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HIS Leadership and Governance in Kenya

As a key member of the Kenya electronic medical record (EMR) system technical working group, I-TECH works to implement and standardize the EMR systems used in the management of national HIV and AIDS care and treatment data. Similar efforts have focused on ensuring that different electronic systems can communicate with one another (interoperability) and that health care workers, administrators, and staff are well trained to use and maintain them.

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Health Information Systems in Kenya

In 2012, I-TECH designed and developed an electronic medical records (EMR) system, KenyaEMR, to support the care and treatment of HIV/AIDS. KenyaEMR is built on the OpenMRS platform. I-TECH supported the implementation of KenyaEMR in over 300 health facilities throughout Kenya—one of the largest open source EMR rollouts in Africa.

Continue reading “Health Information Systems in Kenya”

E-Learning and Data Quality Improvement Featured at CUGH 2016

Optimized-CUGH banner 2016

The International Training and Education Center for Health (I-TECH) is presenting three posters at the 7th Annual Consortium of Universities for Global Health (CUGH) conference in San Francisco on April 9-11. The theme of this year’s conference is “Bridging to a Sustainable Future in Global Health.”

A critical component in sustainability is the ability to collect accurate and meaningful data through electronic medical records (EMRs) – the subject of two abstracts from the I-TECH Kenya team.

In addition, online learning and electronic learning (e-learning) provides opportunities for health care workers in resource-limited settings to gain critical knowledge and skills while minimizing their need to leave the workplace.

In close partnership with the University of Washington Department of Global Health’s eLearning Initiative (eDGH), I-TECH piloted e-learning modules for KenyaEMR and transitioned the HIV management diploma program at the University of the West Indies into a blended learning program that incorporates online courses.

“Building Human Capacity for Optimal Use of an Electronic Medical Record System in Kenya: Results of a Pilot Evaluation of Two eLearning Modules”

The transcript tab allows learners to read along with the narration.
The transcript tab allows learners to read along with the narration.

Since 2012, the Kenyan Ministry of Health, PEPFAR, and partners have supported implementation of electronic medical record systems (EMRs) at more than 600 public-sector health facilities. The International Training and Education Center for Health (I-TECH) has supported scale-up at more than 300 of these sites.

However, implementation is just part of the story. Successful, sustained use of EMR data depends upon the knowledge and skills of front-line health care workers. To address this need, I-TECH and eDGH developed and piloted two interactive e-learning modules on EMR data quality and EMR data for decision-making.

I-TECH and eDGH found that facility staff were motivated to use EMR e-learning modules and apply what they had learned. Participants found the content relevant to their jobs and cited an interest in additional scenarios and modules. Self-paced e-learning modules were determined to be a viable solution for standardizing sustainable training on EMR systems.

“Institutionalization of a Routine Data Quality Assessment (RDQA) Procedure for Improved Data Quality of Electronic Patient Medical Records in Kenya”

To support progressive EMR data quality improvement, I-TECH developed a Routine Data Quality Assessment (RDQA) standard operating procedure and analysis tool. The RDQA procedure was defined in collaboration with the Kenyan Ministry of Health and integrated within existing policies and procedures.

From 2014 to 2015, 180 baseline and repeat assessments were conducted. I-TECH supported facility personnel to share results during county-level EMR review meetings; these presentations motivated other sites to plan for RDQAs and fostered a culture of ongoing data quality improvement. The RDQA procedure for EMR data has now been institutionalized as a method for progressively improving EMR data quality in Kenya.

“Train, Transfer, and Sustain: Building Capacity for Online Learning at The University of the West Indies Diploma in the Management of HIV Infection Program”

In partnership with the University of the West Indies (UWI), eDGH and I-TECH transitioned a one-year diploma program in the Management of HIV Infection to a blended learning platform that combines online courses with either a clinical practicum or a research project.

The shift in pedagogy, methodologies, and technologies was achieved through a three-phased approach designed to not only train UWI faculty and staff, but also transfer online facilitation skills to them and sustain those skills.

In its second year as a blended learning online program, the diploma program has scaled up to include health care workers from Cayman Islands, Jamaica, and Suriname.

These projects are supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U91HA0680, International AIDS Education and Training Center. The content and conclusions of this post are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS, or the U.S. government.

I-TECH Shares Research at CUGH 2015

CUGH 2015

On March 26-28, Boston University will host the Sixth Annual Consortium of Universities for Global Health (CUGH) Conference.

