It is all about ART database system

1. ART Software
April, 2019
EMR ART V6.0 Software Training
Adama, Ethiopia
June 2022

2. Outline of the Presentation
o Brief presentation on:-
 Training Objectives
 Health Information System and HIV program
 HIV/AIDS HMIS and MER indicators
o Rationale for Improving the Version 5.0EMR-ART software
o Features of EMR-ART V6.0 System
 DashBoard
 Add Patient
 HIV Testing Service
 Provider View
 Treatment and Follow-up
 Viral load
 Exposure Prophylaxis
 Report and analytics
 Administration
 Data quality assurance
 Help
 Log Out
 Quit
o Summary
o Get Started with EMR-ART software

3. Brief presentation on Training Objectives, Information Revolution, Health
Information System, and HIV Program

4. o Describe EMR-ART Module’s core functionalities and features.
• Add Patient feature
• Follow up feature
• New Features: Differentiated Service Delivery, Advanced HIV Diseases, Monthly Visit List and HVL SMS
Consented Client List, Pediatrics Age Out and ETORRS Notifications
• Report feature
o Understand how EMR-ART System serve as data source for HIV/AIDS HMIS and MER indicators
o Understand EMR-ART System data exchange capability with other system: VL-EID and DHIS2 Systems
Objective

5. Health System Building Blocks

6. Health information system (HIS)
• HIS refers to any system that captures, stores, manages or transmits information related to the health of
individuals or the activities of organizations, which will improve health care management decisions at
all levels of the health system
• In general, all functions of the health system rely on the availability of timely, accurate and dependable
information for decision making.

7. Health information system in the context of HIV Program
• Ethiopia has endorsed the UNAIDS 95-95-95 HIV targets and is currently working towards meeting
them.
• HIS are critical for monitoring the implementation of HIV/AIDS programs, tracking progress
towards these targets, and conducting robust surveillance.
• The use of electronic data management systems for HIV programs reduces the resources needed for
manual data entry and management, and improves data quality and data use.

8. HIV/AIDS and related Indicators
 Indicators based on National revised HMIS-HIV/VH Indicators
and
 Based on President’s Emergency Plan for AIDS Relief’s
(PEPFAR) – MER Indicators
HMIS-HIV Indicators
Federal Ministry of Health has adopted standardized HMIS in the past
decade.
According to the National FMOH HMIS indicator guide 2021.
• HIV/AIDS and Viral Hepatitis program is represented by
15 HIV indicators and
• 2 TB/HIV indicators

9. HIV/AIDS and Hepatitis related Indicators…
HIV HMIS (National) Indicators/ Green Color-New Included Indicators
1. Percentage of people living with HIV who know their status
2. Number of people living with HIV currently receiving ART
3. Number of adults and children with HIV infection newly started on ART
4. ART retention rate
5. Number of ART Clients that interrupted Treatment
6. Viral load Suppression
7. Number of individuals receiving Pre-Exposure Prophylaxis
8. Number of persons provided with Post-Exposure prophylaxis
9. Proportion of clinically undernourished People Living with HIV (PLHIV) who received therapeutic or supplementary
food
10. Proportion of STI cases tested for HIV
11. Percentage of non-pregnant women in the reproductive age living with HIV on ART using a modern family planning
method
12. Proportion of patients enrolled in HIV Care who were screened for TB
13. Proportion of HIV positive women (15+) on ART screened for Cervical Ca
14. Number of individuals tested for Hepatitis
15. Proportion of diagnosed Hepatitis B and C patients who received treatment

10. HIV/AIDS and related Indicators…
TB/HIV (National) Indicators
• Proportion of registered new and relapse TB patients with documented HIV status
• Proportion of HIV-positive new and relapse TB patients on ART during TB treatment

11. Facility-Based MER Indicators
There are around 35 Standard MER indicators of which Ten are included in the 2nd phase of EMR-
ART System implementation
a) TB_PREV Indicator(prevention)-Reported Semi-Annually
• Proportion of ART patients who completed a standard course of TB preventive therapy within the semiannual reporting period
b) TX_NEW(Treatment)-Reported quarterly
• Number of adults and children newly enrolled on antiretroviral therapy (ART)
c) TX_CURR(Treatment)-Reported quarterly
• Number of adults and children currently receiving antiretroviral therapy (ART)
d) HTS_INDEX(Testing)-Reported Quarterly
• Number of individuals who were identified and tested using Index testing services and received their results
e) PrEP_NEW:- Reported Quarterly:-
• Number of individuals who were newly enrolled on pre-exposure prophylaxis (PrEP) to prevent HIV infection in the reporting period
f) PrEP_CT:-Reported Quarterly
• Number of individuals, excluding those newly enrolled, that return for a follow-up visit or re-initiation visit to receive pre-exposure
prophylaxis (PrEP) to prevent HIV during the reporting period

