This meeting featured short presentations from national EMR implementers discussing how these tools are used in the continuity of treatment (retention):
KenyaEMR was presented by Otieno Benard of Palladium’s KenyaHMIS II Project. The system is implemented in over 800 facilities. They identified four categories of features that support retention: clinically oriented features, such as appointment management; reports and line-lists; support for clinical appointment keeping; and custom reporting. The data is shared into a national cohort dataset allowing decision-makers to identify gaps in retention and where to support interventions.
UgandaEMR was presented by Stephen Senkomago Musoke with the METS program. The system has been implemented in over 1000 sites with the flexibility to do point-of-care, retrospective, or hybrid data entry. Point-of-care queueing allows for tracking of patients during care so patients are not lost. Dashboards are used to support clinical decision making and give an overview of lab tests and results. The EMR integrates with a mobile app that allows CHWs to assess those who have missed appointments and those that need follow-up to do assessments in the community.
iSantéPlus (Haiti) was presented by Kemar Celestin of Centre Haïtien pour le Renforcement du Système de Santé (CHARESS). The EMR supports a number of reporting tools that allows providers to see lists of patients that have missed appointments, if they are due for viral load testing, or need medications. The Continuum of Care document provides a summary of all the care the patient has received and allows the data to be transferred to between iSantéPlus sites.
NigeriaMRS presented by Gibril Gomez of Jhpiego and implemented in 1000 hospitals. The system supports custom notifications for appointments, medication pick up, and lab reminders. The community pharmacy allows patients who are stable and receiving care to pick up medications and nearby pharmacies.
Lafiya Management Information System (LAMIS Nigeria) presented by Alexander Alozie of Data.FI. LAMIS has been implemented in over 700 facilities. The system supports a number of treatment continuation features including: SMS Reminders for clinic visits, drug refills, and viral load investigations; case management; client status notifications; and LAMISLite which works on a mobile device and supports CHWs in the community.
PIHMalawiEMR presented by Limbani Thengo. Patient’s identified in the appointment report as being missing for two or six weeks are then put into the Tracking Retention and Client Enrollment (TRACE) process. First they will verify the missed appointment 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 Mzawandile Viakati. The system integrates with the national system allowing registered patients demographics to be accessed from any facility. The system provides 92% of the data needed for monitoring the 95-95-95 goals.
The need to obtain consent from patients to receive the messages was a common thread across the SMS interventions. A community member asked how systems are used to predict the risk for treatment interruptions. Kemar Celestin noted that some research on implementation of prediction algorithms for risk of future treatment failure has been done. They are currently doing additional research on machine learning methods to predict risk of treatment failure, which could be used for alerts related to frequency of viral load testing or enhanced adherence counseling. They are also studying the robustness of the prediction across 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 “Questions” page, where some unanswered questions from the meeting have also been posted.