Date post: | 03-Jul-2015 |
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Bobby Jefferson, Senior Health Informatics Advisor, Futures Group
• Principal Investigator CDC HMIS Grant Kenya
• CDC Strengthening HIV Strategic Information Activities In The Central Asia Republics Columbia University
• CDC Partners in AIDS Care and Treatment in Kenya, University of Maryland Institute of Human Virology
• CDC National Teaching and Referral Hospitals Centers of Excellence in Kenya, University of Maryland Institute of Human
Virology
Implementing eHealth EMR for Low Resource Hospitals in Developing Countries
Outline
Description Low Resource Environment
Approach Low cost, appropriate technology
Solutions
Sharing Lessons
We are working across 15 Countries, 1,033 Hospital Facilities + Satellites Clinics , Antenatal Care - PMTCT sites (535 in Tanzania)
Rural, remote, mission hospitals “serving poorest of poor” and Ministry of Health (MOH) facilities
• Intermittent power, • Lack IT staff, • Lack internet, • Sparse mobile coverage
Low Resource Environment
Results
• Internet
• Mobiles, SMS
Rural, Remote City
# of Facilities
• Sparse Mobile Coverage• No Internet
• Intermittent Power
Online Solutions
MobileSolutions
Offline, DisconnectedSolutions
• Smartphones
Nurses, Clinicians, Adherence Counselors, need health data, M&E program data in knowledge repository
• Lack of referrals, or linkage between HIV, PMTCT, TB, or to existing technology systems
• Cost effectiveness and sustainability -- no funds for proprietary licenses, or yearly maintenance fees
Low Resource Environment
Approach
Use of freely available, reusable, tools, “coded in country” Creative commons approach
Reusable software and technology across countries and programs
Offline Solutions, Disconnected model
Local programmers, all IT staff in country (Africa)
- Programmer training SQL, coding C#, Agile process
Low costs, Inexpensive $200-$350 Netbooks , Solar netbooks
Solar mobile phones, SMS instead of Smartphones
- Use of inverters to address power
Health IT Solutions
Collectively referred to as IQSolutions
1. Electronic medical records
1. IQCare - Technical Assessment by CDC Atlanta, WHO,
USAID, NASCOP and MOH
2. IQChart - French language Rwanda
2. Mobile Phone solution (IQSMS technology)
3. Visual Dashboards
4. Monitoring & Evaluation Electronic reporting
5. SQL Training, Programmer Training, Virus Remediation
Training
6. Data Demand and Information Use (DDIU) and reducing
operational costs
IQCare
*Paper-based records automated
*Clinicians able to review individual patient histories, prescribed drugs, ordered tests and results, and progress on care and
treatment during the exam
Clinicians able to review individual patient histories
*Clinicians review patient histories, prescribed drugs, ordered tests and results, and progress on care and treatment during the exam
Browser, SQL Express, .NET, openSSLArtifacts• Entity Relationship Diagram (ERD)• Data Dictionary• Use Case Document• Business Rules Document
EMR SystemIQCare
(Facility Level)
DonorsOGAC, CDC, HRSA, USAID
MOH National ReportsNext Gen Indicators (NGI)
Community Mobile health solutionsDimagi, mHealth Alliance,
Nethope
HL7 v2.4
SDMX-HD
mHealth
Pharmacy , Supply ChainManagement Sciences Health,
ARV dispensing tool (ADT)
Clinical/Medical PartnersSchool of Medicine, Faith Based Orgs
Mennonite Christian Charities
CHAK, IMA
Integrated HIV, TB, PMTCT
Intel World AheadNetbooks, low cost,
low power
Financial Mgmt PartnersPastel Software,
Tableau Dashboard
Laboratory PartnersOpenELISBika Labs
TherapyEdge
District Indicators, DHIS v2.0 software,
Other EMR
• Improved Data Quality• Improved Data Use at health facility• 200 Data Managers trained• Reducing Costs, Improved Patient Workflow
Kenya Results
• PMTCT forms• Integrated HIV, TB, PMTCT 3IPMS
MOH 711 , MOH 257 “blue card”
TotalTotal
Patients served Non ART ART Transactions UniqueVisits
Visit Type
ARTFollow UpVisits
Labvisits
pharmacyVisits
31 118,820 67,806 51,014 4,178,313 2,005,502 1,405,984 741,075 1,501,027
This is to sincerely thank you for having come to our users’ training that was held at Baraton from 1st – 5th August 2011. We had a successful meeting attended by 60 users from South Rift, Kisumu West and KDoD. From their feedback, they liked the IQCare because of its robustness, ease of use and especially the way it captures our forms. We shall be having more of this especially refresher courses in future after we have rolled out IQCare. As of now we are confident on the system and ready to implement the system.