12. Facility-Based MER Indicators…
g) PMTCT_ART(Treatment)-Reported quarterly
• Percentage of HIV-positive pregnant women who received ART to reduce the risk of mother-to-child-
transmission during pregnancy
h) TX_TB(Treatment)-Reported Semi-Annually
• Proportion of ART patients screened for TB in the semiannual reporting period who start TB
treatment.
i) TX_PVLS(Viral Suppression)-Reported quarterly
• Percentage of ART patients with a suppressed viral load (VL) result (<1000 copies/ml) documented
in the medical or laboratory records/laboratory information systems (LIS) within the past 12 months
j) TB_ART-Reported quarterly
• Proportion of HIV-positive new and relapsed TB cases on ART during TB treatment
k) TX_ML-Reported quarterly
• Number of ART patients (who were on ART at the beginning of the quarterly reporting period) and
then had no clinical contact since their last expected contact
l) Tx_RTT--Reported quarterly
• Number of ART patients with no clinical contact (or ARV drug pick-up) for greater than 28 days
since their last expected contact who restarted ARVs within the reporting period

13. Rationale for Improving the existing EMR-ART software and overview on
the revised EMR-ART V6.0 software

14. Rationale for improving the existing EMR-ART software
 To address complaints raised by the system users at various levels of the health system
and gap identified through LGA.
• Because of National & PEPFAR indicator changes in HIV/AIDS program
• To Incorporate new features data management changes in HIV/AIDS program
• Improve the role of care providers by providing patient level data for
completeness improvement and use of data for clinical care quality
improvement
• Initiate the involvement of patients on own care provision

15. Rationale for improving the existing EMR-ART…
 There was national revision of HMIS indicators in 2021.
• Indicators change
• Age Disaggregation change
 The needs to accommodate additional PEPFAR reporting requirements
 To address classified user defined reports
• Custom report

16. Rationale for improving the existing EMR-ART …
 Needs to establish interoperability layer with the DHIS2 system
 Needs to establish interoperability layer with the VL-EID system
• helps to reduce TAT for VL test
• helps to improve VL related data quality issues(such as UAN and MRN missed in the request form)
• Helps to intervene HVL
• Helps to identify VL eligible clients
• helps to integrate VL result with patient medical record
 Emergence of new features:-
• Pediatrics Age-Out Functionality
• Advanced HIV Disease
• HIV SMS Consented Clients List
• Differentiated Service Delivery
• Monthly Visit List
• ETORRS Notifications

17. EMR-ART Software Features
Features of improved EMR-ART System
• Dashboard
• Add Patient
• HIV Testing Service
• Provider View
• Treatment and Follow-up
• Viral Load
• Exposure prophylaxis
• Report and Analytics
• Administration
• Data Quality Assurance
• Help
• Log Out
• Quit

18. EMR-ART software Features …
Dashboards
• Helps to visually tracks,
analyzes and displays key
performance indicators,
and metrics

19. EMR-ART software Features …
Add Patient
• Centrally all features are
accessed here

20. HTS: Tracking HIV Positive and Case Based Surveillance:
HTS:
Enables users to document service related to tracking HIV Positives and Case Based Reporting.

21. HTS: Retest
HTS: Retest:

22. HTS: Index Case Testing:
Index Case Testing:
• Personal information
• Family Index Case
Contacts
• Partner Index Case
Contacts

23. Post-Exposure Prophylaxis
Post-Exposure Prophylaxis:
• Exposed person information
• Exposure detail
• Exposed person follow-up

24. Pre-Exposure Prophylaxis
Pre-Exposure
Prophylaxis:
• Use to capture PrEP
data for FSW and
Discordant Couples

25. Treatment and Follow-up
Sub-functionalities under Treatment
and Follow-up :
• General
• Nutrition, Pregnancy & FP
• TB Screening, OI and Pain Management
• CTX preventive therapy & lab results
• ARV drugs/TO Management
• HIV prevention plan
• DSD
• Cervical Cancer
 Print functionality for lost patient cards

26. Treatment and Follow-up: DSD
Treatment and Follow-up : The DSD
menu in SmartCare helps to record
information on differentiated models for PLHIV,
ARV regimen and follow-up. :-
• Improve service quality, results in cost
savings or reduce health care costs,
• improve health outcomes,
• Accelerate the achievement of the second
95 target by Offloading workload from
overburdened health facilities and Improve
adherence and retention

27. Treatment and Follow-up: DSD Models

28. Treatment and Follow-up: Different DSD Model
No DSD Model Type Description
1 Appointment Spacing Model Stable clients will be appointed every six months for clinical visit and medication refill.
2 Three Months ARV
Dispensing (3MMD)
In the three months ARV dispensing model, clients who are eligible but not willing to
be enrolled in 6 MMD (ASM) will be appointed every three months for both clinical
visit and medication refill.
3 Fast Track ARV Drugs Refill
Model
Fast Track ARV drugs Refill (FTAR) is one of the facility based Differentiated Service
Delivery Models of HIV care where patients categorized as stable make clinical visit
once every six months but collect their medication every three months from
pharmacy.
4 Health Extension Professional
Managed Community ART
refill group (HEP_CAG)
Community ART refill groups (CAGs) are groups comprising of stable clients on ART
living in the same community/locality that have a shared understanding. This model is
managed by health extension professionals (HEPs) who already have roles in HIV
testing and other HIV service provision as one of their packages.

