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INTERGRATING TB/HIV DATABASES

INTERGRATING TB/HIV DATABASES. Presenter: DR. LAMECK DIERO. Presentation Outline. Introduction Aims Activities Challenges. Introduction. HIV/TB co-infected patients access care in two ways. 1) TB clinic patients test positive for HIV or

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INTERGRATING TB/HIV DATABASES

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  1. INTERGRATING TB/HIV DATABASES Presenter: DR. LAMECK DIERO

  2. Presentation Outline • Introduction • Aims • Activities • Challenges

  3. Introduction • 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

  4. Long term Goals • Improve delivery of patient care • Improve staff efficiency • Improve reporting of public health data to the Ministry of Health.

  5. 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.

  6. 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

  7. 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.

  8. Project Design • Aim 1 • Train data management and entry staff • Patient registration into the system • Develop pre-programmed queries to generate monthly reports.

  9. 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

  10. 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

  11. Completed tasks • 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.

  12. Completed tasks [ cont..] • 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.

  13. Sample Universal ID Card Front Side Back Side

  14. AMRS TB Encounter Form

  15. Training • 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.

  16. Progress • Total number of 545 TB patients registered • 389 HIV co infected

  17. 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

  18. 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.

  19. Logistical challenges • Fitting the whole process within the hospital workflow with minimal changes to it.

  20. 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

  21. Acknowledgements • Project Team • CDC • USAID-AMPATH • IeDEA

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