Considerations for Electronic Surveillance Systems Bill Coggin CDC
Considerations for Electronic Surveillance Systems Bill Coggin CDC South Africa
“Nothing has really happened until it has been recorded. ” Virginia Woolf
“Nothing has really happened until it has been recorded. ” Virginia Woolf “…. and validated, analyzed, reported and ACTED UPON. ”
Overarching principle • Electronic systems facilitate analysis at sub • • district, provincial and national levels but represent only one tool. Timely and accurate completion of the patient card and register is paramount Foster data use at facility-level, program evaluation and improvement.
Pre-2000: Aggregate system • Problems inherent in design of system (TBSYS) • Not based on cohort • Difficult to breakdown to implementation level, eg • • • validate results back to paper register. Prone to subjective interpretation, calculation errors (reporting only on known outcomes) More useful at higher levels No issue of patient-record confidentiality
Revised R&R • • • Cohort-based District-based WHO-IUATLD standard definitions Management tool Patient-based ETR since 2000 (Epi 6, Dos-based) 6/9 provinces
Electronic tools • • ETR: Epi 6 > Windows NTCP mandate to have all provinces’ CF data on one system as of Qtr 1/2004 Platform: Epi. Info or other Microsoft. Net Framework Started December 2003 Emulates ETR (Botusa) SA-based programming and support
Approach • Project plan/specifications: • – Stepwise addition of required functionality (CF, SCR, TO, Fac. Rep, exports, checks, etc) – Prioritized task list, resource requirements (eg programming time, costing, testing, stakeholder consultation) – Delineation of monthly release/update schedule. HIV/TB surveillance component – from April 2004
ETR. Net • • Features: – Validations – Add/edit facilities – Standardized reports – User/admin setup – Application updater – Standardized reports – Import from prior systems Last three provinces, implemented since April 2004
Experience with ETR. Net • In-country expertise • Rapid development • Simplified application development for standalone • • • and distributed systems No DLL registration, no DLL version conflicts Stability across various Win platforms (Win 98+) Excellent user interface (Windows user familiarity) Multi-language support (isi. Zulu or Xhosa ETRs? ) Copy and paste deployment
HIV surveillance in ETR. Net • Implementation of Comprehensive Plan offers • • • renewed impetus to accelerate VCT and access to HIV services for TB patients ETR. Net process is opportune time to integrate HIV data elements into software Challenge: HIV test data has not been part of routine collection Technical and administrative approaches to address this issue
Administrative and technical approaches • • Register “Annex” No pt identifiers Link to register via TB register number (? ID #) Training in confidentiality • • Built-in MS Access database security Built-in MS. Net security • • • Custom developed security: – User names and PWs – Different user types and permissions • Administrators • Users • HIV allowed or not Patient data only visible at lowest level Aggregate reports available at all levels
ETR. Net HIV data elements
Limitations • TB recording and reporting system is a surveillance • • • & program management tool for a priority program. Is not a POS patient management system. Address this with linkages: – Export aggregate data to national HIS – Collaborations for linkages with other systems (eg PIS for ART) Use of. Net framework facilitates such linkages.
Plans • TBHIV surveillance pilots in: • – Selected TB/HIV Training Districts – Selected districts implementing Comprehensive Plan – A 500 -bed TB hospital funded for expanded TB/HIV services via Emergency Plan Continued development/enhancements of overall ETR. Net.
Issues in Implementing Electronic Systems * • Need to build for the long term while still meeting • • short term needs Must adjust to situations that vary considerably among countries – Infrastructure – Human capacity – Stage of electronic systems development No one size fits all – need tailored solutions * Meade Morgan, June meeting
Conclusions • Let time determine scope of project. • Succeed via continual incremental improvements. • Require progress not perfection. • Recycle proven concepts. • Consult widely and often; integrate demonstrated • • best-practice based on operations research and field experience. Importance of NTP/NACPs, donors, WHO to commit resources for TB/HIV surveillance. Not number-crunching but prog evaluation > service improvement > improved quality-of-life
Acknowledgements • South Africa Department of Health • • – NTCP: Lindiwe Mvusi, Carina Idema – TB/HIV Team: Kgomotso Vilakazi, V Tihon – Provincial TB Coordinators Wam. Technology: Paul Maree & team CDC Botusa team
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