Implementing Electronic Medical Records (EMR) in Global Children’s Airway Reconstruction Missions: Challenges, Strategies, and Outcomes

Introduction: This presentation describes creating an electronic medical record (EMR) system for international healthcare focused on pediatric open airway surgery. This initiative emerged from over a decade of international surgical experience and was refined through direct collaboration with host-country healthcare providers.

Methods: After 15 years of collaborative work, host country providers were interviewed where they identified need for longitudinal, transmittable, and bidirectional documentation of care, prompting the creation of a cloud based, HIPAA compliant EMR. The EMR was created via joint effort with the host countries. Then from January 2023 to December 2024 we conducted a retrospective study of children who underwent open airway surgery as documented in the EMR. Decannulation was the primary outcome measure. Demographic data, surgical approach, and country were examined as independent variables.

Results: The result of qualitative interviews indicated a need for an integrated platform to store bronchoscopic images, multidisciplinary notes, and end-of-mission summaries which help support local team’s ongoing care. Since implementation, the EMR has been used in 6 outreach programs across 3 countries, documenting 253 procedures, including 44 open airway surgeries (39 laryngotracheal reconstructions [LTR], three tracheal resections with re-anastomosis [TRR], and two cricotracheal reconstructions [CTR]). Overall, 88% of children undergoing surgery were decannulated; decannulation rates were 100% for TRR, CTR, and single-stage LTR, and 83.33% for both 1.5-stage and double-stage LTR. There was no significant difference in decannulation outcomes by surgery type (p=0.653) or country (p=0.739).

Conclusions: Implementing an EMR tailored to international pediatric airway surgery has proven vital for improving documentation, ensuring longitudinal care, and enabling outcomes monitoring. By fostering robust communication among multidisciplinary teams, this EMR promotes higher-quality global surgical partnerships and enhances care for children undergoing complex open airway procedures.