demo
http://173.203.65.108/iqcare/frmLogin.aspx
Username: user1
Password: 1
Facility/Satellite: 001-01-01-Demo Site
PMTCT Currently consists of 4 types of monthly reports
1. PMTCT Antenatal Clinic (ANC) Monthly Summary Form
2. PMTCT Care Register Monthly Summary Form
3. PMTCT Maternity (L&D) Monthly Summary Form
4. PMTCT Mother - Child followup SummarForm
IQSMS PMTCT Reports
IQSMS – Mobile Phone Reporting by Health Workers
Monthly and Quarterly Reports
PMTCT Report
Must Pass All Data Quality Rules,District Office
Data Quality Checks
NUMBER OF CLIENT HAD HIV TEST AT ANC
• Nurses and community health worker receive per diem or transports costs for picking up or bringing their list and reports back and forth to health facilities, district offices, etc.,– they’re not interested in losing out in reimbursement;
• After early adopters, health care workers not keen sending message unless they have free airtime and toll free number available from their mobile telecom provider ; we increase use by 50% when toll free is available
• The older staff have more difficulty using mobile for messaging and reporting;
• Often other people have access to the phones (25% share phone vs. Own) and often those text message can be forwarded to others
• Staff in rural areas want their SMS messages in Swahili or local language; Detailed instructions in Swahili to how to do reporting and use phones for reporting
technology isn’t the barrier to scale up
Facility Name District
Distance from
Facility to
District (KM)
Time spent to
Deliver PMTCT
Report (Hrs)
Bus Fare (Tsh)
MWANZA Region
NYAMAGANA DISTRICT
Mwamashimba Health Centre Kwimba 50 1.30hrs 10000
Malya Health Centre Kwimba 25 1hr 5000
Kikubiji Dispensary Kwimba 102 4hrs 20000
Kiliwi Dispensary Kwimba 100 4hrs 20000
KWIMBA DISTRICTNyakalilo Health Center Sengerema 46 2 HRS 8000
Mwangika Health Centre Sengerema 98 4 HRS 10000
Sengerema Health Centre Sengerema 10 20MIN 3000
SENGEREMA DISTRICTKharumwa Health Centre Geita 115 3HRS 20000
Nzera Health Centre Geita 48 2HRS 8000
Katoro Health Centre Geita 50 45MIN 6000
Nkome Dispensary Geita 80 2HRS 6000
Nyang'hwale Health Center Geita 85 2HRS 7000
Kasamwa Health Centre Geita 25 30MIN 4000
Bukori Health Centre Geita 60 1:30HRS 6000
Tanzania
• Delays with data flow and information reporting from the District and Regional level to the National level
• Inaccuracy of reports being received thus requiring further on site data verification
• High cost of supervision and sending report to district in regards to travel costs to access the 535 health facilities
• Ever used the phone for SMS servicesNo 52.17%
Yes 47.83%
Total 100
– All staff own the telephone handset and share it in daily personal uses
Any problems with small buttons on the phone?
Response Freq %
No 30 85.71
Yes 5 14.29
Total 35 100
Instruction on Swahili critical to using IQSMS
Response Freq %
No 6 17.14
Yes 29 82.86
Total 35 100
• Reasons For Not Sending Monthly Report– Majority said they don’t understand English
language
– Need message understandable in Swahili language
IQSMS Instructions in Swahili
• Anything that can be improved on report submission to make report to be on time
• Response Freq %
• No 14 40.00
• Yes 21 60.00
• Total 35 100
Barriers to implementing mobile phone reporting for submitting all four reports each month Mobile Network Problem/failure
Server don’t respond on time
PCR report type is hard
It have been found that free Airtime is critical for scale up
*EMRS – Electronic Medical Records System
Health IT Solutions
*EMRS – Electronic Medical Records System
Health IT Solutions
Tanzania mobile phone coverage and mobile penetration Vpdacom Tanzania
•
Excel
PMTCT MONTHLY REPORT
PMTCT Antenatal Clinic (ANC) Monthly
Summary Form
ANC 01. New ANC clients this month
118
8ANC 02. Previously known to be HIV
positive 17
ANC 03. Total number tasted 574ANC 04. Number of new client had HIV test
at ANC 277
ANC 05. Tested HIV-Positive 37ANC 06. Post-test counseled for positive
and negative 574
ANC 07. Number of partners tested for HIV 16
ANC 08. Tested HIV-Positive 4
Orphans Vulnerable Children (OVC), Most At Risk Population (MARPS), Maternal Child Health (MNH)
Ms Access Database
PDA device
Web Internet Desktop
Excel Only
M&E Electronic Reporting SystemSolar Power Cell phones
Site Capacity Dashboard
demo
http://scademo.dyndns.org
Username: demo
Password: demo
Collaborators and Users
Rwanda
ICAP Columbia University 44 sitesIntra Health International 17 sitesElizabeth Glaser EGPAF 16 sitesFamily Health Inter FHI 45 sitesCatholic Relief Services 13 sites
Kenya
Catholic Relief Services - 32Pathfinder InternationalGertrude Children HospitalDOD Walter Reed - 28 Mount Kenya UniversityMOH Kenya Sites
AIDSReliefJohn Snow InternationalRakai Health Services Vaccine Research
Uganda
Intra Health International Southern Sudan
Mennonite Christian CharitiesAIDSRElief 35 sites
Nigeria
PMTCT , ANC sites 535 sitesElizabeth Glaser EGPAF
Tanzania
World Vision NETHOPE
Zambia
Ministry of HealthMinistry of Education
Guatemala
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.atsdr.cdc.gov
For more information http://www.iqstrategy.net/frmiqcare.shtml
Source Forge
Contact
Bjefferson at futuresgroup.com
Lburrows at futuresgroup.com