Patient Management System Goes Digital
Managing the records of a single patient on Anti Retroviral Therapy (ART) is no mean task, especially if—as is common practice in Zimbabwe—the work is done manually. In a country with an estimated 700, 000 people on ART, this translates into huge workload, straining the already over-burdened health worker.
“Sometimes, the data clerk or nurse has to fill up to 23 registers for one individual. This involves a lot of paper-work. That is why our storage facilities are full to the brim with files and registers” explains Dr. Regis Choto who is deputy OI/ART (Opportunistic Infections Anti-Retroviral Treatment) coordinator, HIV and TB Unit in the MoHCC.
The introduction of the electronic Patient Management System (ePMS), supported by the UNDP-administered Global Fund programme is changing all that, ushering a new exciting era for patient management.
“This labour-intensive task is now being reduced to one paper trail through the use of the mandatory OI/ART booklet. The rest is done electronically through ePMs” says Dr. Choto.
Introduced in Zimbabwe in 2013, ePMS will go a long way in improving access to patient health information and to making well informed clinical decisions leading to better patient outcomes.
“The primary interest of the Global Fund is to support the Ministry of Health and Child Care to improve its ability to monitor patient data”, says Mr. Perry Mwangala who oversees Zimbabwe’s portfolio at the Global Fund. With the electronic patient monitoring in place, policy makers will have more reliable data on patients, including those on long-term treatment, he said. Stressing the value of reliable, real-time data in health care, Mr. Mwangala said that the ePMS “will improve forecasting and quantification for commodities since health officials will have more reliable data on people undergoing treatment”.
“The system is automated. Therefore it is mandatory to complete the OI-ART number which is the identifier for the patient, including the surname, sex and date of birth” relates Mr. Chris Magama, who is the monitoring and evaluation officer based at the Ministry of Health and Child Care.
“It is very ideal for electronic calculations, analysis, patient information consolidation as well as providing information on early warning indicators and the rate of patient survival,” he says.
In addition, increased access to detailed patient information will create more robust programme evaluations while computerized data aggregation will eliminate multiple entry of patient information across different paper registers.
“So far, most of our healthcare staff are very excited about the new system. Before it was introduced they had to fill multiple registers forcing them to go home late after work,” says Dr. Choto, adding that managers and supervisors will also benefit tremendously from the use of ePMS. “Data security and staff oversight will become easy because everything can be verified online.”
The initiative, financed with a US $ 2.5 million contribution from the Global Fund and technical support from WHO and other development partners will culminate in the phasing out of paper registers and introduction of ePMS throughout the country. WHO support included the provision of technical assistance and support for the conduct of monitoring and evaluation needs assessment in 2012.
Based on the implementation plan, an estimated 534 high-volume ART sites will be covered in three years starting 2013. When completed in 2015, about 97% of patients on ART would be covered.
The first phase kicked off in 2013 tragetting 83 sites, mainly central, provincial, district hospitals and few city clinics. An estimated 61% of patients on ART nationwide were covered by ePMS at these sites by the end of 2013. In 2014, an additional 267 facilities comprising rural, mission hospitals and some large clinics will be added, bringing the cumulative sites to 350. The remaining 184 facilities will be covered during Phase 3 in 2015.
In the Global Fund new funding model, that features improved predictability of funding, appropriate resources have been approved to support the three phases of implementation.
To enable them fulfil their duties effectively, four nurses, one pharmacist, a matron and health information officers from each facility, district and province have been trained on the new software.
The implementation of the ePMS also benefited from a University of Dar es Salaam, Tanzania team that provided technical support for development of the system and training of in-country personnel on the appropriate application of the new system.
“We have trained cadres from key health facilities on how to use the system” emphasizes Dr. Choto.