The theme of this year’s conference is “Mobilizing Research for Global Health,” and featured speakers include Olusoji Adeyi, Director, Health, Nutrition and Population, World Bank; Paul Farmer, Co-Founder, Partners in Health; and Stephen Morrison, Vice President, Center for Strategic and International Studies.

Staff members from the International Training and Education Center for Health (I-TECH) will attend to present research on several topics:

Malawi

  • Quality improvement practices decrease adverse event rates in a surgical male circumcision program in Malawi
    Kohler PK, Chilongozi DA, Namate D, Barr BA, Msungama W, Phiri O, Tenthani L, Chalulu K, Perdue T, Barnhart S, Krieger JN
  • Improving nursing and midwifery clinical education by developing local faculty mentoring capacity in Malawi
    Holman J, Muyaso M, Msiska G, Namate D, Wasili R

Haiti

  • An assessment of data quality in Haiti’s multi-site electronic medical record system
    Puttkammer N, Baseman JG, Devine EB, Hyppolite N, France G, Honoré JG, Matheson AI, Zeliadt S, Yuhas K, Sherr K, Cadet JR, G. Zamor, Barnhart S

Kenya

  • Evolution of the KenyaEMR training program: Towards efficiency and quality in scale-up
    Atelu C, Antilla J, Muthee V, Puttkammer N

About CUGH

Founded by leading North American university global health programs, CUGH aims to:

  • Define the field and discipline of global health;
  • Standardize required curricula and competencies for global health;
  • Define criteria and conditions for student and faculty field placements in host institutions;
  • Provide coordination of projects and initiatives among and between resource-rich universities and less-developed nations and their institutions.

CUGH is dedicated to creating balance in resources and in the exchange of students and faculty between institutions in rich and poor countries, recognizing the importance of equal partnership between the academic institutions in developing nations and their resource-rich counterparts in the planning, implementation, management and impact evaluation of joint projects.

 

KenyaEMR Implemented at More Than 340 Sites in Under Two Years

The I-TECH Kenya team celebrates implementing KenyaEMR at more than 340 facilities -- along with a congratulations card from I-TECH HQ.

The I-TECH Kenya team celebrates implementing KenyaEMR at more than 340 facilities — along with a congratulations card from I-TECH HQ.

A shifting government structure, power outages, and even the threat of crocodiles didn’t deter the International Training and Education Center for Health (I-TECH) from implementing the electronic medical records system KenyaEMR at more than 340 clinics and district hospitals across Kenya.

One of the largest EMR rollouts in Africa, this work was supported by the U.S. Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC) through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

When PEPFAR care and treatment partners in Kenya identified lack of timely and complete patient data as a major barrier to effective HIV/AIDS patient management, I-TECH and in-country partners set out to design and develop KenyaEMR, expanding on the OpenMRS platform to build an EMR system to collect health data and improve patient care.

These efforts were first led by I-TECH Kenya’s then-Country Director, Dr. Patrick Odawo, and were assumed by his successor, Dr. Willis Akhwale, supported by dedicated teams in Nairobi and at Seattle headquarters.

Challenges along the way

The KenyaEMR team wades across the Turkwel River.

The KenyaEMR team wades across the Turkwel River.

This was no small feat – there were many obstacles overcome to equip the sites in just under two years.  Among these were the devolution of the Kenyan government to a county-based government halfway through the implementation, lack of reliable power, and establishing server rooms in facilities that were never designed to protect electronic systems.

In fact, Implementation Assistant Wilfex Terer remembers obtaining an escort and wading across a crocodile-infested river to reach a health facility in North Rift Valley, one of the most remote areas of Kenya.

“Because of high insecurity in the southern parts of Turkana County, we hired two Kenya police reservists to provide security escort,” says Terer. “We then left our vehicle and waded across the Turkwel River to a health facility vehicle awaiting us on the other side. After some minutes we arrived at the facility in wet clothing.”

Implementing the system

KenyaEMR is a customized system that supports the care and treatment of HIV/AIDS. The system was designed and developed by I-TECH and partners in 2012, following Standards and Guidelines developed by I-TECH in collaboration with the Kenyan Ministry of Health.

The pre-implementation phase comprised engaging stakeholders, specifically the Kenyan Ministry of Health, forming technical working groups to share strategies, and assessing the networking and hardware at the facilities.

Particularly important to effective implementations were sensitization meetings with county, hospital, and facility administrators to build their awareness of the benefits of KenyaEMR and to obtain their support for its implementation and operations.

