Digitising TB Data into TIER.Net - District Hospital Guidance

1. Comprehensive Trainings to support the National Integrated TB/HIV Information System Implementation Digitising TB Data into TIER.Net - District Hospital Guidance

2. Background District Hospitals (DHs) provide TB and HIV services to patients referred from Primary Health Care (PHC) facilities District hospitals are required to report TB/HIV data into DHIS (per 2011 DHMIS policy) as part of the PHC reporting platform NDOH decision taken in 2015 to digitise both TB and HIV data into TIER.Net to account for TB patients diagnosed and initiated on treatment in district hospitals mitigate ‘missing’ TB cases and facilitate accurate reporting in webDHIS District Hospitals have been digitising HIV patient information in TIER.Net (since 2011) TIER.Net is typically maintained in Wellness Clinics

3. Reporting challenges in district hospitals Problematic reporting Inconsistent reporting Not accounting for all TB cases Poor linkage to care Missing TB Cases District hospitals are discharging patients without capturing into TB register/clinical stationery Receiving facilities are capturing patients as “transferred in” BUT hospitals are not capturing them as “newly registered” • These cases are excluded from the Treatment Initiation report Receiving facilities are capturing patients as “newly registered” • In the absence of any documentation in hospitals – do not know how many of these patients do not arrive at the referring facility

4. 4 TB / HIV data flow Patient-level data Aggregate data Electronic HIV & TB facilities National 25th: national data signed off by DG webDHIS Integrated National TIER.Net HIV/TB Patient Database 20th: provincial data signed off by HOD Province webDHIS Integrated Provincial TIER.Net HIV/TB Patient Database 15th: district data signed off by District Manager (Sub)District 10th: sub-district data signed off by sub-district manager Export quarterly ART cohort & DS-TB outcome data webDHIS TIER.Net 5th: monthly data signed off by Facility Manager and reported to webDHIS Dispatch quarterly Facility / District Hospitals TIER.Net TIER.Net TIER.Net HIV & TB data from patient folder HIV & TB data from patient folder HIV & TB data from patient folder

5. Purpose of District Hospital guidance document Provide guidance to district hospitals re: digitising TB patient information into TIER.Net to ensure that TB services are documented in accordance with the TB HIV Information System (THIS) integration strategy TB data is accurately reported from district hospitals into TIER.Net and DHIS Patient flow and data flow are integrated and streamlined in order to facilitate the accurate reporting of all TB/HIV services provided Assist (sub)district managers to identify and map out TB service points in Out Patients Department (OPD), Wellness/HAST Clinics and In-patient wards

6. Digitising TB data into TIER.Net in District Hospitals Data management processes in district hospitals are different from those in PHC facilities In some instances bespoke implementation approaches will be needed However the THIS principles remain TB and HIV data must be captured into TIER.Net and then submitted to webDHIS per DHMIS guidelines TIER.Net will replace the paper TB register and ETR.Net will be discontinued (March 2019) HTS and TB Identification Registers remain the source documents for capture into the HTS and TB Identification modules respectively

7. 4 Important steps and considerations for implementation 1. Conduct an assessment to identify patient flow as well as folder/register flow 2. Have full knowledge of source documents used for TB/HIV data digitisation 3. Understand the key clinical and operational processes required at TB/HIV service points Out Patients Department (OPD) Wellness clinics In-patient wards 4. Ensure active communication between referring and receiving facilities where possible

8. Assessing Patient Flow and Folder/Register Flow Important to map out where and how TB/HIV services are provided – helps identify potential gaps in the data recording and reporting process TB/HIV service points in district hospitals • Identify and document all reception points including where patient folders for TB/HIV services are retrieved, opened, and/or filed • Identify and document within the hospital where TB/HIV services are rendered Data capturing points for TB/HIV data • Track the data flow for the TB treatment cascade – this should include TB/HIV co-infected patients • Document the data flow process to identify potential ‘gaps’ in data collection/folder flow Facility Baseline Assessment document - modified for district hospitals and should be used to assess the patient and folder management flow

9. Assessing Patient flow and folder management Identify all clinical service points Identify all registration points Identify all data capturing points

10. District Hospital Baseline Assessment

11. Knowledge of source documents TB TB screening documentation • MOPD Register/Screening Register TB Identification Register • This will be digitised in TIER.Net (but not replaced by TIER.Net) TB blue card Inpatient clinical stationery • This may differ between hospitals, however it is key to know where the information required for digitisation can be found • TB blue card • TB Register - will be stopped once digitisation is complete

12. Understand key clinical and operational processes required at TB/HIV service points Critical that follow-up occurs for all down referred patients to ensure that they arrive at the referred facility HAST managers must ensure that patients reach their destination facilities to continue treatment Although the primary service points for TB services occur in the OPD, Wellness Clinics, and Inpatient Wards, there may be other service points that need to be considered

13. It is critical that all information for patients who are screened, tested, and/or initiated on treatment are accounted for, regardless of where the patient receives those services.

14. Out-Patients Department (OPD)

15. Wellness Clinic

16. In-Patient Ward

17. Ensure active communication between referral hospital and receiving facility Whenever a patient is referred from a district hospital it is imperative that HAST Managers follow-up to verify the following the patient arrived at the PHC facility the patient received the appropriate referral intervention Information to be recorded in the appropriate register or on the clinical stationery if Symptomatic TB patient referred for GXP testing TB positive patient referred for treatment, information to be captured in TB Identification register and/or patient file TB patient on treatment is TFO (down referred) to a PHC facility follow up with ‘referred to’ facility is required, and findings documented

18. Communication for success Communication is key between district hospitals and Primary Health Care facilities in order to prevent ‘loss’ of TB patients Correct identification, documentation and capturing of TB patient’s clinical care s required in order to prevent ‘loss’ and to ensure treatment success

19. Thank you Thank you NIT_Support@health.gov.za