Seeking advice on mobile/electronic data collection in routine health facilities

[Luke Davis]

Dear ict4chw Group,

I am a physician and clinical researcher working with the Makerere University - University of California San Francisco Research Collaboration in Uganda on tuberculosis (TB) diagnosis and case finding activities. For several years we have been working in government primary health centers looking at the use of "real-time" performance monitoring of clinical staff for quality improvement purposes. We are part of a wider infectious disease surveillance network that includes several disease control programs and Health Management Information Systems (HMIS) within MoH. Some of the guiding principles of our work have been a belief in the value of "horizontally-integrated" (i.e. across diseases) rather than the "vertically-integrated" data collection systems that have traditionally been the norm with disease control programs, individual patient tracking to identify lost opportunities for evaluating patients in accordance with national guidelines, and routine feedback to health workers using standardized indicators. In the process, we have come to finding that was unexpected (at least in the TB community): gains in case finding from improving disease evaluation practices has an impact several fold higher than improving the diagnostic tests themselves.

To date, we have used a low-tech approach for this work: a simple carbonized paper record form paired with data entry on conventional desktop PC-based databases linked to a central server. We are now hoping to expand to other health centers and potentially use mobile data collection tools to improve scalability. The one-page form captures all information required for testing and treatment orders, clinical documentation, and public health reporting, and could in theory adapted to a mobile phone interface. To be successful, however, speed and simplicity of the user interface would be essential. Does anyone have any advice on or experiences with using mobile data collection tools managed by routine health workers, especially in the field of TB? Just to clarify, our goal is not to build an EMR, but a focused and adaptable interface for reporting and quality improvement.

Thanks,

Luke Davis

[Mark Spohr]

ODK Collect and Aggregate work well to collect data on-line and off-line.

If you're looking to integrate data horizontally, you'll need something that can keep a longitudinal record linked to individuals. DHIS works well for this and has mobile data entry capabilities (not as nice as ODK).

.Mark

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[Nachiket]

We (www.ictph.org.in) have used a tool developed by Artoo: https://www.artoo.in/portal/sectors/primary-healthcare to collect data in the field for CVD and Diabetes risk factors.  The people collecting data have been locally hired young women that have received a day of training in using the tool.  It has worked very well for us.

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[Sarah Bird]

Hi Luke,

A number of people have used openXdata (www.openxdata.org) for TB programs. There are folks at Makarere in Uganda who work on openXdata so maybe you can meet them in person.

Best,

Sarah Bird

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skype: birdsarah
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[Lars Kristian Roland]

Hi,

since you are in Uganda, I think there will be several benefits choosing
the DHIS2 software which is also used by the MoH. The DHIS2 software
supports both aggregate and case-based data. This is free and open
source software available at dhis2.org, and let me know if you need more
information on how to fit it to your purpose. There are quite a few
people in Uganda who have competence using DHIS2 for various purposes,
also at Makarere.

Best regards,
Lars

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Lars Kristian Roland
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[Sean Blaschke]

Hi Luke and Uganda eHealth enthusiasts,

The MoH in Uganda has taken a strong stand in coordinating all eHealth related initiatives; before looking at possible technologies, I would first familiarize yourself with the national eHealth strategy. This will provide clear guidance on government principles on how technology should be used to strengthen the health system, which technologies the government has already approved for usage, and the criteria / process for trialing new technologies.

As Lars mentioned, DHIS2 is one of the core tools the MoH has approved and identified as a priority for scale-up. Another - mTrac, built on RapidSMS technology- has been identified as the primary choice for SMS interactions. Currently, both DHIS2 and mTrac/ RapidSMS are fully integrated, and can easily be paired. Receiving approval with these technologies should be very straightforward.

If you want to trial a different technology, there is an approval process that must be followed to ensure that any solutions adhear to national laws and government guidelines. In the past, this has taken a long time (up to 6-8 months to get feedback); however, the MoH is finalizing a process that should significantly speed this up.

Note that if you are interested in anything that has to do with patient records (including sending reminders to TB patients), there is a lot of sensitivity around this issue as the MoH is still working on policies that will guide areas including patient privacy, security of health records, and data storage / ownership. DHIS2 is probably the only realistic option at this stage to even consider for this... least for another 2-3 months until the MoH finalizes their strategy around the National Health Records Databank and EMRs.

