aidsrelief iqcare hmis emr
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Building Sustainable Strategic Information Systems in Low-Resource Countries
Bobby JeffersonSenior HMIS Advisor
AIDSRelief projectFutures Group International LLC
Presenting on behalf of Lanette Burrows, Pat Bass, Ian Wanyeki
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
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
212 ART Treatment
Facilities (Clinics) + 122 satellite
Sites + 288 PMTCT sites
3
7
29
18
2510
78
18
24
Where we work
Futures Group Overview• Futures Group provides strategic information (SI)
capacity building and focuses on:– Improved data demand and information use (DDIU)– Enhancing/implementing patient monitoring and
management (PMM) systems that meet local requirements
– Enhancing Data quality for better services and clinical outcomes
– Using local experts to build capacity at partner sites
Regional Software development teamsin Kenya, Rwanda, South Africa, India
Strategic Information• Committed to collecting only information essential for
clinical management and quality improvement • Capacity building (local ownership)• 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
Patient Management and Monitoring
Typical Hospital Records Center
Finding patient information in the past
Key Features
• 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
Monitoring our programs through IQSolutions
Demonstrate outputs and outcomes– Clinics ability to hit set targets– Trend analysis– CD4 count changes– Mortality & Lost-to-follow-up rates
Case studies demonstrating outcomesUsing data collected on a routine basis for:
– Life table analysis– Defaulter tracking– Quality of life analysis
“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
Implementing IQCare
Number of Sites
Number ofPatients
Kenya 28 65,500
Uganda 20 63,000
Nigeria 27 60,000
Total 75 188,500
Missed ART > 20 days in August- December 2008 per LPTF
Local Partner August September October November December
Hospital # 1 78 21 12 4 3
Hospital # 2 51 23 5 0 0
Hospital # 3 25 22 7 5 5
Hospital # 4 17 19 13 1 1
Hospital # 5 5 0 0 0 0
Hospital # 6 5 1 0 0 0
Hospital # 7 2 0 1 1 2
Hospital # 8 1 1 0 0 0
Hospital # 9 0 0 0 0 0
Hospital # 10 0 0 0 0 0
Hospital # 11 0 0 1 0 0
TOTAL 184 87 39 11 11
What does it provide us with? ARV Pickup Report
Close monitoring of the ART pick up habits over time at LPTFs has helped ensure that fewer patients miss collecting their ARTs on time
What does it provide us with?
August September October November December0
20
40
60
80
100
120
140
160
180
200184
87
39
11
11
All sites
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
Three sites showing the sub-districts they service
# Defaulters per village – Green <5, Yellow 5-10, Red >10
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
Select a village to see the defaulter list and HCW assigned
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
# Defaulters (red) vs avg distance travelled to reach site (blue)
Thank youThank you
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