Summary: The Red Cross Red Crescent Health Information System (RCHIS) is an electronic health records and health information management system designed for international disaster response scenarios for medical documentation and reporting in the Red Cross/ Red Crescent equivalent of the Emergency Medical Teams (EMT), which are classified by the World Health Organization (WHO). It incorporates both a cloud-based server and a local server to address temporary internet outages, allowing remote information management and operational support when data-sharing agreements permit. To enhance its functionality in settings with no internet access, RCHIS was adapted to operate entirely offline, ensuring operational continuity and redundancy. These settings may either be conflict settings without internet access or settings where data storage in the cloud is prohibited by local privacy or health data protection laws. An analysis of its architecture identified components reliant on the cloud-based server, and offline alternatives were developed to maintain full functionality. Key modifications included the introduction of a second local server to improve redundancy and business continuity. This change enables data recovery from locally stored backups without requiring an internet connection. The system’s account creation process was revised, replacing cloud-based mechanisms with a local process that generates and displays temporary passwords. Additionally, the system now supports offline generation of the WHO EMT Minimum Data Set (MDS) report. These adaptations required significant architectural changes. While the shift to a fully offline mode sacrifices some cloud-based benefits, such as remote information management and operational support opportunities, RCHIS is now a robust tool for deployment in environments without internet connectivity. Furthermore, the use of a local server supports compliance with data sovereignty regulations, broadening the system’s applicability in diverse operational contexts.
Holl et al. (Sun,) studied this question.