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M la Grange 10 December 2009 University of Stellenbosch

The Evolution of an electronic Patient Information System at the Tygerberg Hospital Infectious Diseases Clinic. M la Grange 10 December 2009 University of Stellenbosch. Some goals are important. South African ARV Rollout Programme.

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M la Grange 10 December 2009 University of Stellenbosch

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  1. The Evolution of an electronicPatient Information Systemat the Tygerberg Hospital Infectious Diseases Clinic M la Grange 10 December 2009 University of Stellenbosch

  2. Some goals are important

  3. South African ARV Rollout Programme • Operational Plan For Comprehensive HIV & AIDS Care, Management And Treatment For South Africa (19 November 2003). Aims: • To provide care and treatment for people living with HIV and AIDS • To facilitate the strengthening of the National Health System • Objective of this operational plan: • By 2009: All individuals requiring treatment for AIDS able to access comprehensive care and treatment • Actuarial Society of South Africa estimated that by 2009, about 1.4 millionpeople would require ART • ARV Rollout Programme started in 2004

  4. Implications for Clinics • Vast increase in patient numbers • Monthly statistical reporting, including: • Patients started on ART • Patients on ART at month end • Patients who stopped ART, became LTFU, died or were TFO • Adverse events • Pregnant patients • In addition to clinical notes, doctors to provide data for reports

  5. Birth of an Electronic Database • The Infectious Diseases Clinic developed an Electronic Patient Information Systemto address these challenges. • First phase of Patient Information System: • MS Access database developed and maintained by doctor • Patient Visit Form allows doctors to complete both clinical notes and data for reports on one form • The Patient Visit Form presents clinical information for the specific patient during follow-up • Filing clerk used for data capturing • Basic patient information captured • Interactivity between doctors and the system

  6. Flow of Information

  7. Strengthening the System • Problem: Poor data accuracy leading to poor doctor compliance • PEPFAR funding was obtained in 2006. • In 2007, the following staff were employed • Data Manager • Full-time data capturer for the Adult PEPFAR project • 2 full-time data capturers for the Paediatric PEPFAR project • Next phase of Patient Information System: • Access database centralized and migrated to MS SQL Server • Detailed patient data captured accurately per patient • Visit forms re-introduced to clinic

  8. Note: Personal patient information used in this presentation has been altered.

  9. Patient Visit Form

  10. Patient Visit Form - continued

  11. Patient Visit Form - continued

  12. Data Quality Data quality is the difference between a data warehouse and a data garbage dump. - Jarret Rosenberg

  13. The Next Level: e-Filing • Problem: Thousands of physical patient folders • A secure web-based, e-filing system for storage of digital images of patient records is being implemented • Barcodes on documents are used to store scanned documents to patient folders • Data from existing ID Clinic database is used to automatically index data (by file number, first name, surname, DOB, ID) • Part-time scanning clerk appointed, 1.5 days per week

  14. System Context Diagram

  15. Benefits of the System • Improved Clinical Care • The customized Patient Visit Form presents accurate, up-to-date clinical information during follow-up at a glance • The system minimizes unnecessary and repetitive note-taking • Doctors have more time for patient interaction due to time gains • The PatientVisit Form prompts doctors to address habitually neglected health care issues, e.g. last PAP smear and condom use • Secure internet access to e-filing system • Doctors are able to securely access scanned patient records via the internet, e.g. for after-hours telephonic consultations • Down-referred patients followed up efficiently at primary clinics • User password required and https protocol

  16. Benefits of the System - continued • Statistics can be retrieved for Rollout and PEPFAR reports • The clinical team evaluates morbidity and mortality data every month • Data used for research • Data supports the clinic operationally, e.g. to identify patients living in a specific area for making transport arrangements

  17. Success Factors • Doctors, patients and administrators benefit from captured data due to the design of the Patient Visit Form. • The Patient Visit Form promotes cooperation of doctors, which increases data accuracy. • The development of the system has been initiated by the clinic doctors. Therefore, the original database design was relevant to the clinic’s needs. • A dedicated data team is responsible for data capturing, monitoring and reporting. • Data is stored in a centralized database, ensuring that up to date data is available to all system users. • Laboratory results are imported into the database, ensuring data accuracy.

  18. Acknowledgements • Dr. Hans Prozesky did the initial development of the system and continues to play a crucial role in maintenance thereof • Dr. Michele Zeier secured funding for, and established a dedicated data team for the clinic • This project forms part of a program of the Perinatal HIV Research Unit (PHRU) and funding is provided through PEPFAR

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