futures group ehealth briefing feb 2012

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Informational Briefing Futures Group eHealth and mHealth

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Page 1: Futures Group eHealth briefing Feb 2012

Informational Briefing

Futures Group eHealth and mHealth

Page 2: Futures Group eHealth briefing Feb 2012

Bobby Jefferson, Senior Health Informatics Advisor, Futures Group

Manage 36 Programmers India (10) , South Africa (10) , Kenya (10), Tanzania (2), Nigeria (1), Guatemala (1) , Uganda (2)

• U.S. Government President AIDS Relief Program $15 Billion – 10 Countries HIV, Prevention Mother to Child Transmission, TB, OVC

• Principal Investigator– National Health Informatics System (HMIS) Kenya Datawarehouse , National Electronic Medical Records 6,000 hospitals

• Lead IT Project Manager- Community Level Orphans and Vulnerable Children (OVC) electronic data system (World Vision, UNICEF, CRS, Africare) – Zambia, Tanzania

• Health IT Advisor - 5 Central Asia Republics (CAR) Consortium for AIDS Strategic Information in Central Asia (CASICA)

• Kazakhstan, Kyrgyz Republic, Tajikistan,

• Turkmenistan, Uzbekistan

Implementing eHealth and mHealth for Low Resource Communities

Page 3: Futures Group eHealth briefing Feb 2012

502 Staff

30+ countries

Multi-disciplinary

Majority doctoral and masters-level

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Staff Profile

Page 4: Futures Group eHealth briefing Feb 2012

CHSS Geographic Focus

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Latin America and

the Caribbean: Guatemala

Guyana

Haiti

Honduras

Africa: Kenya

Lesotho*

Mozambique

Nigeria

Rwanda

Tanzania

Sierra Leone

South Africa

Swaziland

Uganda

Zambia

Zimbabwe*

Asia and the

Middle East: Afghanistan

China*

India

Pakistan*

Europe & Eurasia Georgia*

Ukraine

Page 5: Futures Group eHealth briefing Feb 2012

Informatics Solutions

• IT Database related to Poverty Reduction

– Social Cash Transfer

– Household base assistance, community empowerment,

• Mobile Surveys

• Monitoring and Evaluation system

• PPP

• Capacity Building, Knowledge Transfer,

– Site Capacity Assessment (SCA) tool

Page 6: Futures Group eHealth briefing Feb 2012

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Page 7: Futures Group eHealth briefing Feb 2012

We are working across 15 Countries, 1,033 Hospital Facilities + Satellites Clinics , Antenatal Care – 535 PMTCT sites Rural, remote, hospitals “serving poorest of poor” and Ministry of Health (MOH) facilities, Rural health facilities serving BPL, marginalized and most vulnerable populations

• Intermittent power, • Lack IT staff, • Lack internet, • Sparse mobile coverage

• Lack of referrals, or linkage between HIV, PMTCT, TB, • Cost effectiveness and sustainability -- no funds for proprietary licenses, or

yearly maintenance fees

Low Resource Environment

Page 8: Futures Group eHealth briefing Feb 2012
Page 9: Futures Group eHealth briefing Feb 2012

Results

• Internet

• Mobiles, SMS

Rural, Remote City

# of Facilities

• Sparse Mobile Coverage • No Internet

• Intermittent Power

Online Solutions

Mobile Solutions

Offline, Disconnected Solutions

• Smartphones

Page 10: Futures Group eHealth briefing Feb 2012

Nurses, Clinicians, Adherence Counselors, need health data, M&E program data in knowledge repository • Lack of referrals, or linkage between HIV, PMTCT, TB, or to existing

technology systems • Cost effectiveness and sustainability -- no funds for proprietary licenses,

or yearly maintenance fees

Low Resource Environment

Page 11: Futures Group eHealth briefing Feb 2012

Approach

Use of freely available, reusable, tools, “coded in country” Creative commons approach

