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Electronic Recording and Reporting at Indus Hospital, Karachi, Pakistan
Aamir Khan, MD PhDExecutive Director
Indus Hospital TB ProgramInteractive Research & Development
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Quality care free of cost
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TB Program Overview
Updated till April 22, 2011
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TB (all forms) case notificationIndus Hospital DOTS Clinic 2007‐2011
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Indus Hospital DR‐TB patients (Apr 13, 2011)
Treatment Status
XDR TBN(%)
MDR SUSPECT
N(%)
MDRTBN(%)
PDRTBN(%)
MONOTBN(%)
MOTT
N(%)
TOTAL
N(%)
Enrolled 7(88)
3 (100)
231 (82)
34(92)
20(83)
4(34)
299(81)
* All percentages are of registered patients** Awaiting treatment include self financed patients
Registered 8 3 282 37 24 12 366
Round 9 SR for Sindh and Balochistan province5500 MDR‐TB patients to be put on treatment in Sindh/Balochistan
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Rationale for ERR
• Private sector provider reporting to NTP ‐must follow national R&R system
• Most patients treated in the private sector are not reported to NTP
• Need a system that can be implemented in both the private sector along with the public sector
• DR‐TB patient management is complex
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Why ERR?
• Improved data quality
• Easier backup and storage
• Faster reporting
• Easier analysis
• Accessible remotely
• Role‐based access allows security
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Solution
• Open‐source: low‐cost of initial acquisition, moderate cost of operation
• Integration: 2 existing open‐source solutions OpenMRS and openXdata
• Development: GIS visualization module for both OpenMRS and openXdata
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• Open Medical Record System– in use since 2008– 600+ patients on the system
• MDR‐TB module– Lab tests (smear, culture, DST)– Regimens– Tracking treatment e.g. conversion– Type of TB etc– Transitioning to version 2
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OpenMRS Mobile
• MDR‐TB DOT data via cell phone– Connects to OpenMRS– Treatment supporters visit patient daily
– Enter DOT data on the cell phone• Real‐time
– Allows effective monitoring– Removes paper from the system
• Improves data quality
– Scale‐up underway– Use can be expanded beyond DOT
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TB horizonReal‐time data visualization on Google Earth
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Patient medical recordsReal‐time data visualization on Google Earth
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Patient medical recordsReal‐time data visualization on Google Earth
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Individual Aggregate Real‐time data visualization on Google Earth
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OpenMRS MDR‐TB module v2
• Currently in transition
• Faster system
• Better documented
• Easier to install and set up
• More user friendly
• Downside: – no data migration path from v1 to v2
– development required to connect to openMRS mobile
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Challenges
• Requires dedicated IT staff
• High memory consumption in older software version– New version and dedicated hardware have helped
• Initial implementation requires a lot of effort– From IT staff
– From program staff
– From clinical staff
• Interaction with Indus Hospital’s HMIS– In the works
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Mobile phone based Conditional Cash Transfer
Indus TB REACH grant
• GPs: identifying and referring suspects, TB case
confirmation, cure/completion
• CHWs: household contact tracing, identifying and referring suspects, TB case confirmation, cure/completion
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Q1 2011 in comparison to Q4 2010Indus Hospital DOTS Clinic 2010‐2011
• 108% increase in all forms TB• 125% increase in pulmonary TB• 133% increase in SS+ pulmonary TB• 114% increase in SS‐ pulmonary TB• 75% increase in extra‐pulmonary TB• 44% increase in childhood TB
Indus Hospital has become the highest DOTSreporting center in Sindh province in Q1 2011
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Percent change over previous quarter in DOTS TB (all forms) case notificationIndus Hospital DOTS Clinic 2010‐2011
TB REACHintervention
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Projections: DOTS TB registration at April 2011 rateIndus Hospital DOTS Clinic 2010‐2011
Drug supply and management
breakdown
?
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Pediatric TB cases at Indus Hospital: Annual enrollment and Reporting to NTP
2010: Children accounted for 20% (142/709) of total TB cases
35% cases diagnosed through TBREACH
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Results HIV N(%)
HCVN(%)
HBVN(%)
Reactive 2 (1) 35 (13) 11 (4)
Borderline 0 4 (2) 0
Non‐reactive 324 (99) 222 (85) 248 (96)
Total Tested 326 261 259
HIV, HCV & HBV Serology Status in Registered DR TB Patients (Apr 13, 2011 )
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HbA1c > 6.5% in Registered DR TB Patients (Apr 13, 2011)
Age RangeN(%)
Proportion Positive of Total TestedN(%)
Total Patients >6.5%
Total Tested
NMale Female
>6.5 Tested >6.5 Tested0‐<15 0 5 0 6 0 1115‐<25 3 (10) 31 6 (11) 55 9 (10) 8625‐<35 5 (21) 24 2 (7) 28 7 (13) 5235‐<45 10 (32) 31 4 (20) 20 14 (27) 5145‐<55 3 (27) 11 4 (36) 11 7 (32) 2255‐<65 2 (25) 8 2 (33) 6 4 (29) 14>65 1 (50) 2 0 2 1 (25) 4Total 24 (21) 112 18 (14) 128 42 (18) 240
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Key lessons learnt & advice for countries
• The R&R system must provide useful feedback to data generators
• TB is a complex disease; ERR systems need to allow for locally relevant data points
• Partnerships are key. There is no single solution available for countries.
• Visit ERR sites before selecting a system.
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Quality care free of cost