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This meeting featured short presentations from national EMR impl= ementers discussing how these tools are used in the continuity of treatment= (retention):
KenyaEMR was presented by Otieno = Benard of Palladium=E2=80=99s KenyaHMIS II P= roject. The system is implemented in over 800 facilities. They identified f= our categories of features that support retention: clinically oriented feat= ures, such as appointment management; reports and line-lists; support for c= linical appointment keeping; and custom reporting. The data is shared into = a national cohort dataset allowing decision-makers to identify gaps in rete= ntion and where to support interventions.
UgandaEMR was presented by Stephe= n Senkomago Musoke with the METS program= . The system has been implemented in over 1000 sites with the flexibility t= o do point-of-care, retrospective, or hybrid data entry. Point-of-care queu= eing allows for tracking of patients during care so patients are not lost. = Dashboards are used to support clinical decision making and give an overvie= w of lab tests and results. The EMR integrates with a mobile app that allow= s CHWs to assess those who have missed appointments and those that need fol= low-up to do assessments in the community.
iSant=C3=A9Plus (Haiti) was prese= nted by Kemar Celestin of Centre Ha=C3=AFtien pour le Renforcement du Syst= =C3=A8me de Sant=C3=A9 (CHARESS). The EMR supports a number of reporting to= ols that allows providers to see lists of patients that have missed appoint= ments, if they are due for viral load testing, or need medications. The Con= tinuum of Care document provides a summary of all the care the patient has = received and allows the data to be transferred to between iSant=C3=A9Plus s= ites.
NigeriaMRS presented by Gibril Go= mez of Jhpiego and implemented in 1000 hospitals. The system supports custo= m notifications for appointments, medication pick up, and lab reminders. Th= e community pharmacy allows patients who are stable and receiving care to p= ick up medications and nearby pharmacies.
Lafiya Management Information System (LAMIS Nigeria) presented by Alexander Alozie of Data.FI. LAMIS has been implemente= d in over 700 facilities. The system supports a number of treatment continu= ation features including: SMS Reminders for clinic visits, drug refills, an= d viral load investigations; case management; client status notifications; = and LAMISLite which works on a mobile device and supports CHWs in the commu= nity.
PIHMalawiEMR presented by Limbani= Thengo. Patient=E2=80=99s identified in the appointment report as being mi= ssing for two or six weeks are then put into the Tracking Retention and Cli= ent Enrollment (TRACE) process. First they will verify the missed appointme= nt is not due to missed data entry, then they signal CHWs via a mobile app = to conduct outreach to bring the patients back to care.
eSwatini CMS presented by Mzawand= ile Viakati. The system integrates with the national system allowing regist= ered patients demographics to be accessed from any facility. The system pro= vides 92% of the data needed for monitoring the 95-95-95 goals.
Slide presentation= s are being shared by presenters here.
The need to obtain consent from patients to receive the messages was a c= ommon thread across the SMS interventions. A community member asked how sys= tems are used to predict the risk for treatment interruptions. Kemar Celest= in noted that some research on implementation o= f prediction algorithms for risk of future treatment failure = ;has been done. They are currently doing additional research on mach= ine learning methods to predict risk of treatment failure, which could be u= sed for alerts related to frequency of viral load testing or enhanced adher= ence counseling. They are also studying the robustness of the prediction ac= ross varying levels of system data quality and across patient subgroups to = build into clinical decision support in the future.
You can post follow-up questions and thoughts to our Discourse =E2=80=9CQuestions=E2=80=9D page, where some unanswered questions= from the meeting have also been posted.