IMPROVING HEALTHCARE USING HEALTH INFORMATION SYSTEMS IN GUYANA An integral component of the CIDA FUNDED PUBLIC HEALTH STRENGTHENING PROJECT IN GUYANA IMPLEMENTED BY THE CANADIAN SOCIETY FOR INTERNATIONAL HEALTH Gavin Walters, Paul D. Fisher, John Farley, R. Benedict Objectives Guyana HIS Version 0.1 Screenshots (Continued) Introduction CONCLUSIONS Justification Guyana HIS Development Team Health Information Systems (HIS) play an important role in the efficient delivery of care and in the planning and management of health care services. A properly designed HIS provides key epidemiological information, which is valuable at the government level in making human and material resource allocation decisions. At the clinical level, HIS streamlines the flow of data into the system, communication of data across the system, and information generation by the system. This supplies health care providers access to information that allows them to make more knowledgeable decisions and deliver better care and treatment to the patient. At the patient level, HIS systems improve the efficiency and quality of care that the patient receives as well as providing patient confidentiality. Data collection in Guyana is currently done on paper or using disconnected databases. There is very little interoperability between the data collection systems, a high degree of data duplication, a high error rate, and long reporting delays. Patient confidentiality is an important requirement and will be reflected in the HIS. A properly designed and implemented HIS and appropriately trained users are needed to streamline the collection of data and improve the efficiency of clinical processes. The primary objective of the HIS component of the Public Health Strengthening in Guyana project is to develop a primary and ambulatory HIS that is flexible, scalable, secure and sustainable to be utilized in different health care settings and customizable to meet the diversified needs of different clinical providers. Description of Methods The initial horizontal scope of the project is primary and ambulatory care at the Genito-Urinary Medicine (GUM) Clinic, TB Clinic, and Dorothy Bailey Health Center (DBHC). Each of the pilots sites have there own local area network. The GUM and TB Clinic buildings are networked together and share one central database server. The DBHC has its own database server. Each of the locations will have around 5 workstations so the different users of the system can test out the different aspects of the HIS. The vertical scope of the project is clinical decision support, institutional resource management, health care services planning and epidemiological reporting. Description of Approaches (1) Design a HIS, based on current clinical, management and planning activities, that is flexible and scalable to accommodate for future needs. In addition, the HIS will be designed with a strong emphasis on security to ensure the confidentiality of the patient data. (2) Develop a multi-user, client server, Windows based HIS with Visual Basic.Net clients and Microsoft SQL server for the database server. (3) A prototyping development approach will be used where a prototype HIS system is implemented, tested by the users and feedback is obtained. This implies several cycles or prototyping with the end result being a quality, customized HIS. The Guyana HIS Development Team is comprised of Dr. Paul Fisher, Gavin Walters, Amar Samaroo, Nellie Chang, and Dr. John Farley. Dr. Paul Fisher is an expert in HIS (s) and the HIS Team leader. He contributed significantly to the overall design of the system as well as providing guidance and is responsible for the administrative details of the project. Gavin Walters is the HIS software developer. He is responsible for developing the HIS database and client software. Amar Samaroo is the local system administrator based in Georgetown. He is responsible for all hardware and software administration. Nellie Chang is a CSIH NetCorp intern working with the HIS development team to lead the training of the users and develop documentation for the HIS. Dr. John Farley, the HIV/STI expert contributed significantly to the design of the HIV/STI modules for the HIS. He provides ongoing consulting advice for various aspects of the HIS. Fig 1 - HIS login screen Guyana HIS Current Status – Prototyping Phase During the early October 2004 mission in Guyana, version 0.1 of the HIS was installed at the GUM and TB Clinics in Georgetown. This was the first prototype version to be installed at the pilot sites. Users from both clinics have the opportunity to see the HIS in operation and also have a chance to use the system. Nellie Chang is continuing to introduce users at both clinics with the HIS and is documenting changes and feedback that will be sent to Gavin Walters so that these changes can be reflected in the next version of the HIS. Guyana HIS Version 0.1 Screenshots Fig 2 - Patient Lookup Screen Fig 3 – Receptionist Workspace Fig 4 – Patient Electronic Record Fig 5 - Scheduler Fig 6 – Clinical Workspace used by Physicians and Nurses Fig 7 – Patient Summary Form Fig 8 – Case Entry Form Fig 9 – Encounter Entry Form Fig 11 – DOT Worker Workspace Fig 10 – Encounter Detailed Form Fig 12 – DOT Encounter Entry Form The next major release of the Guyana HIS, version 0.2 is scheduled for early Feedback and changes requested since the October 2004 mission will be reflected in version 0.2. The new version will include the immunization and pregnancy modules. Version 0.2 will be installed at the DBHC. The HIS at both the GUM and TB clinics will be updated with version 0.2. Work will commence in training users, documenting feedback and changes at the DBHC site, and will be pursued at the GUM and TB Clinics. The prototyping phase will continue, with updated versions of the HIS being released every three to four months, until a stable production version is obtained. Once a production release of the Guyana HIS is obtained it will be available for installation in other regions in Guyana. The Guyana HIS will help significantly improve the delivery of health services in Guyana. CSIH Ottawa office: Roumyana Benedict Project Director, PHSG Tel: (613) Ext.307 CSIH Guyana office: Suzanne Marquis Project Field Manager Georgetown, Guyana Tel: (592) Ministry of Health Guyana CIDA