29. Treatment and Follow-up: Different DSD Model
No DSD Model Type Description
5 Peer lead community based ART
distribution/Group (PCAD/G)
The peer led Community based ART distribution (PCAD) groups are groups of PLHIV comprising
of stable clients living in the same community/ locality. In PCAD, group members will take turns
to pick up ARVs at the health facility and distribute among the other group members in the
community.
6 Health care worker managed DSD
Model for adolescent living with HIV
(DSD for ALHIV)
DSD for adolescents has three core elements which include ART refill, clinical consultation and
psychosocial support. This model is coordinated by trained health care workers (HCWs), and
regularly meet on weekends and share psychosocial supports.
7 DSD for key population (for
FSWs)
In Ethiopia there are efforts to make public and private facilities KP friendly by building the
capacity of providers and arranging service delivery approach to match their needs.
8 MCH _DSD Mothers living with HIV and their infants are important target population for differentiated
service model (DSD).
9 DSD for Adolescent DSD for adolescent is categorized under more intensive models assuming that most of
the adolescents require close follow up and adherence support.
10 DSD-Others

30. Treatment and Follow-up : Tracing
Treatment and Follow-up :Tracing
• helps to track ART patients who missed
their appointments.
• enable us to see different tracing status:
o Missed
o 1st lost
o 2nd lost
o Dropped
o Traced
o Untraced

31. Treatment and Follow-up : Tracing

32. Treatment and Follow-up : Scheduled visit
Treatment and Follow-up :Scheduled Visit
• Appointment list
• Appointment report

33. Treatment and Follow-up : Transfer Out

34. Viral Load/ETORR
Viral Load
• Automated version of viral load
requisition and reporting form.
• Enables to automatically send test
request and receive result using
web API using an internet
connection.
• Display VL eligibility list
• Display VL test request and
result(HVL priority)

35. WebAPI interoperability layer Design/blueprint

36. Process Flow
Provider Facility Lab DC
Runner
P
o
s
t
a
DDC Quality Off.

37. Report and Analytics
Report and Analytics
Enables the users to generate and export
HMIS/DHIS2, DATIM, Line List,
Cohort and Custom reports

38. Report and Analytics: HMIS/DHIS2 New
HMIS/DHIS2: Enable
users to generate and export
HMIS/DHIS2 report
HMIS/DHIS2
Old
HMIS/DHIS2 from the drop-
down content (this form is
preserved to get previous
data)

39. Report and Analytics: DATIM
DATIM: Enables the users to
generate and export DATIM report

40. Report and Analytics Line list: Lost/Dropped
Lost
Status

41. Report and Analytics Line list: Lost/Dropped
Dropped
Status

42. Report and Analytics Line list: TX_CURR Report Analysis
Summary Report: Enable users
to generate Summary report with:-
• PreviousMonth Tx_Current
• To
• Lost
• Drop
• Dead
• Not Updated
• Traced Back
• Restart
• TI
• Newly Initiated
• CurrentMonth
Tx_Current
• Tx_Current Net
Increment

43. Report and Analytics: Cohort
Cohort:Enable users to
generate and export Cohort
report

44. Report and Analytics: Custom Report
Custom Report Enable users to
generate and export Custom report
Helps to :-
• To display clients’, follow up based
on their ART Start Date
• To display patient information
• To display clients last follow up
aggregate report grouped by
follow-up status
• To display custom report based on
filter criteria of “HIV Confirm
Date”

45. Data Quality
Defined as “fitness for use.”
• Data are fit for their intended uses in operations, decision making, and
planning.
• Data reflect real value or true performance.
• Data meet reasonable standards when checked against criteria for quality.

46. Dimensions of Data Quality
Data
Quality
Accuracy
and
validity
Accessibilit
y
Legibility
Timeliness
Completene
ss
Reliability

47. Possible Reasons for poor data quality in HIV related information
Systems
• Poor quality of data in the individual medical record due to
• Incompleteness,
• Duplication (multiple records for the same individual)
• Loss of individual medical records
• Mistyping of figures
• Knowledge or skill gap in using the electronic system
• Not interested in using the system for different reasons

48. Features in EMR-ART for Data Quality
i. Data validations
a. Must to be filed data elements/required fields
b. Limiting the erroneous data entry possibilities
ii. Auto calculating some data fields
iii. Decision Support Systems
iv. Notification and alerts
v. Managing duplicated records
vi. Managing incomplete records

49. EMR-ART System: Data Quality Assurance Feature
Data Quality
Assurance
• Duplication
• Completeness
• Consistency/Validation
• Deleted Duplication

50. EMR-ART System Implementation Status

51. Summary
 Data entry validation thus improved data quality
 Assisted Searching
 Tracing
 TO management and notification
 Computations
 Appointment/Scheduled Visit
 Generates:
 Aggregated report(HMIS, DATIM)
 Line list report
 Cohort report
 Custom report

52. Get Started
Improved EMR-ART software

53. Get Started Improved EMR-ART System
Live Demo

54. Thank You!!!