During implementation, the team purchased hardware, installed intranets, and set up and deployed the software. This phase also included mentorship and on-the-job training: I-TECH supports use of the system by building the capacity of Health Managers and through on-site training to mentors, who then train staff at local facilities.

This approach to capacity building allowed I-TECH to maximize training time, build local capacity, and ensure sustainability when staff transition to other facilities. To date, I-TECH has oriented 625 Health Managers and trained 1,409 system users and champion mentors.

The future of KenyaEMR

Wired for a training in North Rift.

Wired for a training in North Rift.

Post-implementation, I-TECH is providing ongoing software maintenance, support for use of system, and guidance on data use for patient monitoring.  I-TECH is working on expanding the functionality to handle pharmacy and laboratory orders, as well as additional functions at the facility.

“The main focus now is on improving meaningful use of data and defining exactly what that is,” says Steven Wanyee, Implementation and Interoperability Manager.

One example of “meaningful use” is that physicians and other health workers can now see a summarized profile before meeting with a patient, which helps improve quality of care and physician decision making.

Likewise, at the policy level, an electronic database means that various stakeholders in Kenya can collect public health data to assist them in assessing needs and making broad-reaching policy decisions.

“EMRs have been seen as very useful in discussions about the HIV treatment cascade,” says Wanyee, and there is interest in finding out how KenyaEMR can help to identify gaps.

“This project does more than just save space dedicated to paper records,” he continues. “It helps to inform and improve patient care at every level.”

I-TECH Presents at CUGH 2014

Optimized-CUGH 2014 (1)

I-TECH staff will head to Washington, D.C., this week to the Fifth Annual Consortium of Universities for Global Health (CUGH) Conference, which will take place at the Washington Hilton from May 10-12. More than 1,300 participants from 50 countries are expected to attend the conference, co-hosted by the George Washington University and Stanford University.

This year’s theme is “Universities 2.0: Advancing Global Health in the Post-MDG Era,” and I-TECH teams will present on forward-looking topics ranging from the implementation of electronic medical records to partnership with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

Confirmed speakers include President of the World Bank Jim Kim; former Head of UNAIDS and current Director of the London School of Hygiene and Tropical Medicine Peter Piot; and Head of the Earth Institute at Columbia University Jeff Sachs. Dr. King Holmes, I-TECH Principal Investigator and 2013 Gairdner Global Health Awardee, will also speak at CUGH’s Gairdner Lecture on May 12.

For those planning to attend the conference, don’t forget to check out the University of Washington Department of Global Health table — and to stop by the I-TECH presentations, listed below.

Kenya

  • Electronic Medical Record (EMR) Implementation at Scale in the Public Health Sector: Lessons Learned in Kenya

Haiti

  • Using an electronic medical record system to identify factors associated with attrition from the HIV antiretroviral therapy program at two hospitals in Haiti
  • Before and After the Earthquake: A Case Study of Attrition from the HIV Antiretroviral Therapy Program in Haiti

South Africa

  • Successes and challenges in liaising with PEPFAR partners and stakeholders in the TB/HIV Management Program
  • Evaluation of a comprehensive HIV prevention program in North West Province, South Africa: results from the pilot
  • Integrating research into program design: Conducting a situational analysis to inform comprehensive HIV prevention and care in North West Province, South Africa
  • Mystery patients: Training actors to serve as unannounced standardized patients to evaluate training outcomes for sexually transmitted infections in South Africa

Lab Leadership and Management

  • Certificate Program in Clinical and Public Health Laboratory Leadership and Management

Contact Anne Fox in Communications to see any of these completed posters.

About CUGH:

Founded by leading North American university global health programs, CUGH aims to:

  • Define the field and discipline of global health;
  • Standardize required curricula and competencies for global health;
  • Define criteria and conditions for student and faculty field placements in host institutions;
  • Provide coordination of projects and initiatives among and between resource-rich universities and less-developed nations and their institutions.

CUGH is dedicated to creating balance in resources and in the exchange of students and faculty between institutions in rich and poor countries, recognizing the importance of equal partnership between the academic institutions in developing nations and their resource-rich counterparts in the planning, implementation, management and impact evaluation of joint projects.

The Bill & Melinda Gates Foundation provided the leadership and funding to plan this consortium. The Rockefeller Foundation provided a grant to help develop the organizational structure of CUGH in its first year of existence.