INTEGRATED SYSTEM FOR HIVAIDS AND TB DATA MANAGEMENT IN SOUTH AFRICA

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

• Thatsit 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 thatsit 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.

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DESIGN CRITERIA FOR THATSIT 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 and extensible
• Reuse existing application software and avoid
  reinventing the wheel.

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OPENMRS FORMS IMPLEMENTATION
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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)

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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.

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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

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INCREMENTAL IMPLEMENTATION OF PUBLIC HEALTH AND
CLINICAL INFORMATION SYSTEMS
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OPENMRS HIV/ART AND TB SYSTEM
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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

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OPENMRS ENCOUNTER MANAGEMENT
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OPENMRS COHORT ANALYSIS
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OPENMRS CONCEPT STATISTICS
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OPENMRS FOSS DEVELOPER AND IMPLEMENTER
COMMUNITYWWW.OPENMRS.ORG
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OpenMRS sites

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

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OPENMRS IMPLEMENTATION SUPPORT
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OPENMRS IMPLEMENTERS MEETINGS
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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 AssociationHISA
  (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

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OpenMRS Concept Cooperative

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

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OPENMRS LOCALIZATION (MOZAMBIQUE)
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OPENMRS DECISION SUPPORT
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ELECTRONIC TB REGISTER
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ELECTRONIC TB REGISTER
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IMPORT OPENMRS DATA TO ETR.NET
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WWW.ETRNET.INFO
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DATA TRANSFER ALTERNATIVES
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CASE FINDING REPORT
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EXPORT TO DISTRICT HEALTH INFORMATION SYSTEM
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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

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OPENMRS TELECONSULTATION(available in some
sites)
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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

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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

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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