Cheers,

Sean Blaschke

Health Systems Strengthening Coordinator

UNICEF Uganda

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Sean Blaschke
Child Survival Systems Strengthening Specialist
UNICEF
9 George Street
PO Box 7047
Kampala, Uganda

Switchboard: +256 3 1231 3800
Direct line: +256 4 1717 1554
Mobile: +256 785424271
Email: sbla...@unicef.org

[Mark Spohr]

I am very happy to see that Uganda has a national policy to coordinate HIS technology.  As I recall when I was there a few years ago they had a veritable tower of babel of HIS systems implemented willy-nilly by literally hundreds of projects.

I would strongly advise that you follow their national eHealth strategy and stick to their core approved systems. In this case, DHIS and mTrac since this will greatly simplify integration and communication of data.

Kind regards,

Mark

[Isabel Lobos]

Tride with comm care, for our  is excelent option.
Good lucke
Isabel

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Atentamente

Licda. Isabel Lobos
Directora Ejecutiva
Asociación TulaSalud, ONG
TEL: (502) 5331 2910 FAX: (502) 7952 2455
E-MAIL: isa...@tulasalud.org WEBSITE: www.tulasalud.org

[Jonathan Jackson]

Hi Luke - 

I sent you en e-mail off thread about CommCare (disclaimed, my company provider CommCare).  But I want to emphasize Sean's e-mail.  Uganda is specifically in an interesting place with mhealth and ehealth and I recommend you chat with Sean off thread (he also knows everything going on the ground so is an invaluable resource either way) -- there are policies that you want to make sure you are inline with to make sure you project can proceed with as little friction as possible while still supporting your mission.

Cheers,

Jonathan

Jonathan L. Jackson
Chief Executive Officer
Dimagi, Inc | 585 Massachusetts Ave | Suite 3 | Cambridge, MA 02139
t: (617) 492 2214 | m: (617) 596 6243
web: http://www.dimagi.com/

[Søren Feldbæk]

We are using CommCare to collect data on the performance and development in VSLA groups. It is Village Savings and Loans groups so not in health. But it is  standard one page questionnaire that before was filled on paper but now put on a android smart phone. The phones are used by field workers doing interview in rural areas of Malawi.

We are very happy with the system, both input method and the backend website where we can access the reports when uploaded.

The field workers seem happy with the system and can start use it after 4-5 days of training. The main challenge might be getting used to the touch screen and the keyboard rather than using the electronic questionnaire.

So for this one page form it could be a good system to use CommCare.

best regards

Soren Feldbaek

DanChurchAid - Malawi

M: +265 (0) 88107 4567

Organising team, TEDxLilongwe
www.tedxlilongwe.com
www.facebook.com/tedxlilongwe

[Alvin B. Marcelo]

Is there a link to the Ugandan national eHealth strategy? Looks like they've done their homework very well...

Sent from my BB Curve 9320

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From: Mark Spohr <mhs...@gmail.com>

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Date: Sat, 4 May 2013 10:56:03 -0700

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Subject: Re: [ict4chw] Seeking advice on mobile/electronic data collection in routine health facilities

[Sean Blaschke]

No link to the Ugandan eHealth strategy that i know of, but the MoH is finalizing it for distribution and it will likely be available on their official website soon. I will post a link once it is available online.

[Andy Kanter]

Regarding integration of personal health records or other medical record technology with the open source platforms discussed... I strongly would recommend not trying to use software designed for routine data collection for longitudinal record storage or maintenance. I would also not recommend DHIS2 for individual records although this function has been added recently. If you plan to build out individual medical records, then be very careful what you choose. The Columbia International eHealth Laboratory has been advocating using OpenMRS as the core medical record system with offline data collection tools such as ChildCount+/RapidSMS, CommCare or ODK and then DHIS2 for aggregate reporting and roll-up. Existing standards-based interfaces between these systems make the overall system modular and open. There are also projects integrating OpenMRS with the SMART platform, Pentaho and I2B2 for analytics and warehousing.

I think a common mistake is to take an application which performs one function well, and trying to extend it to do other functions... rather than taking applications with years of experience doing that function and connecting them. You will end up wasting money and not having your data usable in the longer run.

Just my two cents...

Andy Kanter

Director, Columbia International eHealth Laboratory

Columbia University

New York, NY USA

[Luke Davis]

Thanks to all for the many useful insights and helpful suggestions. I will follow-up with many of you individually, and look forward to future posts on the opportunities and challenges of working within national policies on electronic health data like Uganda's.

Best
Luke

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