Integration of electronic TB and HIV data collection

Integration of electronic TB and HIV data collection in facilities HEALTH PATIENT REGISTRATION SYSTEM AND TIER. NET

What is the Health Patient Registration System? § In 2014 the National Department of Health (NDOH) embarked on a process to administratively register all patients § Health Patient Registration System (HPRS) is being implemented nationally § This is an networked, electronic system used to register each patient that comes to a health facility § It records each patient’s demographic information § It also tracks patients’ unique identifier information SA ID number § Passport number § Asylum seeker number § Other primary identification domains § § The system assigns a health patient registration number (HPRN) for each registered patient 2

What is the Health Patient Registration System? (2) § Ten digit health patient registration number (HPRN) is linked with the patient’s SA ID (or other primary identification domain) § Assigned 10 -digit HPRN serves as a secondary unique identifier § Why do we need a secondary unique identifier? § If patient does not have SA ID book/passport/asylum seeker card – s/he cannot be refused access to health services § Refusing access to health care is unconstitutional § Thus in order to be able to track an individual patient, who may or not present with SA ID number (etc. ) – each patient is assigned a secondary unique identifier § The HPRN supports development of a master patient index (MPI) § HPRN will then be used as folder number § Introduction of HPRN has real implications for business administration processes in facilities 3

What is Health Patient Registration System? (3) § Processes where the HPRS is implemented: Each patient who visits facility will be registered on HRPS will automatically assign the patients with an HPRN If this an existing patient at this facility (who already has a patient folder) - the HRPN will replace the existing folder number § File room/ registry will have to manage to parallel filing systems for a period of time (folders with longstanding folder numbers vs. those with HPRN) § With the shift to HPRS, it is essential that the HRPN is a fixed to every piece of clinical stationery, all laboratory request forms, transfer out forms etc. § Filing of the patient files will be according to the last 4 digits of the HPRN § Recording of the HPRN on all stationery and in TIER. Net must include the full 10 digits § § § 4

Why do we need to deploy unique identifiers? § SA has seen the rapid scale-up of critical health services (especially HIV) over past twenty years § It is increasingly essential that we are able to track/account for the services each patient in the national health population is receiving § This in turn demands that each patient in the national health population is uniquely identified § In that way, we are able to definitively build a longitudinal record of the patient § And we can track the patient across services/health facilities 5

HRPS and TIER § The majority of the national ART patient population has been digitised in TIER § TIER has been developed to track individual patients receiving HIV/TB services over a period of time § It is essential to leverage the deployment of the HPRS § National team alongside key partners (UCT CIDER, CSIR) worked to ensure interoperability between TIER and HPRS § This means: Demographic and identifier information can be electronically exchanged between HRPS and TIER § When unique identifier deployed – as patient-level data moves up – will de-duplicate patient database § 6

HRPS look-up in TIER § After searching for patient and clicking Add New the Patient Details window will open. § If HPRS is available, the HPRS database will automatically be searched using the folder number you entered previously. § If the patient is not found, double check that you have entered the complete and correct folder number (HPRN) and then click on the HPRS Lookup button. § If the patient is found in the HPRS database, the patient demographic details will be imported from HPRS to the Patient Details pop-up.

HPRS vs TIER. Net § The existing folder number should be captured as alternative folder number in TIER, § § This will support tracking of patients during the transition to HRPS For example, in some instances the HPRS will be implemented whilst laboratory tests are being processed. Retention of both numbers will ensure the results can be linked up to the patient upon return to the facility. § TIER § § has ability to house the following against each patient: SA ID number/passport number (etc) HPRN (as folder number) Alternate folder number (“old/existing” folder number) TB registration number 8

Operationalising the HPRS/HPRN in facilities using TIER. Net § A standardized approach must be adopted – when introducing the HPRS and HPRN in facilities with existing folder numbers captured in TIER. Net § This will ensure the transition to a new folder number is done in a way that preserves the link between patient management, patient folder, and the unique identifier § The issuing of the HPRN requires the folder number to change in TIER. Net at the same time the new folder number (HPRN) is issued § In most cases this will happen through an automatic link, however if the link does not update this must be done manually § It is essential the folder number in TIER. Net, all patient stationery, and the HPRN is the same. § 10 digit HPRN number must be the number used in TIER. Net and all other paper and electronic systems § The folder will be filed according to the last 4 digits of the HPRN. July and August 2016 9 Comprehensive TIER Training for TB/HIV Integration

Updating HPRN in HIV and TB Treatment Record • When applicable the 10 digit HPRN number in its entirety must be captured on all clinical records and in TIER. Net 10

Going forward § Primary unique identifier (where available) AS WELL AS HPRN/folder number must be written on every piece of clinical stationery, all laboratory request forms § Plan to move towards zebra-labels with the HPRN embedded for individual patients § Needs to messaged far and wide to all clinicians § Where HPRS and TIER 1. 10 implemented – the HRPS lookup in TIER must be used § Imperative to utilise full 10 -digit HPRN § If you use the last four/five digits – this does not make that identifier unique. § In fact it creates duplicate numbers in TIER. Net 11

Thank you 12