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Chris Seebregts, PhDBiomedical Informatics Research, Medical Research CouncilDepartment of Computer Science, University of KwaZulu-Natal
JembiSOUTH AFRICA
OpenMRS and Open Architectures, Standards and Information Systems for Healthcare in Africa
THAT’SIT PROJECTTHAT’SIT PROJECTo That’sit is a methodology for
improving access to HIV care for tuberculosis patients using a best-practices approach.
o The South African MRC is offering ART to qualifying TB patients as part of that’sit in several provinces in South Africa.
o The aim is to improve treatment outcomes for both TB and HIV by introducing and implementing integrated TB-HIV services wherever possible, including information systems.
Example of HIV / ART Structured Medical Example of HIV / ART Structured Medical Record Forms (KwaZulu-Natal, South Africa)Record Forms (KwaZulu-Natal, South Africa)
Example of HIV / ART Structured Medical Record Forms (Free State, South Africa)
Tuberculosis Treatment Card Page 1Tuberculosis Treatment Card Page 1
District Tuberculosis registerDistrict Tuberculosis register
PEPFAR IndicatorsPEPFAR Indicatorso Core Indicator 1: Existence of national policies, strategies and guidelines for ART programmes
o Core Indicator 2: Percentage of districts or local health administration units with at least one health facility providing ART services in line with national standards
o Core Indicator 3: Percentage of ARV storage and delivery points experiencing stock-outs in the preceding six months
o Additional Indicator 3.1: Percentage of ARV storage and delivery points meeting the minimum quality criteria in addition to having no stock-outs
o Core Indicator 4: Number of health workers trained on ART delivery in accordance with national or international standards
o Core Indicator 5: Percentage of health facilities with systems and items for provision of antiretroviral therapy services
o Core Indicator 6: Percentage of health facilities with ART services which also provide comprehensive care, including prevention services, for HIV-positive clients
o Core Indicator 7: Percentage of people with advanced HIV infection receiving antiretroviral combination therapy
o Core Indicator 8: Continuation of first-line regimen at 6, 12 and 24 months after initiating treatment
o Core Indicator 9: Survival at 6, 12, 24, 36, etc. months after initiation of treatment
South African National M&E Framework IndicatorsSouth African National M&E Framework Indicators
1. Number of accredited service points per district
2. % of facilities experiencing stock out of basket of tracer drugs at any time in the last month
3. Full time equivalent (FTE) per category as proportion of required personnel
4. Male and female condom distribution rate
5. % of eligible patients receiving supplement meal and nutritional supplements
6. Proportion of adult patients on antiretroviral therapy with adherence lower than 70%
7. Number of CD4 counts done per month
8. Number of viral loads completed per month
9. Proportion of registered patients on regimen 1a or 1b, 2 or child regimen
10. % of patients with viral load <400 copies / ml
11. % of patients with CD4 > 200/mm3
12. % of patients with weight gain > 10% compared to baseline
13. % of child (6-14yrs) ART patients with CD4 <15% at staging
14. Known-death rate among patients on antiretroviral therapy
15. Proportion of patients assessed medically eligible for treatment
16. % of assessed patients medically eligible for treatment that completed readiness training
OpenMRS (Open Medical Record System)OpenMRS (Open Medical Record System)
www.openmrs.org
REASONS FOR SELECTING OPENMRSREASONS FOR SELECTING OPENMRSo Configurable forms based application that can provide a very
close fit with systems created by the South African Ministry of Health.
o Readily configured for different forms used by different programs and provinces while maintaining the same basic concept dictionary (integration of data and same reports)
o Open source application, in line with the progressive decision by the South African Cabinet to promote the use of open source software within government departments.
o Scalable to accommodate hundreds of thousands or millions of patients on ART.
o Open standards and interfaces allowing interfacing with other applications, notably the electronic TB register and the DHIS.
o Powerful support for localization into other languages (African languages, Portuguese, French etc)
HIV/ART Information Management System in KwaZulu-NatalHIV/ART Information Management System in KwaZulu-Natal
Paper Form Computerized Form
Encounter Forms (HIV / ART and TB)Encounter Forms (HIV / ART and TB)
Integration of OpenMRS with ETR.Net and DHISIntegration of OpenMRS with ETR.Net and DHIS
Integration of OpenMRS with ETR.NetIntegration of OpenMRS with ETR.Net
OPENMRS: IMPLEMENTATION SUPPORTOPENMRS: IMPLEMENTATION SUPPORT
First OpenMRS Implementers Meeting – 130 Participants, 22 countriesFirst OpenMRS Implementers Meeting – 130 Participants, 22 countries
OASIS ObjectivesOASIS Objectives1. OpenMRS Implementers Network
1. Support and expand the OpenMRS implementers network;
2. Strengthen existing implementations in South Africa, Mozambique and Zimbabwe;
3. Investigate cooperative open source software development, implementation and maintenance in developing countries
2. Capacity Development1. OpenMRS Internship Program;
2. Regional Training and Implementers Meetings;
3. Evaluating other health FOSS (free and open source software;)
4. Evaluate data integration, open data access models and data sharing.
5. Explore sustainable models for supporting OpenMRS and other open source health software applications in a commercial competitive market.
