Godwin N. Mugo (MBChB, MPH)1 Victor Ogoti (BscIT)1

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Godwin N. Mugo (MBChB, MPH)1 Victor Ogoti (BscIT)1 7th East African Health and Scientific Conference-Dar es Salaam Use of Electronic Medical Records to Improve Accuracy and Timeliness of Viral Load Documentation in a Faith Based HIV Program in Kenya Godwin N. Mugo (MBChB, MPH)1 Victor Ogoti (BscIT)1 1Christian Health Association of Kenya

Background Electronic medical records critical in strengthening health system decision making and program performance. Timeliness, accuracy and completeness of data is important to inform data quality improvement. 2017 national HIV services data quality audit highlighted gaps in viral load documentation in both paper and EMR based sites. IQCare EMR implemented to bridge these gaps in the CHAK-HIV Program Provides care and treatment to over 48,000 patients Supported by robust data quality audits, data demand and information use processes to drive quality improvement activities.

Study Objective To demonstrate improved accuracy, timeliness and completeness of VL data through the use of IQCare EMR in CHAK-HIV Program.

Methods (1) Study design: Retrospective dynamic cohort Study Period: January 2015-September 2018 Study Location: 79 facilities supported by CHAK-HIV Program,Kenya Data: De-identified patient level data Data source: Medical records from IQCare EMR , using SQL queries. Inclusion-all records of patients in care Study variables-VL results duration to entry, completeness of entry Sample size-37435, 39075, 41856 and 43518 records were reviewed for year 2015, 2016, 2017 and 2018 respectively

Methods (2) Data analysis ANOVA between annual time periods Post hoc comparisons to compare the effect of use of EMR on accuracy and timeliness of VL documentation Two sample t test to compare percentage erroneous entries between study years compared to baseline year.

Results 1: Timeliness and Accuracy of Documentation SOURCE OF VARIATION DF SUM OF SQUARES MEAN SQUARES F RATIO PROBABILITY BETWEEN 3.00 360644.50 120214.80 165.09 0.0000 WITHIN 130650.00 5139088.00 728.20 TOTAL 130653.00 5499736.00 Significant effect of the use of EMR on improving timeliness and accuracy of documentation for the four time periods [F (3, 130650) = 165.09, p<0.001].

Results 2: EMR Utilization Year T VALUE DF P value 2015 2016 -14.620 52738.000 0.0000 2017 -12.669 56874.000 2018 0.390 61674.000 0.6969 2.621 68886.000 0.0089 18.082 73776.000 15.898 77912.000 Post hoc comparisons indicated that the mean score for EMR utilization was significantly different at p<0.05 except in the 2018 year comparison (µ 2015-18.75, 2016-22.28, 2017-21.74, 2018-18.66).

Results 3: Erroneous and Incomplete Entries Year Sample size Erroneous entries t statistic df P value 2015 37435 0.07% 2016 39075 0.24% 5.940 76508.00 0.0000 2017 41856 0.30% 7.397 79289.00 2018 43518 0.18% 4.345 80951.00 There was significant reduction in erroneous and incomplete entries at p<0.001 for year 2016 t(76508)=5.940, 2017 t(79289)=7.397 and 2018 t(80951)=4.345.

Conclusions EMRs improve the timeliness and accuracy of patient level VL data. Programs should adopt and expand their utilization to improve data quality for health system decision making.

CHAK-HIV Program staff Acknowledgements Victor Ogoti Dr Catherine Njigua Dr Douglas Gaitho CHAK-HIV Program staff