Reusable software and technology across countries and programs

Offline Solutions, Disconnected model

Local programmers, all IT staff in country (India, Kenya, South Africa)

- Offer Programmer training SQL, Agile process, Virus Remediation

Low costs, Inexpensive $200-$350 Netbooks , Solar netbooks

Solar mobile phones, SMS instead of Smartphones

-

Page 12: Futures Group eHealth briefing Feb 2012

Rajketu Singh

Jayanta . Das:

Futures IT Team in India

Santosh Ghandi

Piyush Khanna,

Naveen Sharma

Sanjay Rana

Meetu Rahul

Ajay Sharma

Archana Mahawar Kanchan Verma Deepika Sain,

Page 13: Futures Group eHealth briefing Feb 2012

Collaborators and Users

ICAP Columbia University 44 sites Intra Health International 17 sites Elizabeth Glaser EGPAF 16 sites Family Health Inter FHI 45 sites Catholic Relief Services 13 sites

Catholic Relief Services - 32 Pathfinder International Gertrude Children Hospital DOD Walter Reed - 28 Mount Kenya University MOH Kenya Sites

AIDSRelief John Snow International Rakai Health Services Vaccine Research

Intra Health International

Mennonite Christian Charities AIDSRElief 35 sites

PMTCT , ANC sites 535 sites Elizabeth Glaser EGPAF

Ministry of Health Ministry of Education

Users

World Vision Clinton Foundation Columbia University UNICEF DFID

Page 14: Futures Group eHealth briefing Feb 2012

Health IT Solutions

Collectively referred to as IQSolutions

1. Electronic medical records

1. IQCare

2. Independent Technical Evaluations Performed

WHO, USAID, CDC Atlanta, CDC in-country, Ministry of

Health

2. Mobile Phone solution (IQSMS technology)

3. Visual Dashboards

4. Monitoring & Evaluation Electronic reporting

Page 15: Futures Group eHealth briefing Feb 2012
Page 16: Futures Group eHealth briefing Feb 2012

Clinicians able to review individual patient histories

*Clinicians review patient histories, prescribed drugs, ordered tests and results, and progress on care and treatment during the exam

Page 17: Futures Group eHealth briefing Feb 2012

demo

http://173.203.65.108/iqcare/frmLogin.aspx

Username: user1

Password: 1

Facility/Satellite: 001-01-01-Demo Site

Page 18: Futures Group eHealth briefing Feb 2012
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Mobile Phone Reporting by Remote Workers

Page 20: Futures Group eHealth briefing Feb 2012

PMTCT Currently consists of 4 types of monthly reports

1. PMTCT Antenatal Clinic (ANC) Monthly Summary Form

2. PMTCT Care Register Monthly Summary Form

3. PMTCT Maternity (L&D) Monthly Summary Form

4. PMTCT Mother - Child followup SummarForm

IQSMS PMTCT Reports

Page 21: Futures Group eHealth briefing Feb 2012

Monthly and Quarterly Reports

PMTCT Report

Must Pass All Data Quality Rules, District Office

Data Quality Checks

Page 22: Futures Group eHealth briefing Feb 2012

NUMBER OF CLIENT HAD HIV TEST AT ANC

Page 23: Futures Group eHealth briefing Feb 2012

Excel

PMTCT MONTHLY REPORT PMTCT Antenatal Clinic (ANC) Monthly

Summary Form

ANC 01. New ANC clients this month

118

8 ANC 02. Previously known to be HIV

positive 17

ANC 03. Total number tasted 574 ANC 04. Number of new client had HIV test

at ANC 277

ANC 05. Tested HIV-Positive 37 ANC 06. Post-test counseled for positive

and negative 574

ANC 07. Number of partners tested for HIV 16

ANC 08. Tested HIV-Positive 4

Orphans Vulnerable Children (OVC), Most At Risk Population (MARPS), Maternal Child Health (MNH)

