In partnership with CDC, CHARESS helps the Haitian MSPP to implement the national care improvement program, HealthQual, by training providers on quality improvement concepts and using data from the EMR, iSanté, for clinical decision making and improved care. Continue reading “Continuous Quality Improvement in Haiti”
Category: Health Information Systems
Guyana Revamps Its Health Information System with I-TECH Support
The International Training and Education Center for Health (I-TECH) recently partnered with the Ministry of Public Health in Guyana and the U.S. Centers for Disease Control and Prevention (CDC) to launch a new health information system (HIS) that will protect patients’ privacy, maintain confidentiality, and provide security for sensitive data.
In an article in Guyana’s Kaieteur News, Deputy Chief Medical Officer, Dr. Karen Boyle, described how health officials hope to reduce health service quality inequities between coastal regions and other parts of the country as part of the national 2020 plan, in part by reducing waiting time for medical services and improving patient health literacy. Dr. Boyle stated they expect to “improve access to health information” and allow for “shared responsibility” for health care decision-making by providers and patients.
The health information upgrade is also being supported by PAHO (the Pan-American Health Organization), UNAIDS, and local collaborating partners such as the University of Guyana, e-Government, the National Insurance Scheme, and the Government Technical Institute (GTI).
E-Learning and Data Quality Improvement Featured at CUGH 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.
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.
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.
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.
New Evaluation Highlights Benefits of iSanté to Care and Treatment
For a decade, the iSanté electronic medical record system and OpenELIS lab software, developed by the International Training and Education Center for Health (I-TECH), have allowed health care providers to document HIV patient care and patient care histories.
A recent evaluation, “Report on Best Practices in ‘Point of Care’ Implementation of iSanté and OpenELIS Data Systems,” has expanded the current knowledge of iSanté’s use at point of care (POC) as well as highlighting the benefit of iSanté use to care and treatment.
The evaluation also identifies strengths and challenges in POC use of the iSanté and OpenELIS systems in clinics and hospitals in Haiti, in order to guide improvements in the quality of I-TECH’s technical assistance.
The move to point of care
Until 2012, most sites used iSanté primarily to capture data that providers had recorded on paper forms. In 2012-13, with impetus from the Haitian Ministry of Health and funders, I-TECH supported some iSanté sites to move toward POC implementation.
This involves providers using iSanté during patient visits to enroll patients, review health history, capture clinical assessments and treatment plans, and record drug and laboratory orders.
Evaluation shows positive impact
Through in-depth interviews and focus group discussions with hospital personnel, I-TECH was able to grasp the positive impact of iSanté POC system use has on care and treatment.
Facility personnel at all levels were satisfied with the transition to POC system use. All five sites evaluated reported increases in provider confidence and improved human resource management, citing reduced provider workload and more effective use of provider time.
Personnel also perceived a number of positive effects of system use on productivity and quality of care including benefits to patient experience (reduced wait times) and service quality.
I-TECH Shares Research at 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.
MOU Signed with the Ukrainian Centre for Socially Dangerous Disease Control
From L to R: Igor Kuzin, Head of the National M&E Center at UCDC; Dr. Natalia Nizova, Director of UCDC; Matt Heffron, I-TECH Informatics Implementation Specialist; Anna Shapoval, I-TECH Ukraine Country Director; and Mykhailo Rabinchuk, PR and Event Manager at UCDC.
On March 11, the University of Washington Department of Global Health (DGH) signed a Memorandum of Understanding (MOU) with the Ukrainian Centre for Socially Dangerous Disease Control of the Ministry of Health of Ukraine (UCDC).
This landmark event consolidated cooperation between the International Education and Training Center for Health (I-TECH) — a DGH center — and UCDC. This partnership started in 2013 with the launch of the I-TECH-developed Clinical Assessment for Systems Strengthening (ClASS) tool within a project to build clinical and managerial capacity of HIV/AIDS services in Ukraine.
All parties expressed confidence that this MOU would help foster relationships and the development of possible collaborative projects in capacity building, monitoring and evaluation, and research aimed at quality improvement of health care services in Ukraine.
“I-TECH is very excited about this new development in our collaboration with UCDC,” said Anna Shapoval, Country Director of I-TECH Ukraine. “The MOU will help to formalize, fortify, and, hopefully, expand our partnership with the UCDC in the coming year and beyond — in particular in the area of health systems strengthening through development of human resources for health and supporting strategic information systems.”
Haiti’s Electronic Medical Records System iSanté Proves Useful Tool to Improve Patient Outcomes
For nearly a decade, iSanté has allowed providers to share information among care team members and health professionals.
Over the past several years, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has invested heavily in health systems and clinical data analyses in low-income countries around the world, in its efforts to support the care and treatment of those affected by HIV and AIDS.
With the support of PEPFAR, through the Health Resources and Services Administration (HRSA), in 2005, the International Training and Education Center for Health (I-TECH), together with Haiti’s Ministère de la Santé Publique et de la Population (MSPP) and the U.S. Centers for Disease Control and Prevention (CDC), developed and implemented iSanté — an electronic medical record system to capture and report information on patients living with HIV and AIDS.
