AIDSRelief EMR software

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

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

10. M&E specialists

11. HIV/AIDS experts

12. Clinicians

13. HMIS experts

14. Programmers

17. Capacity building (local ownership)

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

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

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

46. Trend analysis

47. CD4 count changes

49. Defaulter tracking

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

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

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

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.