deliver annual technical meeting key bridge marriott - june 2005
TRANSCRIPT
DELIVER Annual Technical Meeting
Key Bridge Marriott - June 2005
Application of Biometrics / SmartCard Technology for
Anti-Retroviral Therapy (ART) in South Africa
John Wilson & Rovaro BayardJSI South Africa
Secure Technology Advancing Treatment
THE OPERATIONAL PLAN FOR COMPREHENSIVE HIV AND AIDS CARE, MANAGEMENT AND TREATMENT FOR
SOUTH AFRICA – November 2003
JSI requested by NDOH Chief Director to survey what systems are available in South Africa
that can help with the ARV roll-out, especially in terms of Logistics,
Patient Information Systems and Program Monitoring
CRITICAL REQUIREMENTS:
• Must be ‘attractive’ to clinicians and healthcare workers
• Capable of tracking drug distribution to end user
• Will generate NDOH / Emergency Plan indicators (2-7-10)
• Confidentiality
• Authentication / Verification
• Data Security
• Responsive to the very high mobility of South Africans
• Can operate in an off-line environment (community outreach)
FINDINGS:
• Of the 9 systems reviewed that are currently in use in 6 Provinces of South Africa only 1 system is sufficiently responsive to the mobility issue, and can operate off-line in community outreach settings
NET1 Biometrics / Smart Card system used for dispensing more than 4 million pensions and
social grants in 6 Provinces (began 1999), which seemed to have applicability in an ART setting
NET1 “UEPS” system for pension payout
• More than 4 million pensions & social grants dispensed using SmartCard/ Biometrics in 6 South African Provinces since 1999;
• This indicated potential applicability to ART in overcoming challenges.
Pensioners receiving payouts from mobile unit
STAT™ System Development
Phase 1: Conceptual Framework
Phase 2: Proof of Concept
Phase 3: Systems Development in Clinical ART Settings
Phase 4: “Live” Implementation in Diverse Field-Test Sites
JSI Partners Developing Biometric / Smartcard Solution for Patient Information and
Drug Stock Control System
Phase 1: Conceptual Framework - Timeframe 4months
Phase 1: Conceptual Framework (2) – additional 2 months
STAT™ System Development
Phase 1: Conceptual Framework
Phase 2: Proof of Concept
Phase 3: Systems Development in Clinical ART Settings
Phase 4: “Live” Implementation in Diverse Field-Test Sites
Phase 2: Proof of Concept – plus five months.
Patient Database Development & card to card data transferability – the “Boardroom Demo”
Prototype Smartcard readers
Fingerprint scanner
POS device
STAT™ System Development
Phase 1: Conceptual Framework
Phase 2: Proof of Concept
Phase 3: Systems Development in Clinical ART Settings
Phase 4: “Live” Implementation in Diverse Field-Test Sites
Systems Development in Clinical Community Outreach Setting
STAT™ System Development
Phase 1: Conceptual Framework
Phase 2: Proof of Concept
Phase 3: Systems Development in Clinical ART Settings
Phase 4: “Live” Implementation in Diverse Field-Test Sites
Patient RegistrationOn “Live” system
STAT™ System for ART
• Based on existing RSA Biometrics and Smartcard technology
• ART patients retain their cards
• Healthcare workers have their own cards
• Cards hold 64Kb of data in 255 data wallets.
Provider can print prescription, sign and store in patient folder
How STAT works in practice:Patient ART Center Visit/Home Visit
Script
RxScript
Rx
Coded data entry:•Symptoms•Weight•Lab results•Prescription
Provider enters codes for drugs prescribed, gives drugs to patient
and returns STAT™ Card
Alternatively, if pharmacy available…
ARVs Dispensed in Pharmacy
Pharmacist dispenses drugs as prescribed and recorded on patient card
Pharmacist gives drugs to patient, returns Patient’s
STAT™ card
Script
Rx
Rx
Rx
Script
Rx
Rx
Rx
OPTIONAL:Patient gives
prescription to pharmacist
Data Batch Upload to STAT Reporting Database
Encrypted Data on Service Provider STAT™ cards
uploaded to Net1 Switch by dialup or broadband at end of
day
Data from Net 1 FTP’d to JSI STAT™
Reporting database server
Features of the STAT™ System
• Patients can use their card at any STAT™ ART center; • Ideal for home visits - Battery operated and portable• STAT™ system functions off-line, with upload of data to
central database at end of day;• JSI STAT™ central database runs on Microsoft SQL
relational database, hosted on a MS-SQL Server incorporating SQL Reporting Services;
• Able to accurately record facility-level ARV inventory.
• Only the owner or proxy in exceptional circumstances of the STAT™ card can use it to obtain treatment;
without = X• Patients cannot receive more than the appropriate amount of
drugs in any month;• Potential ARV leakage at ART centers minimized due to higher
level of accountability through use of provider STAT™ cards.
Electricity/phone line available availability:• Since card readers powered by rechargeable batteries, no
electricity required during home visiting;• Battery pack allows estimated 320 patient interactions
on single charge;• Patient visits at ART centers can continue during power
outages;• No need for constant online connection – dialup and
upload at end of day only.
ARV inventory control, security, & data management:
• Incoming drugs entered on pharmacist’s STAT™ card and deducted from inventory on hand as drugs dispensed to patients;
• ARV stock status uploaded daily to national STAT™ database;• Precise consumption data generated to enable accurate
forecasting;• Supervisors can check physical inventories against up-to-date
stock status data.
Verifying Private Provider Billing:• Private practitioners can claim payment made through
data uploaded through Net 1 switch;• Eliminates need for paper billing.
STAT™ Implementation (FY 04 PEPFAR COP)
• Currently live field testing in Hospital, Static Clinic & Community outreach environments ( Target 2500 on ART, 4000 on Care and Support)
• Uplink to STAT™ central database went live April 8, 2005
•By end FY 05 funding, 5,700 patients on ARV's plus 38,000 patients on care and support utilizing STAT™ in 23 CRS/SACBC sites in 8 of 9 provinces
•In addition, as appropriate, public sector sites in provinces (so far 4 provincial sites
•Testing of STAT Drug Inventory Module
•Development of TB, Pediatric, and Nutrition modules
Planned Implementation of STAT per FY 05 COP
SmartCard/Biometrics Readers
• Portable, rechargeable battery operated card readers;
• Patient and provider cards inserted in card reader;
• Built-in fingerprint scanner;• LED screen to guide provider
through treatment protocol;
• Numeric keypad for data entry.
Potential New Partners?
Broadreach
Aid for Aids
Absolute Recovery for Kids (ARK)
}Malawi (Malswitch Reserve Bank)
Nigeria (FHI?)
Private GPService Providers
Billing / Verification potential!!
Long Term Vision ??
LOGO ADVERTISEMENT
•The Patient-Retained Record System of Choice ?
•Reduced Shrinkage in Supply Chain Management Systems ??