SmartCare System

1. SmartCare System Training Manual: Deployment Framework

2. Deployment Maintenance National Training Provincial Training Implementation Roadmap to SmartCare • The Roadmap to SmartCare is composed of the Big 5 • National Training • Provincial Trainings • Deployment • Installation • Maintenance

3. Roadmap to SmartCare Deployment Maintenance National Training Provincial Training Implementation • Teach use of new PMTCT paper system, and how SmartCare works with it • Describe the vision of SmartCare within the national health system • Provide leadership, expertise, and ongoing support to users maneuvering through the Roadmap

4. Roadmap to SmartCare • √National Training DONE • Provincial Training You are doing it • Deployment Pending • Implementation Pending • Maintenance Pending

5. Roadmap to SmartCare Deployment Maintenance National Training Provincial Training Implementation • Continue to distribute District Health office equipment & updated Manuals • Complete instruction for the Facility Deployment, Implementation & Maintenance processes • Coordinate Provincial Deployment Calendar priorities (Facility Deployment) • Review data protection/confidentiality (Implementation & Maintenance) • Review routine data use (reports) and local feedback (Maintenance)

6. Deployment Maintenance National Training Provincial Training Implementation 1st Site Facility Deployment • The 1st facility to be deployed in each Province will begin Facility Deployment after the Provincial training

7. Deployment Maintenance National Training Provincial Training Implementation Roadmap to SmartCare • Timeline • Site Selection • Site Preparation Checklist • Operations Analysis • Baseline Study • Educate Facility Staff • Install SmartCare Equipment

8. Roadmap to SmartCare Deployment Maintenance National Training Provincial Training Implementation • SmartCare Key Concepts • Software and Paper Forms • Backlog Data Entry • Information Use • Data Management • Equipment Maintenance (establish process) • Inventory Management (establish process)

9. Roadmap to SmartCare Deployment National Training Provincial Training Maintenance Implementation • Ongoing quality improvement for system and operations • Daily Data Entry & Backups • Regular Facility by Facility Data Merges • Regular Reporting & Use • to Improve Patient Outcomes • to Improve Facility Management • to support HMIS & Policy Level Use • Maintain Equipment (continued good practice, SIF) • Maintain Inventory (continued good practice)

10. Provinical Training Objectives Particpants will be able to: • Teach use of the SmartCare system to future trainees at District level. • Describe the vision of SmartCare within the national health information system to trainees. • Teach the proper use of SmartCare • to improve the quality of clinical care • provide for continuity of patient care and • as a monitoring and evaluation tool that supports HMIS, and other related health information systems. • Provide leadership, expertise, and ongoing support in the training, administration, and management of the SmartCare system to facility staff within your district.

11. Participants’ Packet • Agenda • Pre-test • User’s Guide (DRAFT) • Procedures Manual (DRAFT) • with Appendices • Trainer of Trainer Methodology Manual • Training Manual • Facility Level Training Manual

12. SmartCare Training Format • Trainer Presentations • Using SmartCare forms & software • SmartCare concepts • Training Exercises • Post Test • Discussion

13. Training Norms • Classes will be interactive and participative • Participants will provide frank feedback to the facilitators on; • the training, • the presentation of materials, • The functionality of the SmartCare system • Participants and facilitators will respect the times • Respect participants and facilitators (no parallel discussions) • “Parking lot” issues will be recorded on flipchart and participants are encouraged to add to list • Cell phones will be turned to vibrate & calls received outside of the classroom

14. Facility Deployment Framework: Moving Facilities from Paper to Electronic Health Records Systems Road Map #3 Procedures Manual

15. Facility Deployment • To understand the process by which the SmartCare system will be rolled out to facilities • To gain an understanding of basic facility deployment tools Learning Objectives

16. Deployment Maintenance National Training Provincial Training Implementation Facility Deployment 6 Baseline 8 5 4 3 2 1 7 Educate Facility Staff Facility Deployment Landmarks DHIO facilitates entire Deployment

17. 8 5 4 3 2 1 Facility Deployment Landmarks • Timeline • Site Selection • Site Preparation • Operations Analysis Facility Deployment 6 Baseline Provincial Training 7 Educate Facility Staff • Using the Ops Analysis • Baseline Study • Educate Facility Staff • Installing Equipment

