Frischseminar: Laura Derksen
Privacy at What Cost? Using Electronic Medical Records to Recover Lapsed Patients Into HIV Care
Laura Derksen, Anita M. McGahan and Leandro Pongeluppe
We show that Malawian healthcare staff save lives by tracking down HIV patients lapsed from care -- even against their wishes -- using data made accessible with the implementation of an electronic medical records (EMR) system. HIV patients in Malawi receive antiretroviral therapy (ART), a highly effective treatment that also prevents transmission, for free at clinics. Yet patients frequently lapse from care, resulting in increased community transmission and unnecessary deaths. The introduction of EMR allowed health providers to manage patient data, trace lapsed patients, and encourage lapsed patients to reinitiate treatment. We implement an event study analysis using data from 106 clinics that adopted EMR between 2007 and 2019 and find that the introduction of EMR leads to an immediate increase in the number of patients actively in care and to a decline in patient deaths. After five years of implementation, facilities with EMR have approximately 34 percent more patients in care and 28 percent fewer patient deaths than facilities without EMR. These effects are concentrated among patients under 50, and are larger among young children. Effects are also concentrated among patients who do not wish to be traced; these patients are in fact more likely to lapse from care and require tracing. Robust to additional specifications and supported by interview findings, the results demonstrate that an initial preference for privacy gives way to patient reinstatement in care when the health consequences are critical.