True-Doctor
Running a clinic with no internet
The network will go down on a busy morning. A clinic that has decided in advance what happens then keeps seeing patients and loses nothing. One that has not ends up with two records that disagree.
Decide before it happens
Write a one-page plan and pin it at reception. It answers three questions: who decides that the system is down, what everyone does instead, and who enters the paper afterwards.
What to keep on paper
A small set of papers, kept ready in a drawer:
- A downtime register: date, time, patient name and number, what was done, what was paid.
- A numbered receipt book, so every payment taken by hand can be traced.
- The signed forms the law asks for: consent for procedures, referral letters.
- The Ministry's HMIS registers, if your district still expects paper registers.
What not to keep on paper
Do not keep the full patient record twice. Notes written on paper and typed later are typed late, or differently, or not at all. If your system works offline on a phone or tablet, write the notes there and let it send them when the signal is back.
Keep paper for what must be signed or what proves money changed hands.
A routine for each outage
- Before: keep phones and tablets charged, signed in, and synced at least once a day. A UPS for the router and a power bank at reception cost little.
- During: keep working on the devices that work offline. Use the downtime register only for what cannot wait.
- After: enter the paper the same day, by one named person. Then check that nothing is waiting to be sent on any device.
Keep the paper safe
Paper with patient names on it is personal data like any other. Lock it away, and shred it once it has been entered and checked.
Sources
- Ministry of Health, Uganda: HMIS registers and tools
- Personal Data Protection Office: the Data Protection and Privacy Act, 2019