient monitoring and management of ART treatment. To solve these challenges, the Ho Chi Minh City Department of Health (HDOH) and the Ho Chi Minh Center for Disease Control (HCDC) requested that PATH and the US Centers for Disease Control and Prevention (CDC) partner with them in upgrading and enhancing the eClinica system.

With funding and technical support from the CDC’s Technical Assistance Platform, PATH collaborated with the HDOH and the HCDC to develop an online version of eClinica and provide training and technical assistance to OPCs on system use.

The development of eClinica leveraged OpenMRS, the world's leading open-source electronic medical records platform, sustained by a global community. The new and improved version of eClinica—built using OpenMRS 2.5—introduced several innovative features:

• A centralized online platform where a patient’s complete health history is entirely digitalized, securely stored online, and accessible for health workers at all OPCs to enable comprehensive patient treatment life cycle management.
• The ability to electronically refer patients, allowing patients and their electronic medical records to be easily transferred between OPCs.
• Automatic deduplication of ART patients across OPCs through the system, identifying duplicated records based on patients’ identifying information and merging them to ensure a unique record of each patient in the system.
• Management of comorbidities through modules that track other health concerns, such as noncommunicable diseases, and preventative services and test results, such as mental health screening and cervical cancer screening.
• Comprehensive reporting with medical records now accurately, completely, and rapidly compiled in a centralized database for use by OPCs, the HDOH, and the HCDC.

PATH has extensive experience in HIV prevention, diagnosis, and treatment, built on more than three decades of work across 32 countries since 1987. With a rich background in data analytics, data management, and health technologies, we leverage this expertise to address global health challenges.

PATH has been active in Vietnam since 1980, collaborating with leaders, communities, and local changemakers to build sustainable systems for tackling priority health issues.

PATH’s Center of Digital and Data Excellence is a global team specializing in co-creating data platforms tailored to partners’ needs. The team also focuses on data aggregation, quality, advanced analytics, and capacity-building for health workers to enhance data use.

In partnership with the Vietnamese government, PATH has co-created and scaled digital innovations to support the Ministry of Health in areas like medical supply tracking, vaccination rate monitoring, and predictive modeling for communicable disease outbreaks.

To create a connected, complete data system, all data in the offline eClinica at each OPC were seamlessly migrated to the online version after a thorough review and cleaning. End users from OPCs, the HCDC, and the HDOH were involved throughout the development process, including providing technical requirements, participating in user testing, reviewing the merged data, and planning the system rollout. This ensured the system’s alignment with user needs.

During the implementation phase, PATH collaborated with the HCDC and the HDOH to provide OPC staff with in-person training courses and technical assistance, both online and in-person. This has ensured that end users have the capacity to effectively use the system.

The online eClinica was successfully tested in two OPCs in HCMC for one month, during which identified bugs were fixed and user modification requests regarding system requirements and functionality were addressed. Subsequently, the system was rolled out to 34 OPCs, fully replacing the offline system by the end of September 2023. More than 80,000 patient records were successfully transferred to the new system, and records from different OPCs were merged to create a full treatment history of each patient. A consultation workshop and focus group discussion with OPC staff were conducted in December 2023 to collect feedback and identify needs for system modifications.

Feedback was highly positive, with users praising the system’s functionality and improvements from the previous version. A staff member from OPC District 4 said, “I am very satisfied with this new eClinica system. The system not only transfers data well but also has many superior features compared to the old eClinica system, such as supporting noncommunicable disease screening and management. Currently, the facility has been effectively managing the noncommunicable disease section on the system.” Health workers now benefit from flexible access to the secure system anytime, anywhere, generating reliable reports on HIV treatment and program indicators.

The successful implementation of the online eClinica also demonstrates the efficacy of OpenMRS in managing ART treatment in Vietnam. The HDOH and HCDC plan to expand the system beyond HCMC, with PATH providing technical assistance. The participatory and user-centered approach employed in eClinica’s development will serve as a model for future health information systems within PATH’s projects.

Planned next steps include expanding the eClinica system to private clinics, allowing for a broader reach and improved patient management. PATH will also strengthen the HCDC's capacity to operate and maintain the system, and provide technical support to the end-users of the system.