6. Integrate and evaluate the lessons learned.
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LOCALIZATION (MOZAMBIQUE)LOCALIZATION (MOZAMBIQUE)
OpenMRS Training – Harare, ZimbabweOpenMRS Training – Harare, Zimbabwe
Proposed Integrated PHC SystemProposed Integrated PHC System
Facility
HIV/ART DataOpenMRS(Vanderbilt)
PHC Data (TB)OpenMRS(OASIS)
HL7
Modulo BasicoMS-AccessVanderbilt
DHISMS-Access
(OASIS)
IXF
IXF
ObitoMS-Access
(OASIS)HL7
ObitoReports
District
DHISMS-Access
(OASIS)
DH
IS
National
DHISMS-Access
(OASIS)
Province
DHISMS-Access
(OASIS)
DH
ISD
HIS
CRIS IXF
ETR.Net(CDC)
PHC Data (TB)OpenMRS(OASIS)
HL7
IXF
IXF
Modulo BasicoMS-AccessVanderbilt
Modulo BasicoMS-AccessVanderbilt
IXF
IXF
Modulo BasicoMS-AccessVanderbilt
IXF
IXF
Standards-based Data IntegrationStandards-based Data Integration
Free and Open Source Software Interoperability LaboratoryFree and Open Source Software Interoperability Laboratory
Mobile Data Collection Linked to OpenMRSMobile Data Collection Linked to OpenMRS
JavaROSA Open Source Data Collection Application
Rural WorkstationRural Workstation
Integrated Teleconsultation
Low cost diagnostics
Surveillance of Drug Resistance and Genetic SubtypesSurveillance of Drug Resistance and Genetic Subtypes
The Zachman FrameworkThe Zachman Framework
The Open Group Architecture Framework The Open Group Architecture Framework (TOGAF)(TOGAF)
Architecture Development Method (ADM)
Enterprise Continuum
The Health Metrics Network FrameworkThe Health Metrics Network Framework
The HMN Framework (version 2)Roadmap for Implementing the HMN Framework
Example: National TB Control Program
WHO Guideline for TB TreatmentWHO Guideline for TB Treatment
Archimate Notation and Modeling LanguageArchimate Notation and Modeling Language
HMN FrameworkHMN Framework
National TB Control Program (NTP)National TB Control Program (NTP)
Standards-based Data IntegrationStandards-based Data Integration
National TB Control ProgramNational TB Control Program
ETR.Net Function Point AnalysisETR.Net Function Point Analysis
ETR.Net FunctionsETR.Net Functions
Patient Record Analysis Reports
Standard TB Class DiagramStandard TB Class Diagram
TB Diagnosis Class DiagramTB Diagnosis Class Diagram
Standard TB Data ModelStandard TB Data Model
Semantic Table and Field DefinitionSemantic Table and Field Definition
Funders and CollaboratorsFunders and Collaboratorso Centers for Disease Control – Bill Coggin, Subroto Banerjio Dept of Health (KZN) – Chris Jack, Roger Pillayo Dept of Health (National) – Carina Idema, Shaheen Khotuo Foundation for Professional Development – Margot Uyso Google Inco Health Information Systems Program – Calle Hedberg, Jorn Braao International Development Research Centre – Heloise Emdon, Steve Songo Medical Research Council – Karin Weyer, Natasha Naidooo Harvard Medical School and Partners in Health – Hamish Frasero Regenstrief institute – Burke Mamlin, Paul Biondich, Bill Tierneyo University of KwaZulu-Natal – Yashik Singh, Carl Fourieo University of the Western Cape – Harry Hausslero WAM Technology cc – Paul Mareeo World Health Organisation – Christopher Bailey, Mark Spohr
DESIGN CRITERIA FOR THAT’SIT ISDESIGN CRITERIA FOR THAT’SIT ISo Support paper forms and computerized data systemso Integrated TB and HIV information management;o Support chronic care and clinical decision-makingo Integrated with other district, provincial and national health information
systems;o Balanced design between operational requirements and future needs;o Effective by improving patient and treatment information management and
easily providing for aggregate and indicator reporting functions;o Configurable and adaptable to changing needs of the program, other clinics
hospital, provinces and countries, other diseases;o Affordable and available to a large number of sites;o Scalable and able to robustly store a large number of records;o Open standards for data storage and interchange and should use free and
open source software (FOSS), wherever possible;o Sustainable and maintainable;o Powerful and easy to use;o Flexible and extensible;o Reuse existing application software and avoid `reinventing the wheel’.