Overview/Importance of HMIS Health Management Information Systems, the Private Sector, and HIV/AIDS: a discussion of implementation and outcomes. Video Conference, World Bank Offices, Washington, D.C. 18 January 2006 Xenophon M. Santas (xsantas@cdc.gov) Global AIDS Program, Informatics Team Centers for Disease Control and Prevention

The Emergency Plan A multi-agency $15 billion U.S. initiative to provide HIV care, treatment, and prevention services to HIV affected populations in the developing world HMIS committee – draws expertise from USAID, CDC, HRSA, Census Bureau, DoD, and Peace Corps Includes technical expertise from private partners Works closely with counterparts at WHO and UNAIDS

Health Management Information Systems (HMIS) Key component of strategic information systems Definition: “targeted monitoring, evaluation, and surveillance data used to answer key questions about The state of the epidemic The delivery and process of prevention, care, and treatment services The effectiveness of these services Capacity needed to improve programs, meet planning and reporting requirements, and reach goals for impacting the epidemic

Strategic Information Key Components HIV/AIDS surveillance Population-based bio-behavioral surveys and facility surveys Health Management Information Systems for facility-based reporting Program-level monitoring and reporting (non-facility based) Targeted evaluation studies

Components of an Information System Organizational Human resources Communications infrastructure Protocols and training Supervision Quality control Analysis and feedback Paper-based data collection forms Electronic databases Hardware and software Technological

Examples of Information Systems Supporting HIV Programs Pharmacy management Laboratory management Logistics/supply chain management Program monitoring (OVC, palliative care) Facility-based patients systems (e.g., ART) Vital statistics registries Facility-based surveys (e.g., ANC clinics) Population-based surveys National notifiable disease reporting systems

Strategic Information Data Flow President’s Emergency Plan Countries United States Surveys (BSS, AIS, Country etc.) Specific U.S. in - country Survey Results Offices (e.g., MACRO) Embassy USAID CDC CRIS+ or other system D.C. Headquarters System Washington, D.C. Facility- based service providers Ministries of Health Other services (OVC , peer - CRIS+ or Other education, other Databases etc.) system (e.g. BuCen)

Traditional HMIS Partners International Organizations (WHO, UNAIDS) National Governments (MOH, NAC) Donors Provincial governments NGO’s Local universities/schools of medicine U.S./European universities Private partners

PEPFAR HMIS Subcommittee Goals (1) Provide assistance in the collection of Emergency Plan core indicators Improve capacity to collect client-level and clinical service information that will assist in daily management of individual patient care Improve capacity to collect facility-, district- and country-level information that will assist with clinic and program management Develop strategies for better data collection and program monitoring from non-facility-based care or prevention activities, such as OVC services.

PEPFAR HMIS Activities (1) Minimum data set for use in monitoring ART produced by WHO, with input from HMIS subcommittee Concept Paper: Developing Facility-based Management Information Systems, May 2004 Protocol: Assessment of Health Information Systems developed to describe methods for evaluating and assessing country health management information systems, and to aid in obtaining comparable descriptions of these systems (www.rhinonet.org, under the “PEPFAR” tab) Describes background, framework, objectives, team composition, and methodology Four data collection forms: A. HIV/AIDS program inventory B. National HIS overview C. National and sub-National Infrastructure Assessment D. Facility Assessment Translations available in French and Portuguese

PEPFAR HMIS Activities (2) HMIS assessments conducted/initiated Haiti Côte d’Ivoire Mozambique Tanzania Nigeria Uganda Antiretroviral Therapy (ART) Software Inventory (www.rhinonet.org) New Technology White Paper

PEPFAR HMIS Activities (3) Software Tool Enhancements HRSA’s CareWare patient care and management software Pharmacy module for tracking prescriptions and dispensing invoices; inventory and prescription adherence reports Language translator Flexible forms creator that allows user to select certain fields of interest and place them on a form in the order of interest. Regimen builder and tracker PEPFAR reports HL7 export for “transportable” core data Study and produce a feasibility report on integrating biometric patient identifier system with CareWare (e.g., thumbprint reader). Technical assistance and training Collaboration with CDC-Uganda, Track 1 (and other) grantees. Output data to CDC PMTCT aggregate reporting system CDC’s Epi-Info data analysis tool

PEPFAR HMIS Activities (4) ART Facility-Level Systems and Electronic Medical Records (EMR). Support development of Electronic standards for information systems to be used in the monitoring of clinical care (including ART) Guidelines for security and confidentiality of patient data (joint activity with WHO) A standardized Health Level Seven (HL7) message to facilitate secure electronic transmission and exchange of data across data systems Publish specifications for electronic systems that support the care of HIV infected patients

PEPFAR HMIS Activities (5) Enhanced support/management of Graphical Information Systems (GIS) activities Support routine production of maps. Develop/enhance an Emergency Plan web site, both password-protected and for public access Support to WHO for their HealthMapper and Service Availability Mapping (SAM) projects Develop and maintain an inventory of laboratory information systems (LISs) suitable for use in both focus and non-focus countries

PEPFAR HMIS Activities (6) Develop specifications/requirements for in-country program monitoring and evaluation data systems Visit at least three countries with extensive U.S. government presence Develop and document recommendations Support UNAID’s Country Response Information System (CRIS) for enhanced/better management of U.S. mission-specific data