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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. THAT’SIT PROJECT.

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integrated system for hiv aids and tb data management in south africa

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 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
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
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
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
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
openmrs implementation at rch
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 sites
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
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
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
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
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
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
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