Topics from Malawi

• Point of Care

• Primary Care

• Data Quality Services/Reports

• Working with the Ministry of Health (MoH)

• Multi-party Open Source / Open Source Communities

• Data Model

• Data Warehousing

• The Future

Resources

The Baobab home page: http://www.baobabhealth.org/
Partial Demo of HIV Treatment System: http://www.baobabhealth.org/2007/03/23/partial-demo-of-hiv-treatment-system/
Patient Registration Video: http://www.baobabhealth.org/2007/06/26/patient-registration-video/

= Point of Care (POC) =
Baobab has realised the importance of POC.

Baobab uses a simplified interface:

• wizard based interface

• one q. per page

• touch screen

• validation of data before capture (while patient is there)

Challenges:

• System downtime

• Thinking through hardware (not just software) - power backup solutions, low power hardware

First POC put int0 place in 2000:

• patient reg.

• patient tracking

Pretty constrained ART dataset

Rigorous quarterly report system

Began as paper based reporting - turned to Baobab to develop POC system.

ART system currently has 5 sites, with future plans to scale up nationally.

Malawi has no national id system - must generate unique id for each patient

Patients carry health passport:

• contains essential patient data

• uses barcoding

Found that names were spelled incorrectly.

Every word has to end with a vowel sound, these sometimes get added to end of names.

Strategy:

• soundex

• counting vowels as the same

• helps to reduce patient duplication in system

Touch screen system:

• unreliable power system

• servers use DC, 48V

• touch screens use DC

• can set up system using batteries, so can stay running for longer periods without power

• adds management issues - checking battery levels, expense of batteries

Connectivity issues:

• use long range wireless to connect remote areas

• using GPRS to connect to sites

Question on getting assistance from Cellular service providers:

• Discussion of assoicated problems

• using Skyband to assist

• lower rates for smses? -

• Possible strategy - give providers phone, they pay for extra personal use, cell provider provides free service for health care related smses/calls.

Primary Care

Demonstrated Primary Care Diagnosis View

Strategy:

• make sure user do as little as possible, and as easy as possible

• 1 question per page

• targeted user - clinician who may not have used a computer before

• have used system in phases since August 2008

• used it for patient registration initially

• 100 - 200 patients a day

• +- 10000 - 12000 patients in annum

Current Status:

• registration desk

• weight and height values as well

• clinician takes data by hand, punches it in afterwards

• can look up previous prescriptions for different diagnoses

• list shows most popular values, can pick from them or choose new value

• can print a label with weight, height, bmi, and prescription

Birt reports:

• diagnosis

• treatment (drugs given)

• what treatments are being prescribed for each diagnosis

Look at interacting with clinicians to improve interface and add additional features

Different views from different clinicians, need to cater for both.

Need to get mandate from district health officers and MoH for system to work effectively.

Question: What is the average time spent with patient - at what point is the patient refered?

Answer:

• can only capture diagnoses

• look at using system to make referrals

• primary health care done

• protocol driven

• not a lot of complexity of e-form, but kept on paper form

Question: why use complex system just to capture 2 obs/values - diag, treatment
Answer:

• might transition into more complex clinic - work in progress

• looking up patient quicker with barcode

• can show past treatmens for diagnosis - frequency based

• look at weight / height based reccomendations for drugs

• look at treatment options and further additions

• good first step - builds adoption with clinicians using computer

In Malawi - important aspect of completeness of data - what types of drugs must be sent to clinic

Looking at adding decision support

Queen Elizabeth hospital:

• links to labs and diabetes system

• try to keep work coherent and compatible

• influence way care is delivered
  Reporting important aspect

Reporting important aspect

POC usually consists of more complex data

• long history

• helps with decision making

• can show past treatments for diagnosis - frequency based

• look at weight / height based recommendations for drugs

• look at treatment options and further additions

• good first step - develops adoption with clinicians using computer

In Malawi - important aspect of completeness of data - what types of drugs must be sent to clinic

The Future

PIH
Baobab
Jembi
Frontline SMS
Build communtiy of healthcare systems
OCC - Concept Dictionary collaboration
Look at making ART system compatible with OpenMRS
Set of tools that can be used

Baobab's perspective:

• upscaling on OpenMRS

• utilise tools in OpenMRS

• manage large amounts of data

• real time processing

Mateme system writes to data model of OpenMRS

• doesn't use the API

• cannot have sync, since no Hibernate layer - direct to DB

• looking at using API and new 1.5 reporting framework

Question: Upscaling / challenges upgrading OpenMRS versions
Answer:

• proposed data model changes

• look at episode of visit instead of encounter - for when only a few obs

Cost:

• $350 for touchscreen workstation - Baobab hav hardware workshop for touch screens

• label printer - $400 - same as FedEx uses

• barcode scanner - $50

• no local source for labels - imported from US

Total cost of new system - want to move to new touchscreens, rather than having to rewire current screens -

• total incl. servers, workstations, etc.

• for 4 consultaition rooms

• $10 000