Questions: Medical Records and Continuity of Treatment (Retention) Meeting

The following questions had been left without response as we wrapped up the DUC meeting earlier this week. We have tagged those who asked the questions as well as those who may be able to provide a response on our discussion forum.

@botienoh @ssmusoke @ckemar @alexalozie @Fabien @limbani @Mzwandile @ggomez

For all presenters:
What is the the systems centralized or stand alone? If the system is stand alone how do you manage the upgrades and patient duplication?
Do you have any process or SOP focusing on security issues, both hardware, software and data? - @CiceroN

For all presenters:
Can the presenters explain how systems are used to predict risk for treatment interruptions and share data to be used by HCWs to screen/target with additional engagement support? Eg. if there are sub populations (age, sex, characteristics) that are less likely to stay engaged on treatment in the first 90 days, how does the EMR help to define this and cue a HCW response? And if not happening, is there interest to do this?
Also which EMR platforms have existing research protocols in place to analyze data and describe client behaviors? We are also curious to understand within facilities with higher numbers of client interruptions in treatment (LTFU), who are these clients? Are these the same clients who are cyclically churning in and out of treatment, different clients using services at multiple facilities over time, or some other type of barrier to treatment continuity - eg. migration/internal displacement. - @ombijam

For all presenters: For the patients who have experienced their data being managed by both paper registers and electronic systems (EMR), have you experienced any concerns from patients when they learn that their information is managed electronically? - @SamW

For Malawi Team @limbani: Thanks for the presentation! great work. How does the system integrate with the national malawi EMRS? Is there connectivity with MOH to a national database? and any connectivity to LMS? - @ewetzel

For Malawi Team @limbani: For Malawi, was it difficult to implement the chronic care information system for both HIV and NCDs? Usually funding is considerably less for NCDs compared to HIV. How was buy in achieved from the government and other major stakeholders? Do you have any customer satisfaction data to show that the patients are welcoming of being contacted when they miss appointments? - Italia Rolle

For all presenters: I want to ask all presenters if the respective governments are willing and ready to invest in HMIS/EMR? This is because most of the presenters referredto donors supported EMR/HMIS intervention. - Ochonye Bartholomew Boniface

As an update, other questions have been answered by the LAMIS Nigeria team here: Questions on LAMIS during the DUC Meeting on Continuity of Treatment/Retention

@ewetzel - At the moment there is no connection to the national EMR. We only exchange data through reports and raw extracted data.

But we are in the process of working on integrating Neno EMR with the national lab system for viral load data exchange. One of the objectives is to cut back on the turn around time for viral load results. So we are working on linking the two systems so that we can send requests for viral load tests at the point they are being done to the central lab system. And receive results of tests done for viral load once they are ready.
The current process depends on a team of health service courier to move paper forms / results forms between the requesting facility and the lab where the test is done.

Thanks Limbani.
Some of our supported sites are also working on the linkage with national lab. Hopefully that will go smoothly and help with TAT.

Italia Rolle

The EMR evolved along side the model for care delivery for HIV and NCD programs. Before NCD and HIV care were integrated into a single clinic (Integrated Chronic Care Clinic / IC3), they used to be separate clinics altogether with their own EHRs. A charitable trust funded the NCD program and the development of the EMR functionality.

The unique model for integrating HIV and NCD care was also a highlight for the collaboration with the Ministry. Leveraging HIV platforms to work toward comprehensive primary care in rural Malawi: the Integrated Chronic Care Clinic - ScienceDirect

Currently, we do not have data to show satisfaction for the patients who are tracked and contacted when they miss an appointment. But will share when the data is available.