1. 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

2. NCHADS MoH US-CDC (OGAC/PEPFAR) InSTEDDAcknowledgementsAcknowledgements

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

4. 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.

5. 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

6. Duration of Project and Location for Implementation Duration of the project: - Develop software: 1 st April 2012 - 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

7. 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 1,3496521 Maung Russey Hospital 29/04/2013 860 3 RH Sampov Luon 10/04/2013 1,0328438Battambang Hospital 15/03/2013 3,346 25 RH province 15/03/2013 3,61828796Sampov Loun RH 10/04/2013 641 16 Military Hospital 08/05/2013 874252Thmor Kol RH 23/04/2013 1,028 1 RH Thmor Kol 23/04/2013 6454922R5 Military Hospital 08/05/2013 662 1 HC Bavel 23/04/2013 29043 HC Tasanh 30/04/2013 50410 HC Sdau 02/05/2013 49174 HC Trang 11/04/2013 31092 Name of STD service Data of start implement # of Finger Print # of patients show at VCCT HC Anlung Vil 03/05/2013 50783 HC Prek Norin 26/04/2013 41912 HC Kan Toeu II 24/04/2013 42122 Battambang Hospital 15/03/2013 2,707297 HC Boeung Pring 24/04/2013 14301 Sampov Loun RH10/04/2013 1,01028 HC Kas Kralor 30/04/2013 40721 HC Phnom Sampov 03/05/2013 88311 HC Prey Svay 30/04/2013 21500 Implemented Services

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

9.  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

10. Information flow

11. Process detail

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

13. 13 Patient Search

14. 14 Patient Registration

15. 15 Patient Information

16. 16 Synchronization

17. 17 View Patients

18.  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

19. Date StartTo Date# of patients registered# of patients who did not receive drug themselves 01/04/201331/07/20146,537342 Date StartTo Date# of clients tested # of positive clients # of clients reach to pre-ART services # of clients reach to STI services 01/04/201331/07/201411,943618198149 # of positive clients refer to pre-ART # of positive clients show at pre-ART 618421198 # of clients refer to STI # of positive clients show at STI 11,9431149 Date StartTo Date# of clients registered# of clients refer to VCCT# of clients shown at VCCT 01/04/201331/07/20143,71789325 Date StartTo Date# of clients who tested 2 times # of clients who tested 3 times # of clients who tested 4 times(5 times) 01/04/201331/07/2014260292 (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

20. –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

21. –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

22. Thanks for your attention !