INTEGRATED SYSTEM FOR HIV/AIDS AND TB DATA MANAGEMENT IN SOUTH AFRICA

1. INTEGRATED SYSTEM FOR HIV/AIDS AND TB DATA MANAGEMENT IN SOUTH AFRICA Chris Seebregts, PhD Medical Research Council University of KwaZulu-Natal South Africa

2. THAT’SIT PROJECT • That’sit is a methodology for improving access to HIV care for tuberculosis patients through a best-practices approach. • The South African MRC is offering ART to qualifying TB patients as part of that’sit in several provinces in South Africa. • 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.

3. DESIGN CRITERIA FOR THAT’SIT IS • Integrated TB and HIV information management; • Support chronic care and clinical decision-making • Integrated with other district, provincial and national health information systems; • Balanced design between operational requirements and future needs; • Effective by improving patient and treatment information management and easily providing for aggregate and indicator reporting functions; • Configurable and adaptable to changing needs of the program, other clinics hospital, provinces and countries, other diseases; • Affordable and available to a large number of sites; • Scalable and able to robustly store a large number of records; • Open standards for data storage and interchange and should use free and open source software (FOSS), wherever possible; • Sustainable and maintainable; • Powerful and easy to use; • Flexible andextensible; • Reuse existing application software and avoid `reinventing the wheel’.

4. OPENMRS FORMS IMPLEMENTATION

5. REASONS FOR SELECTING OPENMRS • Configurable forms based application that can provide a very close fit with systems created by the South African Ministry of Health. • Readily configured for different forms used by different programs and provinces while maintaining the same basic concept dictionary (integration of data and same reports) • 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. • Scalable to accommodate many thousands of patients on ART (Kenya – 55,000 patients in system). • Open standards and interfaces allowing interfacing with other applications, notably the electronic TB register and the DHIS. • Powerful support for localization into other languages (Portuguese)

6. PATIENT AND PUBLIC HEALTH DATA • District Health Information System collects aggregate data on many diseases • TB managed at (sub)district or provincial level according to a public health model using registers. • HIV/ART managed at an individual level according to a chronic care model using structured medical record forms.

7. PROGRESS TO DATE • Implemented KZN provincial DOH ART forms in OpenMRS • Implemented NTCP TB treatment card in OpenMRS • Customized for North West province • Generating reports at Richmond using cohort builder • Implementing new KZN-DOH ART form in OpenMRS • Implementing remote access for Bergville, KwaZulu-Natal • Localized OpenMRS for Mozambique (translated into Portuguese) • ImplementED data export from OpenMRS to TB Register (ETR.Net) • Implementing data export to District Health Information System (DHIS) • Developing computerized link to MRC TB reference laboratory

8. INCREMENTAL IMPLEMENTATION OF PUBLIC HEALTH AND CLINICAL INFORMATION SYSTEMS

9. OPENMRS: HIV/ART AND TB SYSTEM

10. OPENMRS: IMPLEMENTATION AT RCH • Implementation at Richmond Chest hospital in daily use • In March 2007, 832 patients registered on the system with 3,420 encounters and 136,888 observations

11. OPENMRS: ENCOUNTER MANAGEMENT

12. OPENMRS: COHORT ANALYSIS

13. OPENMRS: CONCEPT STATISTICS

14. OPENMRS: FOSS DEVELOPER AND IMPLEMENTER COMMUNITYWWW.OPENMRS.ORG

15. OpenMRS sites • 7 countries so far • Rwanda • Kenya • Lesotho • Malawi • South Africa • Tanzania • Uganda • Haiti • Zimbabwe • In process/review: • Peru, Mozambique, others?

16. OPENMRS: IMPLEMENTATION SUPPORT

17. OPENMRS: IMPLEMENTERS MEETINGS

18. OPENMRS: UPCOMING EVENTS • October 2007 – Cape Town, South Africa • IDRC: open source developer meeting • November 2007 - Maputo, Mozambique • IDRC: Mozambique Collaborator meeting • December 2007 – Nairobi, Kenya • Who: International Conference on Health Data/Information Standards • OpenMRS: OpenMRS satellite meeting • June 2008 – Durban, South Africa • South African Health Informatics Association:HISA (Health Informatics in Southern Africa) 2008 • SAHIA (South African Health Informatics Association) • OpenMRS (Open Medical Record System) • OSHCA (Open Source Healthcare Alliance) • HISA/OpenMRS/OSHCA • Informatics Evaluation / Pharmacy Management

19. OpenMRS Concept Cooperative • Concept cooperative and coordination for use in other South African provinces • Millennium Villages Project Terminology Services Bureau for localization Mozambique

20. OPENMRS LOCALIZATION (MOZAMBIQUE)

21. OPENMRS: DECISION SUPPORT

22. ELECTRONIC TB REGISTER

23. ELECTRONIC TB REGISTER

24. IMPORT OPENMRS DATA TO ETR.NET

25. WWW.ETRNET.INFO

26. DATA TRANSFER ALTERNATIVES

27. CASE FINDING REPORT

28. EXPORT TO DISTRICT HEALTH INFORMATION SYSTEM

29. OPENMRS: CLIENT SERVER • Richmond application made use of local peer to peer network for client server • Tested and used Internet web application (slow but usable) • OpenMRS data synchronization module imminent

30. OPENMRS: TELECONSULTATION(available in some sites)

31. FUTURE DIRECTIONS • Data synchronization for offline/online use (existing PIH project) • Laboratory information management system integration (existing PIH project) • Extension to handheld computers and mobile phones (existing MRC project) • Complex data types, eg genome data for drug resistance monitoring (MRC project) • Coordination of terms using the OpenMRS Concept Cooperative

32. CONCLUSIONS • Powerful and appropriate clinical and public health information systems for developing countries can be developed with existing tools and technologies • Open standards, architectures and interfaces are critically important to achieving interoperability and realizing economies of scale. • Open source software, eg OpenMRS, offers significant advantages compared to de novo development and, in addition, has substantial cost, development, localization and control advantages • As an example of an appropriate open source technology, OpenMRS has many of the architectural features satisfying the requirements for advanced health software development

33. ACKNOWLEDGEMENTS • Centers for Disease Control – Bill Coggin, Subroto Banerjee • Dept of Health (KZN) – Chris Jack, Roger Pillay • Dept of Health (National) – Carina Idema, Shaheen Khotu • Foundation for Professional Development – Margot Uys • Health Information Systems Program – Calle Hedberg, Jorn Braa • International Development Research Centre – Heloise Emdon, Steve Song • Medical Research Council – Karin Weyer, Natasha Naidoo • Partners in Health – Hamish Fraser • Regenstrief institute – Burke Mamlin, Paul Biondich, Bill Tierney • University of KwaZulu-Natal – Yashik Singh, Carl Fourie • University of the Western Cape – Harry Haussler • WAM Technology cc – Paul Maree • World Health Organisation – Christopher Bailey, Mark Spohr