Experience of OpenMRS introduction in TB service of Tajikistan

Sayohat Hasanova Regional TB pharmaceutical management conference Antalya, Turkey 10 – 13 December 2013

General information about TB in Tajikistan

• TB service has a vertical structure, it is separate from PHC; • TB diagnostics and registration takes place only in the TB

service; • Selling FLD is prohibited, the drugs are provided free of

charge by the TB service; • TB patients – about 50,000 patients in 2007–2013; • MDR-TB patients – about 1,300 patients in 2009-2013; • Treatment is provided under the supervision of TB centers

together with the PHC (priority is given to the outpatient model of care).

Process • Collaborative work of the NTP, WHO and IRD (Interaction Research and Development). The work started from the electronic MDR-TB database with expansion to the common database;

• Adaptation of Open MRS (Open Medical Registration System) with the consultative assistance of IRD, Pakistan:

– Adaptation to the recording and reporting forms of the MDR-TB service in Tajikistan (based on the WHO forms)

– Translation of the program into Tajik

– Broad discussion with the key partners and adjustment of the program

• Development of the training program and user’s manual;

• Appointment of persons responsible at the national, regional and district levels; •Delivery of a number of trainings for launching the pilot.

Advantages/description of the database

Live database;

Flexibility and ability to change according to the NTP needs and requests;

Possibility to develop and introduce new modules if necessary (e.g. drug management module, laboratory service module);

Inexpensive;

Accessible for all users through the system of passwords

Protection from the accidental data entry: special password for the data entry specialists; Language simplicity, a possibility of translation into a local language.

Welcome page

Interface of the database: search/entry of a patient

Interface of the database: overview of patient’s data

Patient Information

Treatment Monitoring

Visits

Interface of the database: overview of patient’s data

Interface of the database: overview of patient’s data

Laboratory Results

Interface of the database: Reporting forms

• Form 07 • Form 08 • Form 10 • Form 07У • Form 08 У • Form 10 У

Reporting Form 07Y

Database piloting • Installation of the main server at the Republican TB Center

• Republican TB Center: – coordinates the process in the country; - ensures adequacy and quality of data; - monitors the work of the regional and district TB centers; - generates the reports

• Regional TB centers (3 centers participate in piloting): – coordinate the process in the region; - ensure adequacy and quality of data in the region; - monitor the work of the district TB centers (which participate in piloting); - enter the regional data; - generate the regional reports.

• District TB centers (3 districts participate in piloting); – enter the district data; – ensure adequacy and quality of data

Challenges at the piloting stage and solutions Challenges Solutions

OpenMRS interface is translated into Russian but should be translated into Tajik

Translation into Tajik is planned

Irregularity of power supply (limits of electric power in winter time)

Desktop computer is replaced with a portable notebook, ADSL modem is replaced with a 3G modem.

Poor computer literacy of the statisticians

A step-by-step data entry guidelines were developed, training courses and on-the-job trainings are being provided during the monitoring.

Outflow of staff due to low salaries Motivation and training of statisticians

Lack of data entry staff (to enter the data on susceptible TB)

Engagement of additional data entry specialists (contractors)

Challenges at the piloting stage and solutions Challenges Solutions Quality of data: - Some data were not complete, invalid and some were duplicated:

• Inadequate keeping of recording and reporting forms in hard copy (where the source information comes from); • Human factor

The Usage Statistics module is introduced. The module detects gaps in the mode of data entry, tracks changes and maintains data integrity.

User manual and Cohort Builder functionality were developed.

Regular data quality monitoring is being formed (weekly).

Interaction with each facility for inclusion of missing data into the forms.

Trainings are needed to improve quality of record keeping, reporting and analysis of data.

The Usage Statistics module.

It allows the administrator to keep track of the utilization statistics by location, user’s role, date and time.

Cohort Builder

Cohort Builder

Facilitates the search by: •Searching patients by Concept/Observation, e.g. searching by treatment outcomes. •Searching patients by Patient Attributes: gender, age ranges, birth date ranges, etc.

Searching patients by Encounters: encounter type, location where encounters took place, forms filled, along with date ranges.

Searching by Program Enrolment: DOTS or MDR-TB program, workflows, states, as well as date ranges.

Searching by Drug Orders:

(1) Prospects: expansion of database Additional financial and technical assistance is required

Expansion of the database beyond the pilot districts. Data entry at the level of district TB centers:

– Additional financing for purchasing notebooks and ensuring access to the Internet

– Training of the local staff

Ensuring adequate data collection: ensuring proper keeping of the patient registration journals (TB 03, ТБ 03у and other journals) at the sites.

Enhanced monitoring of quality and data adequacy

(2) Prospects: expansion of database Additional financial and technical assistance is required

Integration of TB/HIV co-infection rates into the database;

Involvement of the laboratory staff in the process of entering the laboratory data to ensure timely entry of the laboratory results and treatment monitoring;

Utilization of the system for better patient management during the outpatient/community-based treatment (cell phones, GPS)

Introduction of the drug management component for calculation of needs in TB drugs.

Utilization of the system for timely adjustment of doses of TB drugs.