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AIDSRelief IQCare HMIS EMR

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AIDSRelief EMR software

AIDSRelief EMR software

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    Daniel Kalibbala,
    Data Manager,
    Nsambya Home Care
    AIDSRelief ARTproject
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  • 1. Building Sustainable Strategic Information Systems in Low-Resource Countries
    Bobby Jefferson
    Senior HMIS Advisor
    AIDSRelief project
    Futures Group International LLC
    Presenting on behalf of Lanette Burrows, Pat Bass, Ian Wanyeki
  • 2. AIDSRelief Overview
    PEPFAR Track 1.0 Initiative
    Catholic Relief Services – Prime (CRS)
    University of Maryland Institute of Human Virology (IHV)
    Futures Group
    Catholic Medical Mission Board (CMMB)
    Interchurch Medical Association (IMA)
    5-year project focused on increasing access to high quality HIV care and treatment
  • 3. AIDSRelief Overview
    Implemented in 9 countries:
    Guyana, Haiti, Kenya, Nigeria, Rwanda, South Africa, Uganda, Tanzania, Zambia, Ethiopia (April 2009)
    Focus on building capacity for quality HIV care and treatment
    lab, pharmacy, clinical services, M&E
    More than 212 local partner treatment facilities (LPTF)
    Small Rural Health Centers
    Rural Health Clinics
    District Hospitals
    Mission Hospitals
    Urban High Volume hospitals
  • 4. Where we work
    7
    29
    212 ART Treatment Facilities (Clinics) + 122 satellite Sites + 288 PMTCT sites
    18
    25
    10
    78
    3
    18
    24
  • 5. Futures Group Overview
    • Futures Group provides strategic information (SI) capacity building and focuses on:
    • 6. Improved data demand and information use (DDIU)
    • 7. Enhancing/implementing patient monitoring and management (PMM) systems that meet local requirements
    • 8. Enhancing Data quality for better services and clinical outcomes
    • 9. Using local experts to build capacity at partner sites
  • The team
    • Futures Group AIDSRelief is a comprehensive team of:
    • 10. M&E specialists
    • 11. HIV/AIDS experts
    • 12. Clinicians
    • 13. HMIS experts
    • 14. Programmers
    • 15. Project Managers
  • Regional Software development teamsin Kenya, Rwanda, South Africa, India
  • 16. Strategic Information
    • Committed to collecting only information essential for clinical management and quality improvement
    • 17. Capacity building (local ownership)
    • 18. Committed to feeding back information to the local partner treatment facility (Clinic) to address gaps in program and services
  • To offer a library of tools and solutions built around adaptive management, high quality data, and sustainability
    Freely available software, no licensing fees
    User , Admin Training, and In-country Programmer or Database Training available
    To develop requirements through practical field experience and lessons learned
    To take a collaborative approach using local experts throughout the development process
  • 19. International Quality Solutions
    Sound products based on experience in the field
    – IQCare – IQChart – IQTools – IQGeo – IQReporting – IQShare – IQTrack – IQTraining
    – Training and Mentoring – Local Experts – DQ & QI – Ownership + Data use
    Skills transfer
    Increased Capacity
    Adaptive Management
    Improved services
    Sustainability
    Best Practices
    Positive outcomes
  • 20. Patient Management and Monitoring
    Typical Hospital Records Center
  • 21. Finding patient information in the past
  • 22.
  • 23.
  • 24. KeyFeatures
    Stability and ease of use
    A browser-based, easy-to-use software tool with robust underlying SQL database
    No Internet access required to use system
    Facility and Patient Dashboards
    Real Time data entry and reporting
    Custom reports
  • 25.
  • 26.
  • 27.
  • 28.
  • 29.
  • 30.
  • 31. Data Quality check
  • 32. Data Quality Check
  • 33. Data validation
    Data Quality Check during data entry
    Required Fields
    Enforcement of required fields
    Alerts for data required for reporting or clinical tracking
    Field level data validation present on every clinical form
    Date validation
    Boundary validation for numeric data
    Laboratory result validation
    Alerts for data outside of normal range
  • 34. Other Features
    Automated back up
    Export to Excel or access database
    Custom Fields
    Sites can add data fields for additional indicators specific to their needs
    Documentation
    Training manuals, Browser based help, IQShare portal
  • 35.
  • 36.
  • 37.
  • 38.
  • 39.
  • 40.
  • 41.
  • 42.
  • 43.
  • 44.
  • 45. Monitoring our programs through IQSolutions
    Demonstrate outputs and outcomes
    • Clinics ability to hit set targets
    • 46. Trend analysis
    • 47. CD4 count changes
    • 48. Mortality & Lost-to-follow-up rates
    Case studies demonstrating outcomes
    Using data collected on a routine basis for:
    • Life table analysis
    • 49. Defaulter tracking
    • 50. Quality of life analysis
  • 51. “After successful assessment, the IQ Care system developed and supported by the Constella Futures Group and Catholic Relief Services came up top in terms of overall features (technical and non technical) and also in terms of largest number of installations “
    “From the above data, IQ Care comes out strongly ….recommended for medium to large ART centres.”
    WHO and CDC sponsored EMR Assessment Report , Kenya May 2009
  • 52.
  • 53. What does it provide us with? ARV Pickup Report
  • 54. Whatdoes it provide us with?
    Close monitoring of the ART pick up habits over time at LPTFs has helped ensure that fewer patients miss collecting their ARTs on time
  • 55. Reporting
    ARV Pickup Report
    CDC Track 1.0 Quarterly Report
    Monthly TRAC MOH reports
    Custom user and Data quality reports
    Cohort mortality report
    Display on screen or export to Excel
  • 56. Three sites showing the sub-districts they service
  • 57. # Defaulters per village – Green <5, Yellow 5-10, Red >10
  • 58. Capacity Building and decision making
    Identify defaulters per village or sub-district
    Deploy adherence counselors to follow-up
    Identify trends
    Link defaulter data to average distance travelled or average time taken reach the site
