romanian experience in electronic tb recording and … · romanian experience in electronic tb...
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ROMANIAN EXPERIENCE IN ELECTRONIC TB RECORDING AND REPORTING
Cristian Popa, Elmira IbraimNational TB ProgrammeMarius Nasta Institute of PulmonologyBucharest - Romania
Geneva, April 27th 2011
ROMANIA
Total area: 238 391 km²41 counties + Bucharest (6 sectors)
Population: 21 431 298M: 48.8% F: 51.2%Urban: 53.3% Rural: 46.7%
TB endemic – 2010
• New cases + Relapses = 19 395• Notification rate = 90,5%ooo
• New cases = 16 021 • Pulmonary SS+ = 9 111 • MDR-TB: 2.9% of new cases
11% of retreatments• XDR-TB: 9.9% of new MDR-TB
11% of retreated MDR-TB• TB incidence rate in children =
27.2%ooo
• TB mortality rate (2009) = 7.1%ooo
• Success rate in new pulmonary SS+ cases (2009) = 81.4 %
History of TB recording and reporting
• 1881 – 1900: estimates of TB mortality from TB deaths reported
• Beginning of XX century: TB morbidity estimates from TB cases diagnosed in hospitals or ambulatories
• 1938: mortality and point prevalence (at the end of year)
• 1950: incidence rate of new cases
• 1965: global notification rate (including relapses)
• 1968: incidence rate of pulmonary smear positive cases and rate of bacteriological confirmed cases
• 1997: outcomes registered and reported
• 2001: all re-treatment cases (other than relapses) notified
• 2000: reporting of the TB cases in electronic format (epi info) in paralel with paper
• 2004-2005: development of the new electronic system for TB (SQLS database); use of the electronic system in parallel with paper (Global Fund support)
• 2005-2007 equipment of the TB units with computers & internet
• 2005 →→ trainings for the staff involved in electronic reporting and recording
• 2009: paper based system dropped
Steps in development of the electronic reporting and recording system for TB
- central servers- all (189) TB dispensaries- all penitentiary (3), army (1) and police (1) TB units- MDR-TB centres (2)- all (41) counties TB unit + 6 sectors of Bucharest + equivalent(3) of ministries - 68 of 165 TB laboratories
2006 – TB recording and reporting electronic system (RO-NTBSy) operational and functioning:
Purpose for the creation of the TB electronic recording and reporting system
• TB monitoring tool for central, county and facility level
• Surveillance of drug resistance
• Reports for the NIH, MOH, WHO …
• Data for drug management
• Individual data about TB patients for clinician
40000067%
8000013%
12000020%
software developmentequipmenttrainings
Costs (in USD) of TB electronic recording and reporting system
National TB Surveillance Unit
TB dispensary
County TB unit
MDR-TB centre
Architecture of electronic web based TB case reporting system
TB laboratory
Special units (police,army, prisons)
Access to electronic database limited to authorized staff -protected by password
“Search” module
“Search” module
Registration of TB cases in each TB ambulatory (189)
Bacteriological results registered in the laboratories; matching of data
Registration of TB cases
Recording of hospitalizations
List of hospitalizations
Registration of bacteriological exams results
List of bacteriological results
Recording the treatment
Recording the treatment
Recording the treatment – adverse reactions
Recording the treatment – adherence
Recording the treatment – surgical intervention
Treatment outcome
Registration of transfer
Registration of transfer
MDR-TB module
MDR-TB module
Matching of bacteriological results from dispensary and from laboratory
Validation of treatment outcome
Preformed reports
Custom defined reports
Examples of preformed reports
Examples of preformed reports - aggregate reports
Examples of preformed reports – graphs
Examples of preformed reports – aggregate data
Examples of preformed reports – line listings
Examples of preformed reports – MDR-TB
+ user friendly+ huge amount of information+ security of data+ validation of data+ use of automatic alerts+ avoid duplications+ no delays in data transmission + flexibility to allocate rights to
users+ cases from penitentiary, police,
army in the same database
- limited access to data at different levels (periphery)
- need of technical support inside and outside NTP
- financial sustainability of the system- sources of data only ambulatories &
MDR-TB centers & labs – no hospitals
- module for drug management functional, but not used
- need of good internet connection- maintenance - difficult upgrade (still version I -2005)
Characteristics of TB software application
and some Challenges
+ MDR-TB registry part of the general TB registry
+ double entry of bacteriological data (labs and ambulatories)
+ users have permanent contact each other and with staff in National Surveillance Unit
+ feed back from central level+ data entry at source + various reports (preformed or
custom)+ TB registry permanently updated
- MDR-TB data have to be redefined and updated (date of registration as MDR-TB case etc)
- need of periodic training- few preformed reports- delays in data entry- missing of links with other
databases (pharmacies, NIH, HIV etc)
- data collected to be used for the monitoring of the program performance
Characteristics of TB software application
…and other Challenges