Ms Access Database

PDA device

Web Internet Desktop

Excel Only

M&E Electronic Reporting System Solar Power Cell phones

Page 24: Futures Group eHealth briefing Feb 2012

UNICEF Social Cash Transfer Application

Futures Group International

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STEPS OVC

• STEPS OVC = Sustainability Through Economic Strengthening, Prevention and Support for Orphans and Vulnerable Children

• Program provides

– Support for HIV prevention and behavior change initiatives

– Reducing HIV transmission

– Support for OVC, at-risk youth and adults, and other vulnerable populations

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Page 29: Futures Group eHealth briefing Feb 2012

STEPS OVC Login

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STEPS OVC Beneficiary Search

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STEPS OVC Beneficiary - OVC

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Page 32: Futures Group eHealth briefing Feb 2012

STEPS OVC Reports

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Page 33: Futures Group eHealth briefing Feb 2012

ICT for Development – Best PC Security Practices

Page 34: Futures Group eHealth briefing Feb 2012

District Health Training - Mobile Phone Survey using SMS

Page 35: Futures Group eHealth briefing Feb 2012
Page 36: Futures Group eHealth briefing Feb 2012

Held Training of 600 District Health Officers in Kenya On New District Health Reporting Tool Ministry of Health NASCOP

SMS 1: Have you entered /Imported data into the new tool ? Yes or No SMS 2: Have you run reports using the new district tools ? Yes or No SMS 3: Have you discussed the new district tools and reports with other members of the district health team ? Yes or No SMS 4: In what district do you work? Your answers are confidential and a Ksh 20 refund will be given for each valid reply

Page 37: Futures Group eHealth briefing Feb 2012

Mobile Phone Survey Architecture

Assessment Database

(Excel)

Valid?

SMS Provider service

(Zain/Safaricom)

SMS archived in

frontlinesms application DB

Survey responses/corrections via SMS

FrontlineSMS Assessment Application

Survey questions and

acknowledgement via SMS

Get SMS data

Save

Yes

No

Acknowledge

(Reimburse airtime)

Request for correction

Co

nv

ert

SM

S

con

ten

t to

DB

dat

a

Page 38: Futures Group eHealth briefing Feb 2012

8 provinces involved in the survey, a total of 388 interviewees sent some reply; 101 interviewees completed the survey

Graph 1: N Participated = 165; N completed = 101

Percentage participation/completion in the DHPT text message survey by province

Page 39: Futures Group eHealth briefing Feb 2012

Table 5: Time in minutes to complete the survey

Province N =

131

Minimu

m

25th

Percentil

e

Median 75th

Percentile

Maximum Mean

Central 12 11.00 22.00 27.00 59.00 5861.00 999.33

Coast 12 5.00 9.00 27.00 54.50 969.00 106.75

Eastern North 5 15.00 17.00 25.00 30.00 31.00 23.60

Eastern South 20 3.00 9.00 18.00 480.00 9703.00 1202.10

North Rift 17 15.00 34.00 50.00 262.00 17561.00 2512.06

Nyanza 22 9.00 19.00 27.00 152.00 17534.00 1722.05

South Rift 19 2.00 15.00 35.00 1623.00 27553.00 3162.63

Western 24 4.00 768.00 1372.50 19012.50 30063.00 9424.38

Response duration and times

Graph 2: N: 131 interviewees who responded to at

least 2 questions

Median times (in minutes) participants used to

complete the SMS survey

Page 40: Futures Group eHealth briefing Feb 2012

Response duration and times

• Most of the respondents attended to the SMS after 5pm

• Sending multiple questions drastically reduces the response rate

• Re-sending an answered question does not guarantee a response

• Contact (physical, by mail or otherwise) significantly increases the response rate

• The longer the duration between a response and the next question the lower the chances of getting the next response

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www.futuresgroup.com www.facebook.com/FuturesGroup www.twitter.com/FuturesGroupGbl

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