18. Facility Deployment 6 Baseline 8 5 4 3 2 1 7 Educate Facility Staff Landmark 1: Timeline • Each District draws up their Deployment timeframe with partners and stakeholders for their first site • Sync schedules for technical assistance • Sync schedules with facility

19. Facility Deployment 6 Baseline 8 5 4 3 2 1 7 Educate Facility Staff Landmark 1: Timeline Exercise • List the tasks you have to complete in the next month on your calendar. • When do you have time to complete the Deployment landmarks? • Confer with stakeholders to see if these dates work for them

20. Facility Deployment 6 Baseline 8 5 4 3 2 1 7 Educate Facility Staff Landmark 2: Site Selection • Ideally, one site will be chosen in each Province to begin their 1st Facility Deployment before the Provincial Training • Consider; • Location of the site • Services provided by the site • Complexity of implementation • Amount of technical assistance needed to Deploy you 1st site

21. Facility Deployment 6 Baseline 8 5 4 3 2 1 7 Educate Facility Staff Landmark 3: Site Preparation • Assesses whether the site meets minimum requirements for Implementation and Maintenance • Use Site Preparation Checklist (see Procedures Manual Appendix C)

22. Facility Deployment 6 Baseline 8 5 4 3 2 1 7 Educate Facility Staff Landmark 3: Site Prep Exercise • Discussion • In this example, what does this facility need to do before it will be considered a SmartCare candidate? • Is there anything that you think is essential to have in the facility, something that would not allow for SmartCare which is not addressed on this checklist? • Questions & Answers

23. Facility Deployment 6 Baseline 8 5 4 3 2 1 7 Educate Facility Staff Landmark 3: Site Preparation Exercise • Chose a convenient site in your District you know well • Complete Site Preparation forms • What changes need to be made? • How would you make those changes?

24. Facility Deployment 6 Baseline 8 5 4 3 2 1 7 Educate Facility Staff Landmark 4: Ops Analysis • Used to incorporate SmartCare into facility operational processes • Describe facility operations • Analyse operations and SmartCare procedures

25. Facility Deployment 6 Baseline 8 5 4 3 2 1 7 Educate Facility Staff Landmark 4: Ops AnalysisDescribe Operations • Patient & Information Flow Chart

26. OperationsAnalysis • Patient & Document Flow without SmartCare • ANC example

27. OperationsAnalysis • Patient & Document Flow with SmartCare • ANC example

28. Facility Deployment 6 Baseline 8 5 4 3 2 1 7 Educate Facility Staff Landmark 5: Ops AnalysisUsing the Ops Analysis • Analysing the Patient and Information flow is an art meaning there is no one right answer and creativity is required • The analysis will help facilities to determine the best way to incorporate SmartCare into the facility’s current processes

29. Landmark 5: Ops AnalysisCase Study • Directions: The facilitator will divide the larger group into smaller groups and distribute a case study exercise for you. Read through the case study. You will be expected to fill out a site prep checklist form, and complete an ops analysis.

30. Steps to complete the ops analysis include: • Draw the physical layout or the floor plan of the facility. • Draw a Flow Chart for current facility operations (see example on previous slides) • List the staff and their responsibilities in terms of operations on the flow chart you developed in step 2. • Determine which SmartCare configuration (E-First, E-Fast, E-Last) is appropriate for you facility based on type of service and resources • Consider which computers will be on a LAN, and whether • one wants a client server solution, or if • one is willing to do frequent merges • Revise Flow Chart for operations that include SmartCare forms and software in the flow

31. Discussion of ops analysis pre-SmartCare • DHIO will have to work with facility staff to develop the floor plan and data and patient flow charts. • Be sure to assign who is responsible for each task identified on the flow chart.

