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Evolving Electronic Patient Information System at Tygerberg Hospital's Infectious Diseases Clinic

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This document details the development of an Electronic Patient Information System (EPIS) at the Tygerberg Hospital Infectious Diseases Clinic in response to the South African ARV Rollout Programme's demands. The system enhances data accuracy and improves clinical care by consolidating information from patient visits, enabling efficient reporting and management of HIV and AIDS care. With the transition to a secure web-based e-filing system, the clinic aims to ensure better patient interaction, timely follow-ups, and a more robust data management system benefiting doctors, patients, and administrators alike.

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Evolving Electronic Patient Information System at Tygerberg Hospital's Infectious Diseases Clinic

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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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