In this week's PLoS Medicine Magazine, Gerry Douglas and colleagues describe their experience scaling up electronic medical records (EMRs) in six antiretroviral treatment (ART) sites in Malawi. The need for electronic records was clear. By December 2009, 46 of the ART clinics in Malawi had each registered more than 2,000 patients, which meant that nurses and medical record clerks were taking up to five days to prepare quarterly cohort reports, sometimes closing the clinic in order to complete this task. This often lead to risk of the completeness and accuracy of primary outcome data being compromised, say the authors in describing the rationale for their project.

Despite the challenges faced in implementing EMRs, the authors say that "the experience gained, and infrastructure built, through successful deployment of the ART EMR will facilitate further rollout to other high-burden ART sites in Malawi. We also see great potential for its adaptation and use for other chronic diseases such as tuberculosis, diabetes mellitus, and hypertension, preparing a foundation for a comprehensive electronic health record system."