Partners In Health Touchscreen point-of-care EMR for Integrated Chronic Care (IC3) in Neno District (Malawi)

1. July 2019
New Digital Solutions using Point-of-
Care EMR for Chronic Care in Neno

2. 2
Overview
Integrated Chronic Care Clinic (IC3) is an innovative method of
providing treatment in Neno District (Malawi) health facilities.
The EMR is now used at point-of-care at the clinic for capturing
data and assisting with the workflow of patients as they are
screened and treated for HIV, TB, malnutrition, hypertension,
diabetes, pregnancy, cervical cancer, etc.
Dr Emily Wroe and the Boston Medical Informatics team present
the latest from Neno.

3. 3
Integrated Chronic Care Cascade
COMMUNITY
PRIMARY CARE
SECONDARY CARE
ADVANCED CHRONIC DISEASE CARE
INTEGRATED CHRONIC DISEASE CARE
COMMUNITY SCREENING AND
EDUCATION
Communit
y
Screening
IC3
Advanced
NCD &
MH clinics
HOME
COMMUNITY HEALTH WORKERS
CHW
Househol
d Model

4. 4
Integrated Chronic Care Cascade
COMMUNITY
PRIMARY CARE
SECONDARY CARE
ADVANCED CHRONIC DISEASE CARE
Integrated primary healthcare: one
model for HIV and NCDs
Community education and integrated
screening for common conditions
Communit
y
Screening
IC3
Advanced
NCD &
MH clinics
HOME
Home based support, longitudinal follow
up, missed visit tracking, and linkage to
care
CHW
Househol
d Model

5. 5
2018 IC3 patient volume

6. 6
Integrated Chronic Care Clinic
Client Check-
in and triage
Screening &
direct referral
Client sees
clinician
Collect
medicine and
check out
Education
• All HIV and NCD clients seen in one clinic
• Patient-centric care model
• One appointment for all conditions
• Added efficiencies for staff and space
IC
3
Integrated
Chronic
Care
Clinic
IC3
  

7. 7
IC3 Clinic Screening Workflow
Record
s
Station
Vitals
(Height/
Weight)
Vitals
(BP/
Glucos
e)
TB/HIV
Registration
Clinical
Encounter
Nurse
Station
(Meds, FP,
Check-out)
HTS Viral Load
(DBS)
Informatics
enters data from
MC into child
servers

8. 8
Paper-based screening form

9. Paper Mastercard

10. 10
EMR use in Neno
●EMR
Intervention​
●Addressing the problem ●Results​
●Appointment
Report​
• Bottlenecks in wait time​
• Task sharing for VL &
laboratory testing​
●• Reduced wait time by
26% (58 min to 43 min)​
●• Increased VL testing
from 65% to 88%​
●In Ward Report​ ●• Link outpatient care reports
to inpatient system​
●• Insert one page summary
into inpatient charts ​
●• >40% of admissions​

11. 11
EMR use in Neno
●EMR
Intervention​
●Addressing the problem​ ●Results​
●Defaulted patients​ ●• Patients missing
appointments or defaulting
from care​
●• Two tiered process to
find patients​
●• >90% of all HIV and NCD
patients are consistently seen
every 3 months​
●Monthly and quarterly
monitoring reports​
●• Data fluency​
●• Quality improvement​
●• Mentorship​
●• Biweekly team meetings​
●• Quarterly data review
meetings​
●• System improvement
projects ongoing​

12. 12
IC3 EMR App – Project goals
The implementation of this new IC3 application solves the
following issues:
• Screening and alert criteria are complicated and difficult for the
screeners and clinicians to track
• No electronic screening data
• Duplicate entry of monitoring data for enrolled patients
•
• Strategic objectives:
•
• Next-generation user interface for PIH EMR systems
• Framework for point-of-care entry of mastercard data

13. 13
IC3 EMR App – Unique features
Unique features
• Layout optimized for touchscreen tablet
• Automated screening station queues
• Alert action banner
• Patient alerts displayed for nurse and
clinician
• Integration with existing Mastercard data
entry

14. 14
Demo
DEMO

15. 15
POC EMR implementation: lessons learned
•
• Staff currently report that they anticipate POC EMR will improve
• data quality
• efficiency for clerks
• quality of screening with decision support built in
• the ability to monitor screening data
•
• Challenges:
• network interruptions
• mixed system of POC and retrospective data entry
• getting all staff comfortable with tablets, mobile data entry, and the interface

16. 16
Screening app – Future direction
• POC EMR evaluation including an ongoing time motion study
• Dispensing integration
• Expanded clinical decision support at point of care
• Support fully paperless mastercard entry across all programs
•
IC3
Registration
and
Screening
IC3
Dispensing
integration
AdvancedNCD
Clinic
Expand
Clinical
Decision
Support
PHASE 1 PHASE 3PHASE 2