Health Toolkit - Managing Medical Information in Low Resource Settings

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  • + jvillacisve jvillacisve 2 years ago
    I am in Ecuador. Very nice presentation. I am interested about the possibility of download it. Do you think you can allow me this favour?.

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Health Toolkit - Managing Medical Information in Low Resource Settings - Presentation Transcript

  1. Managing Health Information in Low Resource Settings William A. Lester Chief Information Officer - EngenderHealth
  2. Objectives of the Presentation • Identify some of the problems associated with capturing, managing, and sharing health data in low resource settings • Discuss some existing ICT solutions, with a focus on 3 case studies • Discuss what’s missing and what doesn’t work • Help the presentation participant to better evaluate the health toolkit • Capture suggestions to take back to the developers of ICT solutions
  3. Definitions • Information and Communications Technologies (ICT) • Low Resource Settings • Clinics • Community-based healthcare organizations • Health Management Information Systems (HMIS) • eRiders/iRiders • PDAs (Personal Digital Assistants) • Interoperability • Resource Bucket
  4. The Problem - 1 • The number of people living with HIV/AIDS continues to grow • The crisis is particularly acute in the developing world • Front line workers operate out of public and private clinics, and community and religious groups • Providers need to capture, manage, and share health care information • Developers assume local infrastructure will support prescribed solutions • If the resources are not in place, the solutions will fail • Digital Divide/Last Mile Problem • The physical distance may be short, but the resource gap can be insurmountable
  5. The Problem - 2 So, the problem we are facing is to …find effective solutions to capture, manage, retrieve, and share health care information that will work in low resource areas…
  6. The History - 1 • In 2004, under a grant from the Soros Foundation, we visited 5 countries in southern and western Africa (Botswana, Ghana, South Africa, Swaziland, and Zambia) • We conducted focus groups with 60 individuals (all involved in HIV/AIDS care within organizations in their countries) • We explored patterns and practices related to data capture, management, and sharing, as well as identifying the most critical gaps and shortcomings associated with current data management systems • We performed in-depth technology assessments of several NGOs in these countries
  7. The History - 2 • In parallel, we looked at existing proprietary and open-source medical records systems: – Care2x – CareWare – Cell-Life – DHIS – EpiInfo – ESTHER/ESOPE – FUCHIA – GAP Zimbabwe – Haiti HIV-EMR – HIPS DOCA+ – OpenEMR – OpenVista – PKC – SOLUTIONS – SQL Clinic – Starfish Project – VOXIVA
  8. The History - 3 • We wrote a report (static) • We created a web site (dynamic) – Resources – Tools – Field Research – Partners and local organizations www.healthtoolkit.org
  9. Interesting Study Results • Most clinics in low resource areas are overworked, understaffed, lacking in many basic necessities – Capacity building is necessary – Training of staff, especially non-medical staff, is needed • When dealing with HIV/AIDS, many patients never get to a clinic – The contact is often a local person from a community or religious affiliation – Faith-based NGOs play a significant role in the process – Community-based healthcare workers need training
  10. Medical Information • Medical records – Patient information – Patient history – Current status – Treatment Regimen – Test results • Clinic Management – Appointments – Best practices • Local health information and regulations • Regional information • Global information – Research – Journal Articles – Communities of Practice
  11. Medical Information • Medical Records Requirements – Unique – Searchable – Comply with policies of privacy and access – Safe (backup)
  12. Beliefs • Paper-based systems are the only solution for low resource areas • Staff are unskilled and not capable of learning new ways. • The costs of new solutions are prohibitive • There’s no local support available to keep new systems up and running • The return on investment is minimal. There’s nothing to be gained by implementing new systems and solutions
  13. Suggestions • There are other solutions, beyond paper-based systems – Affordable – Sustainable – Appropriate for low-resource settings • There are cost-effective approaches to training staff – In the use of ICTs – In long term capacity building skills, like clinic management, informed consent, infection prevention, etc. • One size does not fit all – In some locations, there is no better solution, yet… – Often, there are many solutions (which creates a new problem) – In all locations, there is room for improvement
  14. Standards • The need – Data standards are the principal informatics component necessary for information flow and exchange. – Data is collected and reused for multiple purposes – Common data standards support effective assimilation of new knowledge into decision support tools. • The problems – There is no agreement on standards. There are competing standards experts. – There is only negligible sharing or exchange of health information concerning individuals or communities between the disparate electronic health record systems employed by provider organizations. – Unique identifier
