Although evaluations of important indicators
of care are difficult to do well, this review has
confirmed that they are feasible even in very challenging environments. Initial benefits were
shown in systems that track patients through
treatment initiation, monitor adherence, and detect
those at risk for loss to follow-up; tools to
decrease information communication times
within and between institutions, as well as errors
in reporting laboratory data; barcoding for patient
identification cards and laboratory samples;
handheld devices for collecting and accessing
data; and the ordering and management of medications. Because of the lack of infrastructure
and backup systems in resource-poor environments,
well-designed e-health solutions may
have a much larger impact on quality of care than
in more developed areas. As e-health becomes
widespread in developing countries, these and
other benefits will need to be identified by more
rigorous evaluations that include long-term
follow-up and are carried out by independent
evaluators.