For nearly a decade, this system has allowed providers to document HIV patient care, look up patient care histories, and share information between care team members and health professionals.
The MSPP has been particularly concerned with patient adherence to antiretroviral therapy (ART) and treatment failure due to a number of factors, including the 2010 Haiti earthquake. While iSanté has gotten kudos in Haiti for storing and linking patient data, three recent papers, lead-authored by I-TECH Research and Evaluation Advisor Nancy Puttkammer, have illustrated the potential of using this data source to identify and help solve the challenges of adherence and patient attrition.
- “Before and After the Earthquake: A Case Study of Attrition from the HIV Antiretroviral Therapy Program in Haiti,” published in Global Health Action in August 2014, compared attrition from the national HIV ART program at two large public-sector hospitals where I-TECH works. One site was less than 30 km from the epicenter of the devastating earthquake of January 2010, while the other site was outside of the area strongly affected by the earthquake. Surprisingly, the paper showed that attrition improved after the earthquake in the site closest to the epicenter. This finding underscores the resilience of patients and providers, and contributes evidence that it is possible to maintain continuity of HIV services even in the context of a complex humanitarian emergency.
- “Development of an Electronic Medical Record Based Alert for Risk of HIV Treatment Failure in a Low-Resource Setting,” published in PLOSOne in November 2014, shows that ART-dispensing data and other data contained in iSanté can be used to estimate patients’ adherence to their medications and predict the patients most likely to experience ART treatment failure in the future. Having an alert to signal patients with high risk of future treatment failure could help providers better target counseling and other adherence support.
- “Patient Attrition from the HIV Antiretroviral Therapy Program at Two Hospitals in Haiti,” currently in press at the Pan American Journal of Public Health, examines ART attrition at the same two hospitals, during the period 2005-2011. The study found higher risk of attrition among patients who lived farther away from the hospital, who started on non-standard ART regimens, who did not receive ART adherence counseling before initiating ART, and who rapidly started ART following their enrollment in HIV care and treatment. The findings suggest opportunities for several quality improvement interventions at the two hospitals.
“This research has provided a valuable contribution in documenting health outcomes and encouraging improvement in the ART program in Haiti,” says Dr. Scott Barnhart, Professor of General Internal Medicine and Global Health at the University of Washington. “We are at the dawn of translating large investments in EMRs into useful data for improving the care of patients, as well as supporting important pub
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.
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.
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.
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 Supports More Than a Quarter of a Million Trainings
SEATTLE, Sept. 30, 2014 — The International Training and Education Center for Health (I-TECH) is pleased to announce an incredible milestone: to date, more than a quarter of a million people have been trained with the support of I-TECH and its partners. This total includes:
- more than 100,000 nurses;
- nearly 29,000 physicians; and
- approximately 11,500 community-based health workers.
These health care workers are tracked using the Training System Monitoring and Reporting Tool (TrainSMART), an I-TECH-designed web-based training data collection system that allows users to accurately track data about health training programs, trainers, and trainees, to better evaluate training programs, plan new programs, and report activities to stakeholders.
“In many limited-resource countries, there aren’t enough health care workers to meet needs,” said Robert McLaughlin, Manager of Information Systems at I-TECH. “It’s critical to train new workers, and with the advent of new medicines, techniques, and technology, there is also the need for continuously updated skills and knowledge.
“Tracking which training is being offered, and where training is needed most, can be difficult,” he continued. “TrainSMART was designed as a solution to these challenges.”
TrainSMART tracks health care workers in nearly 72,000 facilities in more than 25 countries worldwide. Because TrainSMART is free, open-source software, it is appropriate for use in resource-limited settings and can be customized to meet specific needs.
For example, in 2012, at the request of the South Africa National Department of Health (NDoH), I-TECH developed a web-based application called Skills System Monitoring and Reporting Tool (SkillSMART), based on the same programming as TrainSMART. SkillSMART is now the NDoH’s database for monitoring and reporting on health care workers skills in South Africa; the database currently contains approximately 20,000 clinicians.
“I could not be more pleased to mark this quarter-million milestone,” said Dr. Ann Downer, Executive Director of I-TECH. “It’s a testament not only to the progress being made in health worker training worldwide, but also to I-TECH’s ability to create innovative and adaptable solutions to some of the most pressing health problems.”
The initial development of TrainSMART was funded by a grant administered by the U.S. Health Resources and Services Administration (HRSA) through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
ABOUT I-TECH
The International Training and Education Center for Health (I-TECH) is a center in the University of Washington’s Department of Global Health. I-TECH’s approximately 2,000 worldwide staff work with local ministries of health, universities, non-governmental organizations (NGOs), medical facilities, and other partners to support the development of a skilled health work force and well-organized national health delivery systems.
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I-TECH Presents at CUGH 2014
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.