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INTERGRATING TB/HIV INTERGRATING TB/HIV DATABASESDATABASES
Presenter:
DR. LAMECK DIERO
Presentation OutlinePresentation Outline
Introduction
AimsActivitiesChallenges
HIV/TB co-infected patients access care in two ways.
1) TB clinic patients test positive for HIV or 2) HIV-clinic patients are found to be infected with TB• Ideally services provided in these two clinics
should be well integratedHowever, communication between the two
clinics is often fragmented leading to disruptions of care and mismanagement of some co-infected patients
Introduction
Long term GoalsImprove delivery of patient careImprove staff efficiencyImprove reporting of public
health data to the Ministry of Health.
Specific AimsImplement TB EMR at MTRHLink the TB EMR to the existing
HIV/AIDS EMR◦ to improve integration and
monitoring of care of TB patients◦To increase the percentage of TB co
infected patients completing treatment
◦To increase the percent of TB patients referred to and retained by the HIV care program.
Specific AimsImplement the use of patient
summary sheets and clinical reminders◦To improve delivery of care◦To increase the % of TB patients
receiving appropriate AFB smear follow up after initiation of treatment
Project DesignAim 1: Implement the primary care
EMR◦Program the EMR into SQL programming
language to interface with AMRS◦Program expanded formats for TB into
the system◦Expanded Tb program to include
Patient identifiers, referral site, type of patient (eg smear positive, or smear negative), type of TB ( eg pulmonary or extra pulmonary), sputum smear results, culture results, X rays etc.
Project DesignAim 1
◦Train data management and entry staff
◦Patient registration into the system◦Develop pre-programmed queries to
generate monthly reports.
Project Design Aim 2: Link primary care EMR and existing
HIV/AIDS EMRAll patients presenting to the hospital are
enrolled in the system and given a unique patient ID number◦ By using unique identifiers that all patients within the
catchment's area are given Allows data sharing Allows better tracking of patients
◦ For TB care, it enhances the following Treatment completion
Completion of >95% of patients in the TB register. Successful completion of all recommended sputum
examinations Registration of TB patients into the TB care module
Achieve 100% registration
Project DesignAim 3: Implement use of
summary sheets and reminders◦These will highlight information key
to making treatment decisions◦Generate clinical reminders
Tests to be done Clinical parameters to be measured Treatments to be considered
◦Installation of local area networks in MTRH,
◦Installation of equipment i.e. computers, laminators, server, network, printers, etc.
◦Initiation of on-site data entry at the sites.
Completed tasks
◦Programming of TB encounter form◦Design of the universal ID’s◦Establishment of a patient registration
system at MTRH in-line with the Implementation process towards achieving a complete Medical Records System.
◦Initiated Electronic Medical Records for the TB Clinic.
Completed tasks [ cont..]
Sample Universal ID Card
Front Side
Back Side
AMRS TB Encounter Form
◦Trained over 100 records staff at MTRH on patient registration, data entry and terminal filing system.
◦Oriented all clinicians, nurses and lab technicians at the sites on the correct use of encounter forms.
Training
ProgressTotal number of 545 TB patients
registered ◦389 HIV co infected
Challenges Faced:Challenges Faced:Personnel challenges
◦Having to use records clerks at the facility rather than recruiting our own.
◦Using clerks with no prior computer training. ◦Having insufficient numbers of personnel.◦Attitudes of the personnel[resistance to
change and having the perception that system is burdensome and adds no value to their work]
◦Project inability to enforce rules and regulations on MoH staff.
◦Frequent transfer of trained staff
System challenges◦Programming of forms is a long and
tedious process that requires input from many stakeholders
◦Server and computer breakdowns ◦Frequent power shortages◦Balancing the use of the new
computerized system alongside the old manual system since both run concurrently at the onset.
Logistical challenges◦Fitting the whole process within the
hospital workflow with minimal changes to it.
Next stepsNext stepsComplete the development of the
decision support program (Ongoing).Initiate generation of enhanced
Patient Summary Reports with computer reminders at all project sites.
Conduct a satisfaction survey with health center personnel and administrators at each site
AcknowledgementsAcknowledgementsProject TeamCDCUSAID-AMPATHIeDEA