HEALTH INFORMATICS PUBLIC PRIVATE PARTNERSHIP Project in Cambodia Mr. Phath Veasna Data Management Officer National Center for HIV/AIDS, Dermatology and STD Himawari Hotel, 16 September 2014

NCHADS MoH US-CDC (OGAC/PEPFAR) InSTEDDAcknowledgementsAcknowledgements

Table of contents Goal Objective Duration Data Integration Information flow Result Challenge Lesson learn

Project Goal Use technology in Health Information System to support improvement of quality of health services delivery in Cambodia’s National HIV Care and treatment program.

Project Objective Improve the linkages and referrals between differences services through linking of existing health information system with a patient unique identifier system. Promote the use of data from this new integrated system to monitor and improve the quality of services

Duration of Project and Location for Implementation Duration of the project: - Develop software: 1 st April Implement: Mid March 2013 to 31 July 2014 Location: Battambang Province (Mid March 2013) 5 OI/ART Services 16 VCCT Services 2 STD Services Location: Banteay Meanchey Province (1 st June 2014) 4 OI/ART Services 4 VCCT Services 2 STD Services OI : HIV related Opportunistic Infection ART : Antiretroviral therapy STD : Sexually Transmitted Disease VCCT Voluntary Centers for Counseling and Testing

Name of VCCT service Data of start implement # of Finger Print # of clients positive HIV # of clients show at OI/ART Name of OI/ART service Data of start implement # of Finger Print # of patients show at STI RH Moung Russey 29/04/2013 1, Maung Russey Hospital 29/04/ RH Sampov Luon 10/04/2013 1, Battambang Hospital 15/03/2013 3, RH province 15/03/2013 3, Sampov Loun RH 10/04/ Military Hospital 08/05/ Thmor Kol RH 23/04/2013 1,028 1 RH Thmor Kol 23/04/ R5 Military Hospital 08/05/ HC Bavel 23/04/ HC Tasanh 30/04/ HC Sdau 02/05/ HC Trang 11/04/ Name of STD service Data of start implement # of Finger Print # of patients show at VCCT HC Anlung Vil 03/05/ HC Prek Norin 26/04/ HC Kan Toeu II 24/04/ Battambang Hospital 15/03/2013 2, HC Boeung Pring 24/04/ Sampov Loun RH10/04/2013 1,01028 HC Kas Kralor 30/04/ HC Phnom Sampov 03/05/ HC Prey Svay 30/04/ Implemented Services

 Objective: To link VCCT, OI/ART and STD information for improved patient care  How: Use Master Patient Index (MPI) and Fingerprint Data Integration

 Universality, High uniqueness, high permanence, low cost compared to other biometric.  Use fingerprint template for identifying. Fingerprint template could not be reversed.  Template size: 3000 byte  Speed: 1:20000  4 seconds 1:50000  9 seconds Why Fingerprint ? Biometric Minutia Data

Information flow

Process detail

Patient search Patient registration Synchronization Security System (VPN) View patient Software Feature VPN : Virtual Private Network

13 Patient Search

14 Patient Registration

15 Patient Information

16 Synchronization

17 View Patients

 Duplicate HIV Test rate - Average number of HIV tests per clients  Linkage to Care rate -Rate of patients who test HIV-positive at the VCCT who register at OI/ART  Rates of VCCT / STI Referral - Rate of patients who positive for an STI who later to get an HIV test at VCCT - Rate of patients who test HIV-positive at VCCT who later register at an STI clinic for STI test New Information provided by the system

Date StartTo Date# of patients registered# of patients who did not receive drug themselves 01/04/201331/07/20146, Date StartTo Date# of clients tested # of positive clients # of clients reach to pre-ART services # of clients reach to STI services 01/04/201331/07/201411, # of positive clients refer to pre-ART # of positive clients show at pre-ART # of clients refer to STI # of positive clients show at STI 11, Date StartTo Date# of clients registered# of clients refer to VCCT# of clients shown at VCCT 01/04/201331/07/20143, Date StartTo Date# of clients who tested 2 times # of clients who tested 3 times # of clients who tested 4 times(5 times) 01/04/201331/07/ (2) 2- pre-ART/ART Services 1- VCCT Services 3- STI Services 4- Clients Tested Duplicate at VCCT Services Result of VCCT, OI/ART and STI after UIS deployment

–Some specific problems related to revised source code of Fingerprint SDK met error like increase memory then get stuck so need to get the answer from provider and take long time to get response. –Sometimes Fingerprint not working properly –Workflow place to place is different and not exactly the same as we have known –Some sites has problem with Internet connection or Internet slow. –Unstable electricity which UPS cannot work for long hours –Budget ended since 31 July 2014ChallengesChallenges

–Patient flow is different from sites to sites. We need slightly modify our setup and system to fit with flow. –Create patients fingerprint for temporary first before to see doctor or clinician –Data entry can entry the patients/ clients information after patients from completed by doctors or clinician –Computer knowledge of users are limited. However, the problem can be solved with additional training on basic computer –Some of the sites just start using electronic databases. Need more time to adapt to the system. Lesson Learn

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