and at Indus Hospital, Karachi, Pakistan...• Interaction with Indus Hospital’s HMIS – In the works. Mobile phone based Conditional Cash Transfer Indus TB REACH grant • GPs:
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Electronic Recording and Reporting at Indus Hospital, Karachi, Pakistan
Aamir Khan, MD PhDExecutive Director
Indus Hospital TB ProgramInteractive Research & Development
Quality care free of cost
TB Program Overview
Updated till April 22, 2011
TB (all forms) case notificationIndus Hospital DOTS Clinic 2007‐2011
Indus Hospital DR‐TB patients (Apr 13, 2011)
Treatment Status
XDR TBN(%)
MDR SUSPECT
N(%)
MDRTBN(%)
PDRTBN(%)
MONOTBN(%)
MOTT
N(%)
TOTAL
N(%)
Enrolled 7(88)
3 (100)
231 (82)
34(92)
20(83)
4(34)
299(81)
* All percentages are of registered patients** Awaiting treatment include self financed patients
Registered 8 3 282 37 24 12 366
Round 9 SR for Sindh and Balochistan province5500 MDR‐TB patients to be put on treatment in Sindh/Balochistan
Rationale for ERR
• Private sector provider reporting to NTP ‐must follow national R&R system
• Most patients treated in the private sector are not reported to NTP
• Need a system that can be implemented in both the private sector along with the public sector
• DR‐TB patient management is complex
Why ERR?
• Improved data quality
• Easier backup and storage
• Faster reporting
• Easier analysis
• Accessible remotely
• Role‐based access allows security
Solution
• Open‐source: low‐cost of initial acquisition, moderate cost of operation
• Integration: 2 existing open‐source solutions OpenMRS and openXdata
• Development: GIS visualization module for both OpenMRS and openXdata
• Open Medical Record System– in use since 2008– 600+ patients on the system
• MDR‐TB module– Lab tests (smear, culture, DST)– Regimens– Tracking treatment e.g. conversion– Type of TB etc– Transitioning to version 2
OpenMRS Mobile
• MDR‐TB DOT data via cell phone– Connects to OpenMRS– Treatment supporters visit patient daily
– Enter DOT data on the cell phone• Real‐time
– Allows effective monitoring– Removes paper from the system
• Improves data quality
– Scale‐up underway– Use can be expanded beyond DOT
TB horizonReal‐time data visualization on Google Earth
Patient medical recordsReal‐time data visualization on Google Earth
Patient medical recordsReal‐time data visualization on Google Earth
Individual Aggregate Real‐time data visualization on Google Earth
OpenMRS MDR‐TB module v2
• Currently in transition
• Faster system
• Better documented
• Easier to install and set up
• More user friendly
• Downside: – no data migration path from v1 to v2
– development required to connect to openMRS mobile
Challenges
• Requires dedicated IT staff
• High memory consumption in older software version– New version and dedicated hardware have helped
• Initial implementation requires a lot of effort– From IT staff
– From program staff
– From clinical staff
• Interaction with Indus Hospital’s HMIS– In the works
Mobile phone based Conditional Cash Transfer
Indus TB REACH grant
• GPs: identifying and referring suspects, TB case
confirmation, cure/completion
• CHWs: household contact tracing, identifying and referring suspects, TB case confirmation, cure/completion
Q1 2011 in comparison to Q4 2010Indus Hospital DOTS Clinic 2010‐2011
• 108% increase in all forms TB• 125% increase in pulmonary TB• 133% increase in SS+ pulmonary TB• 114% increase in SS‐ pulmonary TB• 75% increase in extra‐pulmonary TB• 44% increase in childhood TB
Indus Hospital has become the highest DOTSreporting center in Sindh province in Q1 2011
Percent change over previous quarter in DOTS TB (all forms) case notificationIndus Hospital DOTS Clinic 2010‐2011
TB REACHintervention
Projections: DOTS TB registration at April 2011 rateIndus Hospital DOTS Clinic 2010‐2011
Drug supply and management
breakdown
?
Pediatric TB cases at Indus Hospital: Annual enrollment and Reporting to NTP
2010: Children accounted for 20% (142/709) of total TB cases
35% cases diagnosed through TBREACH
Results HIV N(%)
HCVN(%)
HBVN(%)
Reactive 2 (1) 35 (13) 11 (4)
Borderline 0 4 (2) 0
Non‐reactive 324 (99) 222 (85) 248 (96)
Total Tested 326 261 259
HIV, HCV & HBV Serology Status in Registered DR TB Patients (Apr 13, 2011 )
HbA1c > 6.5% in Registered DR TB Patients (Apr 13, 2011)
Age RangeN(%)
Proportion Positive of Total TestedN(%)
Total Patients >6.5%
Total Tested
NMale Female
>6.5 Tested >6.5 Tested0‐<15 0 5 0 6 0 1115‐<25 3 (10) 31 6 (11) 55 9 (10) 8625‐<35 5 (21) 24 2 (7) 28 7 (13) 5235‐<45 10 (32) 31 4 (20) 20 14 (27) 5145‐<55 3 (27) 11 4 (36) 11 7 (32) 2255‐<65 2 (25) 8 2 (33) 6 4 (29) 14>65 1 (50) 2 0 2 1 (25) 4Total 24 (21) 112 18 (14) 128 42 (18) 240
Key lessons learnt & advice for countries
• The R&R system must provide useful feedback to data generators
• TB is a complex disease; ERR systems need to allow for locally relevant data points
• Partnerships are key. There is no single solution available for countries.
• Visit ERR sites before selecting a system.
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Quality care free of cost
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