  15. Interoperability* • Uniform movement of healthcare data from one system to another such that the clinical or operational purpose and meaning of the data is preserved and unaltered. • Uniform presentation of data, enabling disparate stakeholders to use different underlying systems to have consistent presentation of data when doing so is clinically or operationally important. • Uniform user controls, to the extent that a stakeholder is accessing a variety of underlying systems, and the contextual information and navigational controls are presented consistently and provide for consistent actions in all relevant systems. • Uniform safeguarding data security and integrity as data moves from system to system such that only authorized people and programs may view, manipulate, create, or alter the data. *Healthcare Information and Management Systems Society 2005
  16. Web-based Resources • Trusted sources • Timely information • Federated search engines – Information buckets – Prioritized by user • Tagging, XML
  17. Case Study #1: The Starfish Project* Location: Sagamu, Nigeria Participants: Two private clinics Ogun State University Teaching Hospital New York Presbyterian Hospital (Center for Special Studies) Situation: Two private clinics, affiliated with a teaching hospital. Entire patient caseload are HIV/AIDS and related. ARV regimen in place, using donated drugs from the states. However, partner organization wanted a way to monitor clinic records, including patient records, prescribed treatment, test results, and drug inventory. *Based on presentation by Rachel Yasky/The Starfsh Project
  18. The Starfish Project - 2 http://www.thestarfishproject.org Vision - Promoting a collaborative care model, in which clinicians from the USA and clinicians from Nigeria work together to care for patients in Nigeria - Information exchange regarding advances in clinical practice, research, new policies, etc. can be shared and discussed across long distances - Develop a model to demonstrate an innovative approach, using technology and organized communication systems, to enhance health care delivery in a limited-resource setting
  19. The Starfish Project - 3 Visit to Sagamu (May 2004): - Who: EngenderHealth, Consultants, Starfish - Where: 2 Clinics, University, local NGOs - Why: Assess current physical environment Do an information audit Evaluate internet access Evaluate possibilities for a computer network Identify key staff Demo HMIS applications
  20. The Starfish Project - 4
  21. The Starfish Project - 5 Recommendations (three stages): - Stage 1: Dedicated dial-up line Small Server (ShuttleX) Build collaborative database application (separate project) Train one local staff person (iRider) Evaluate results - Stage 2: If warranted, expand project Wired network Satellite connection to the University IT Support person (eRider) Evaluate results - Stage 3: Complete network Train all staff Evaluate results Start process again for future development
  22. The Starfish Project - 6 • Began work on Starfish Database – Written in MS Access (for testing) – To be ported to PHP/MySQL – HMIS system, including: • Medical records • Patient Tracking • Laboratory records • Inventory Management • Clinician <-> Clinician discussions • Multi-user, multi-station
  23. Summary Tab Simple look and feel Tabbed screens Unique ID # English
  24. Demographics Tab
  25. Visits Tab - Popup SOAP Contains 4 fields: Subjective, Objective, Assessment, and Plan. Remember that this form can be filled out for each of a patient’s visits.
  26. Consultation Tab
  27. Labs Form
  28. Other Forms • Other forms within the patient database system include: – Data Export: a form that allows all patient data to be automatically exported to a new file (which can then be sent to Starfish). – Date Import: a form the allows data from a file downloaded from Starfish to be brought into the database. – Starfish Bulletins: a form that pops up automatically after a data import, and may also be opened manually, that notifies the clinic of there are new Starfish bulletins, and if so allows them to be printed. – Inventory Review: a form for reviewing the clinic’s stock of drugs and to manage that inventory. – Log Incoming Bottles: a form for logging incoming bottles of drugs, as from Starfish, into the inventory.
  29. Reports (Examples) • Visit Report: all fields from every field on the visit popup on one page. This is the report that prints when the printer button is pressed next to a row on the visit tab. • List of upcoming visits, overdue visits • Report for Lab of requested tests that do not yet have results entered • List of all messages written about one patient on the consultation tab • List of all NEW messages about ALL patients (the report we called “Starfish Bulletins” in our first meetings) • Patient Chart: all the information that would go on a patient’s chart • This week’s visits (taken from [Next Visit Date] fields). • This month’s visits in calendar format • List of all of the comments entered for a patient on the Nurses tab of Visit popup. • Patient visits stats, including past weights, CD4s, etc, from all past visits, in tabular format
  30. Summary of The Starfish Project • Continues today • Model for other similar collaborations • This project had external money and support • Improvements included new generator, satellite internet connection • Plans for a new clinic facility
  31. Case Study #2: Uganda Health Information Network (UHIN)* Location: Uganda (Mbale and Rakai districts) Participants: Satellife Uganda Chartered HealthNet Makerere University Medical School Connectivity Africa (IDRC funded) Situation: In Uganda, collecting data from rural health centers on utilization, disease surveillance, and supply management is difficult and expensive. Continuing provider development is expensive and difficult to sustain for workers. *Based on presentation by Holly Ladd/Satellife
  32. UHIN - 2 www.healthnet.org Vision - Provide affordable connectivity for healthcare information exchange - Provide a method for data collection and exchange - Make it easy to learn and use by non-technical workers - Make it sustainable