32. SmartCare Configurations • Which configuration is best for you? • E-First • E-Fast • E-Last • Factors to consider • Results from Site Prep Checklist • Needs of clinic • HR at clinic • Resources and capabilities of clinic

33. Revise Patient and Data Flow Diagrams based on SmartCare configuration • After choosing SmartCare configuration that best suits the facility’s needs revise patient and data flow chart with SmartCare represented. • Assign responsibilities of staff to the revisions that are made • Revise floor plan if necessary

34. Discussion • Review findings with group • Discuss what kinds of revisions did each group make to the original data and patient flow charts • Compare the different groups ops analysis for the case study

35. Homework assignment • Using today’s sample as an example, choose one site in your district that you are thinking on deploying and are familiar with. • Complete a Site Prep Checklist for that facility • Draw a floor plan to depict the physical layout of the facility • Draw a patient and data flow chart for the facility

36. Facility Deployment 6 Baseline 8 5 4 3 2 1 7 Educate Facility Staff Landmark 6: Baseline • An baseline survey will need to be completed before SmartCare Implementation to determine where facilities are before the project begins • The same questions will be asked again periodically to compare before and after responses to determine whether or not SmartCare is achieving its objectives and to what extent

37. Facility Deployment 6 Baseline 8 5 4 3 2 1 7 Educate Facility Staff Landmark 6: Baseline • The Baseline will measure availability of & access to information as well as utilization of that information for; • Patient level data • Management level data

38. Facility Deployment 6 Baseline 8 8 5 5 4 4 3 3 2 2 1 1 7 Educate Facility Staff Landmark 7: Education • Continuing Education of Facility Staff • Learning what SmartCare is & how it will affect their operations • Deployment may include portions of Implementation such as introduction of paper forms Deployment 6 Baseline 7 Educate Facility Staff

39. Facility Deployment 6 Baseline 8 8 5 5 4 4 3 3 2 2 1 1 7 Educate Facility Staff Landmark 8: Installing Equipment • Installing SmartCare equipment into a facility marks the end of Facility Deployment and the beginning of Implementation • Initial equipment installation will be conducted by SmartCare central while subsequent installations will require more DHIO responsibility Deployment 6 Baseline 7 Educate Facility Staff

40. System Improvement Form • Provide Feedback (PLEASE!!!) • Systems malfunctions • Ways in which the system interferes with duties • Ways to improve the system • Forms available during the training • Take a couple empty forms • Fill forms out when an idea strikes you

41. Deployment Framework Post-Test • Will every site be able to use the SmartCare system? • Yes b) No • What is the purpose of the Baseline Survey? • Diagram and analyse processes & procedures • Determine whether a site is ready for deployment • Plan how to operate a new system • Understand where the facility started from to compare to later

42. Facility Deployment 6 Baseline 8 5 4 3 2 1 7 Educate Facility Staff Deployment Framework Discussion • Questions or comments about Facility Deployment

43. Implementation: How to put SmartCare into practice

44. Learning Objectives • To understand the steps necessary after SmartCare deployment and to implement these steps at a facility.

45. Roadmap to SmartCare Deployment Maintenance National Training Provincial Training Implementation • SmartCare Key Concepts • Software and Paper Forms • Backlog Data Entry • Information Use • Data Management • Equipment Maintenance • Inventory Management

46. Who is involved in Implementation? • DHIOs • Facility staff end users • Other SmartCare technical staff (e.g. SmartCare HQ, PDMS, implementing partners)

47. Reinforce SmartCare Key Concepts for Facility Staff • System Security Policies must be outlined prior to implementation (during operations analysis) in order to ensure proper procedures during implementation. • Security policies must address all known data access and data integrity conditions. • Other security concerns • Physical security of equipment • Software Security • Data security: backups

48. Key concepts (continued) • Three guiding principles for security procedures for end users Informed User Responsibility: All users are held responsible; no access is provided to persons who didn’t sign the appropriate security paperwork Need to Know : System access is limited to the one person or very small number of persons who “need to know” patient information in order to provide services. Viewing patient records in absence of a patient visit has limited legitimate purpose (with exception of delayed lab reporting) and all such events are logged into the system for review. Separation of Powers: System access and use rights are partitioned among different users; this reduces risk and simplifies oversight

49. SmartCare Software and Paper Based System • Develop a training schedule for staff • Registration and login • Service modules (e.g. ANC, VCT, ART) • Practice data entry from paper system • Provide updates for any new developments

50. Backlog Data • There should be a strategy developed on how to enter existing data into the system without affecting facility services. • You will want to sit down with facility staff and make a plan on how to best accomplish this task. • Backlog Data will need to be entered into system for ART and PMTCT/MCH services