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Considerations for Electronic Surveillance Systems Bill Coggin CDC South Africa

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.”.

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Considerations for Electronic Surveillance Systems Bill Coggin CDC South Africa

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  1. Considerations for Electronic Surveillance Systems Bill Coggin CDC South Africa

  2. “Nothing has really happened until it has been recorded.” Virginia Woolf

  3. “Nothing has really happened until it has been recorded.” Virginia Woolf “….and validated, analyzed, reported and ACTED UPON.”

  4. 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.

  5. 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

  6. Revised R&R • Cohort-based • District-based • WHO-IUATLD standard definitions • Management tool • Patient-based ETR since 2000 (Epi6, Dos-based) • 6/9 provinces

  7. Electronic tools • ETR: Epi6 > Windows • NTCP mandate to have all provinces’ CF data on one system as of Qtr 1/2004 • Platform: EpiInfo or other • Microsoft .Net Framework • Started December 2003 • Emulates ETR (Botusa) • SA-based programming and support

  8. Approach • Project plan/specifications: • Stepwise addition of required functionality (CF, SCR, TO, FacRep, 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

  9. 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

  10. 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 (Win98+) • Excellent user interface (Windows user familiarity) • Multi-language support (isiZulu or Xhosa ETRs?) • Copy and paste deployment

  11. 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

  12. 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 Administrative and technical approaches

  13. ETR.Net HIV data elements

  14. 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.

  15. 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.

  16. 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

  17. 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

  18. Acknowledgements • South Africa Department of Health • NTCP: Lindiwe Mvusi, Carina Idema • TB/HIV Team: Kgomotso Vilakazi, V Tihon • Provincial TB Coordinators • WamTechnology: Paul Maree & team • CDC Botusa team

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