  33. UHIN - 3 Solution - Handheld computers (PDAs) in 160 health centers - 500 healthcare workers trained to collect, send and receive information - Wireless access points at HCIII / HC IV - Use existing cellular network
  34. UHIN - 4 Approach - Use existing HMIS and other MOH forms - Provide Health Centers with PDAs - Route data two-ways overnight - Provide district health information managers with database training - Automate data exchange and uploading to existing database - Broadcast CME/CPD regularly to health workers
  35. UHIN - 5 • Recycled Hardware (free) • Battery powered • Rechargeable • Nothing lost, if power dies •Synch with access point • Pendragon forms
  36. UHIN - 6
  37. UHIN - 7 Router GSM/GPRS Wireless Server Sub-district Office DDHS Office Ministry of Health Village Clinic
  38. UHIN - 8 Access Points
  39. UHIN - 9 Project Focus Year 1 - Proof of concept - Trial of equipment and network - Develop protocols - Train users - Compare data collection efficacy and cost
  40. UHIN - 10 Project Focus Year 2 - Expand to 160 sites - Study on impact of access to information - Concentration on provider education and content development
  41. UHIN - 11 General Outcomes - Discussions underway to integrated UHIN into NHS - Reduced time and cost in data collection and management - Request for more forms on PDA - Sustained usage - Request for more content - Request for more units and email
  42. UHIN - 12 Data Collection Outcomes - 24% cost savings over paper - Sustained improvement in reporting timeliness and accuracy - More rapid response to disease outbreaks and critical needs - Processing reduced from 30 days to 5 days
  43. UHIN - 13 User Feedback - 75 % report having content at POC improves health care delivery - 41% report setting aside their own funds to replace PDA in case project ends - 68% regularly access content from access points - All want email, more PDAs and access points
  44. UHIN - 14 Next Steps - Country-wide adoption - Replication this year in another country - New, less expensive equipment
  45. Case Study #3: Aftercare* Location: Cape Town, South Africa Participants: Cell-Life Desmond Tutu HIV Foundation Situation: Once patients are accepted into an ARV treatment program, counselors visit on a regular basis to monitor their status. Often patients are in remote areas, or not able to get to clinics easily. Counselors need a better method for collecting data, sharing medical information with clinicians, and accessing medical resources appropriate for the patient. *Based on presentation by Rory Flynn/Cell-Life
  46. Aftercare - 2 Statistics (South Africa) - 26.5% prevalence rate - 5.6 million people infected - 1 million HIV+ people require ART - 200,000 people currently being treated Challenges - Geographical distribution - Difficulty in administering treatment - Lacking infrastructures - Limited resources
  47. Aftercare - 3 Solution - Trained counselors monitor patients - Closing the gap between hospital and home Cell-Life Aftercare Solution - Uses mobile phones equipped with customized application software - Menu-based, real-time system to capture treatment-relevant data - Supports home-based care organizations
  48. Aftercare - 4 Goals - Reduce errors - Increase throughput - Attain user satisfaction and comfort Achieved through - Simplicity & Consistency - Confirmed Response - Participatory Design - Language localization
  49. Aftercare - 4
  50. Aftercare - 5
  51. Aftercare - 6 Network Availability - 90% of population have access - Approximately 65% geographical area covered
  52. Aftercare - 7 Considerations - Can use most inexpensive phones (i.e. Nokia 1100) - Cost per transaction varies from month to month depending on number of transactions received - Application stored on SIM card - Can use in any handset
  53. Aftercare - 8 Future - Migration to Java/GPRS, will lower costs - Confirmation of successful data capture - Ability to store and forward later - Can cater any language English Afrikaans
  54. Summary of Cell-Life Aftercare • Cell-Life has identified a number of requirements in order to further such developments and to grow active implementations as follows: – Develop integrated systems – Establish public-private partnerships – Source adequate funding – Adapt technology for other chronic illnesses – Keep systems affordable – Build strategic development partnerships – Interoperability
  55. Acknowledgements • Open Society Institute Information Program – Budapest, Hungary • Teresa Crawford – nonprofit IT Consultant teresa@speakeasy.net • Ungana-Afrika http://www.ungana-afrika.org • Portman Wills – Voxiva http://www.voxiva.net • Council for Scientific and Industrial Research http://www.csir.co.za • Rachel Yassky – The Starfish Project • Holly Ladd – Satellife • Rory Flynn – Cell-Life
  56. Resources Discussion lists, field research tools, Health Toolkit www.healthtoolkit.org protocols and guidelines, reports eRiders are roving technology Global eRiders www.eriders.net consultants who work with a group of related NGOs, helping each organization to develop and implement an ICT strategy Provides technology solutions to remote Inveneo www.inveneo.org villages through non-governmental organizations (NGOs) and through commercial or government owned organizations To promote high quality and practical Routine Health www.rhinonet.org approaches to the collection and use of Information Network routine health information in developing countries, we have created the RHINO (RHINO) Network, comprised of developing country governments, donor agencies, technical groups, and PVOs.
  57. Thank You!
  58. Managing Health Information in Low Resource Settings William A. Lester Chief Information Officer - EngenderHealth

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