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 integrated However, communication between the two clinics is often fragmented leading to disruptions of care and mismanagement of some co-infected patients Introduction
Long term Goals Improve delivery of patient care Improve staff efficiency Improve reporting of public health data to the Ministry of Health.
Specific Aims Implement TB EMR at MTRH Link 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 Aims Implement 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 Design Aim 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 Design Aim 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 EMR All 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 Design Aim 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..]
◦ 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
Progress Total number of 545 TB patients registered ◦ 389 HIV co infected
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 steps Complete 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
Acknowledgements Project Team CDC USAID-AMPATH IeDEA