INTEGRATED SYSTEM FOR HIV/AIDS AND TB DATA MANAGEMENT IN SOUTH AFRICA Chris Seebregts, PhD Medical Research Council University of KwaZulu-Natal South Africa
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.
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’.
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)
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.
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
INCREMENTAL IMPLEMENTATION OF PUBLIC HEALTH AND CLINICAL INFORMATION SYSTEMS
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
OPENMRS: FOSS DEVELOPER AND IMPLEMENTER COMMUNITYWWW.OPENMRS.ORG
OpenMRS sites • 7 countries so far • Rwanda • Kenya • Lesotho • Malawi • South Africa • Tanzania • Uganda • Haiti • Zimbabwe • In process/review: • Peru, Mozambique, others?
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
OpenMRS Concept Cooperative • Concept cooperative and coordination for use in other South African provinces • Millennium Villages Project Terminology Services Bureau for localization Mozambique
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
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
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
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