Systems for ART Program and Patient Monitoring

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Systems for ART Program and Patient Monitoring
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Situation

• We are working in an environment where capacity
  is weak in all areas.
• We have poor infrastructure in transport,
  communication, resources, human resources,
  training, health care skills, supplies,
  equipment, medications.
• We do know that without good information, the
  initiative will fail.

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HIV/AIDS Infection

• Disease Management AIDS is a multi-faceted
  disease that touches on all areas of health care
  and many areas of culture and society.
• Chronic AIDS is challenging since it will
  require continuous lifetime medical care and
  treatment.

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Principles

• AIDS care must integrated into existing health
  system
• HIS is absolutely essential for the Initiative to
  work
• Must build local capacity for sustainability
• Keep it simple - Minimal data set

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Plan

• Strengthen capacity of existing health system and
  HIS
• Build patient longitudinal medical records
• Build ties with laboratory and logistics
• Strengthen program monitoring

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Issues

• Architecture
• Disease Management
• Chronic care model
• Paper interface
• Free open source model is the most Development
  Friendly
• Standards
• Sustainability

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Chronic Disease Management
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Data Standards

• Indicator definitions and nomenclature
• Metadata
• Data standards
• Data communication standards
• Data flow

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Sustainability

• Software systems require constant maintenance
• Imported systems suffer the same fate as other
  high tech equipment
• It breaks and nobody knows how to fix it
• Must have open systems that can be maintained
  locally
• Must build local capacity to maintain the systems

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Network Configuration
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Country / International Data Warehouse
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Key Factors System Overview

• Type of software (EMR, DM, Register)
• Can the system be easily modified?
• Is this free open source software
• Single user/LAN/WAN?

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Key Factors Scope of Clinical Services

• PMTCT
• ART
• TB
• General clinical care
• Advanced ART Disease Mgmt. (guidelines, pt.
  advice)

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Key Factors Reporting/Output Capability

• Patient level reporting
• Clinic level reporting
• Custom reporting
• Exportable data/ standard format

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Key Factors Hardware and Software Requirements

• Client computer requirements (level 1,2,3)
• Server computer requirements (level 1,2,3)
• Operating system
• Database

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Key Factors HR Requirements

• Country level development,support, maintenance?

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Key Factors Security and Quality Checks

• Security level (1,2,3)
• Data validation level (1,2,3)

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Software Inventory
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The Envelope Please

• We do not have a winner.
• We are close.
• Next steps...
• Active development taking place on many fronts
• www.rhinonet.org

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Current Systems

• Proprietary Systems
• TherapyEdge
• Systems Built on EpiInfo/Access
• CareWare
• Thin Client Server Open Source
• OpenEMR, Care 2x

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How

• Need prototype systems that are 90 functional
  and can be easily customized to meet local needs
• RHI register (DHIS)
• PMTCT register
• ART EMR

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Key Criteria for ART Software

• Thin client - server
• Open source
• Basic ART data set
• Disease management

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Free Open Source Software

• Software and Source Code is freely available
• Source code lets you make local modifications
• Enhancements are contributed back to the
  community
• These are sustainable systems
• Build local capacity
• Local maintenance and enhancement

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Client Server Networks
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Inventory Project

• Collaborative Workgroup
• Clearinghouse for information on
• software systems
• implementation
• customization
• metadata
• Feedback on systems
• This is an open system - we want your feedback

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Future Work for the Inventorywww.rhinonet.org

• Logistics Systems
• Information synergies with patient systems
• Laboratory Systems
• Innovative Technologies (smart cards, cell
  phones, PDAs, etc)
• Paper systems interface
• Metadata repository