    Provide supplemental services (transport)
    Open field service centers
  • 59. Select a village to see the defaulter list and HCW assigned
  • 60. Other Developments
    Electronic first (E-First) data entry
    Paperless Clinics
    Pilot in Kenya
    Pilot in Nigeria Clinic
    Wireless at Clinics
    Security, Use of HTTPS,
    OpenSSL
  • 61. # Defaulters (red) vs avg distance travelled to reach site (blue)
    Thank you
  • 62. Useful Practices
  • 63. Useful Low Tech Approaches
    Training local university students as data entry clerks
    Inviting local internet service provider (ISP), and IT staff of other implementing partners to trainings
    Training of local programmers
    Use of daily skype conferencecalls or chat to communicate with in-country teams
    Use of SMS text
  • 64. Useful Practices
    Use local experts to gather system requirements, pilot systems, and perform field acceptance testing
    Use of interactive Storyboards
    Follow up training 1-2 weeks after implementation ensures users have time to acclimatize to the new application and ask more meaningful questions
    Complete documentation of system
    Integrate backup feature into the system and train staff on a standard operating procedure for backup
  • 65. Useful Practices
    Encourage data ownership at Clinics
    Training includes entire HIV case management team and focus on data quality and data use; other training areas include computer basics, data entry, data analysis and interpretation, system administration and custom report building
    Monthly and quarterly feedback to Clinics in addition to on site TA enhances information use and creates strong SI networks among Clinics
  • 66. Build Data culture
    Data is key for informed clinical and programmatic decision making
    Build a data culture use by empowering clinics to make use of the data they collect (Local Ownership)
    Collect data that will be used
    • Routine feedback to stakeholders
    helps improve accuracy of data
    collected and reports generated
    • Use appropriate tools that
    facilitate data use
  • 67. Choosing the right SystemWith Local Partners: PMMS
    • Comprehensive system based on longitudinal medical records
    • 68. Higher capacity site with greater data demand
    • 69. High volume site with multiple data entrants
    • 70. IT supported environment preferred
    • 71. Scalable, single desktop to large hospital network
    • 72. Basic but flexible system based on WHO register data
    • 73. Lower capacity site with lower data demand
    • 74. Minimal IT support required
    • 75. Multi-language capability
  • Tools for data verification, cleaning and reporting
    Clinical reports for adaptive management
    Data migration tool
    In use at 100-150 sites in 5 countries within AIDSRelief
    Local capacity building
    Allows local sites to develop their own reports
  • 76. Overview of GIS
    Highly technical and specialized field
    Skills scarce
    Consulting fees high
    Traditional GIS Software expensive
    Recurring billing
    ‘Per seat’ billing
    Modular or ‘per feature’ billing
    Applications are complex and inflexible
    Designed for use by GIS experts
  • 77. Custom GIS Applications
    Using free Google earth to create custom applications, one can:
    Target specific audiences
    Create simplified and familiar interfaces
    Easier and logical for staff
    Reduced learning curve
  • 78. Google Maps
    Google maps export file format well established
    Easy to interact and share data with other systems
    Easy to share visual data with colleagues via email
    Export to .kml
    Colleagues view results in free Google Earth
  • 79. Futures Group GIS experience
    Google earth integrated with data from
    Local PMMS
    International aggregate databases
    Improve treatment outcomes
    Facilitate adaptive management
    Facility level
    Program level
  • 80. Additional Technical Benefits
    Build our own library of data layers and presentation tools for use and view in familiar Google Earth environment
    Easily store additional information using standard Google Earth markers and tools
    Directions to hospital sites
    GPS coordinates
    Office contact information, Address, location information
    Local photos, street level views
    Facility start date (the date the facility started receiving funding)
    Number of clinical and data managers
    Number of satellites clinics and locations
    Services at site HIV, VCT, PMTCT, TB, Nutrition
    Photo or picture of  hospital facility
    Photo or picture of  satellite facility
    Description of hospital
    Can integrate large quantities of information about the environment and provide a powerful set of analytical tools to explore the data
  • 81. Google Maps -technical considerations
    Application and data hosted locally or on an intranet but...
    Internet connection required
    Basic map data comes from Google
    User data and application stored locally
    Enterprise version can be used offline but
    Annual license fees
  • 82. Custom GIS Applications
    Various data sources can be used
    Excel, Access, SQL, XML
    Developers can create multiple interfaces for different audiences:
    Facility management tool for local management
    Country or multinational program management
    National MOH level interface
  • 83. Current Uses at AIDSRelief
    AIDSRelief was assigned to districts and is providing services throughout the district at all health facilities
    Currently providing services sites and scaling up in the near future
    GIS application:
    Will break down provinces to districts to sectors and cells
    Map current AIDSRelief sites and their current catchment areas and to planned service expansion areas
    Identify areas where coverage may be lacking
    Map prevalence rates by sector or cell and compare to where AIDSRelief is providing services
  • 84. Capacity Building and decision making
    Catchment areas per site identified
    Under serviced areas highlighted
    Compare prevalence rates and population statistics to services provided
    Informed decisions made:
    Open satellite sites
    Deploy additional staff
    Transfer patients from under performing sites to other nearby sites and redeploy funds elsewhere for greater impact.