RTI ppt template

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Using ICT to Improve Patient Care ZEPRS Chris
Kelley, Niamh Darcy Nov 20, 2007
RTI International is a trade name of Research
Triangle Institute
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ZEPRS Key Concepts

• Guides medical personnel through Zambian standard
  of perinatal care
• Concept of flows within the system and related
  data
• Shared terminal usage
• Usage of ZEPRS data for quality assurance and
  supervision
• Patient confidentiality
• Adaptability/Extensibility of ZEPRS system
  (HIV/ART, Safe Motherhood)
• Using mini applications to build computing skills

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ZEPRS Key medical features

• Safe Motherhood
• Pregnancies linked together
• Convert typical visit to problem visit
• Graphical Partograph (matches WHO partograph)
• Patient Referral System
• Use of EDD/EGA calculation and update in display
  (with options for manual over-ride) very useful
  automation for nurses
• Antenatal and Postnatal card generation (supports
  patient mobility)
• Infants linked to mother for each separate
  pregnancy
• Reports
• Problem Management including problems across
  multiple pregnancies

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ZEPRS Key Technical features

• Data export facilitates reporting in Access, SAS,
  SPSS etc
• Connected and disconnected mode
• Standalone mode for remote clinics with
  occasional connectivity - can sync records
  automatically with the main system.
• Open Source Java J2EE Tomcat/Struts/MySQL

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ZEPRS Design Principles

• User driven, collaborative and iterative
• Software developed using open source tools
  (cost-effective) and best-of-breed web
  architecture
• Software adapted easily to other contexts and
  applications
• ZEPRS software released under ASL2 open source
  license
• ZEPRS documentation published under a Creative
  Commons Attribution-NonCommercial-ShareAlike 2.5
  license

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ZEPRS Demo - Antenatal
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ZEPRS Home page
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Patient Status
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Demographics
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Pregnancy Dating
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Medical/Surgical History
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Routine Ante-natal Visits
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Chart Routine Antenatal visits
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Tracking PMTCT/VCT in Safe Motherhood
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Counseling Visits
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ARV Regimen
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Regimen Results
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Entering Lab results CD4
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Pregnancy Dating/Previous Pregnancies
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Referrals
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Referrals Viewing the record that triggered the
referral
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Referrals UTH perspective
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System Generated Problems
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Comments on Problems
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Problem List
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ZEPRS Demo Labor and Delivery
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Partograph
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Partograph Complex data entry with simple user
interface
Tracking Cervix/Decent plot
Entering data
Result
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Partograph Timing Alert
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Partograph conclusion
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Delivery
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Delivery Summary
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Links to Infant record
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Correcting a patient record
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Improvement Highlights on key fields
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Reports
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Report selection
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Reports
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Report selection
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ANC Monthly Report
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Reflex Register
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Software Development

• Agile programming approach iterative
  development (CMM Level II)
• Referral application used to seed development
  approach, training, roll-out and support
• RFP issued to South African/Indian firms rand
  appreciation and responsiveness resulted in
  developing in-house
• Multiple supporting applications developed
  (administration of users, training, web-based
  email, web-based PM, bugtracker)
• User Manual drives training plans
• Detailed test plans and testing, using local
  medical students who we trained in software
  testing

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Software Platform
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Software Development - IDE and Development

• What skills does a developer need to work on
  ZEPRS?
• Experienced Java developer for code changes
• Basic pc skills to modiy ZEPRS forms.
• ZEPRS Dev tools
• Incremental development
• Average 2 builds/month usually simple field
  changes, reports
• Process of installing new builds application
  updates
• Testing
• Unit tests
• Load tests jMeter
• Demo login
• Documentation used Drupal CMS for
  www.idg-rti.org website.

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Software DevelopmentDesign Enterprise Content
Management

• Authorized users may login to the Administration
  section of the ZEPRS application and create new
  forms, add/modify fields to a form, and
  add/modify enumerations to a field.
• Systems administrators may query common values
  using the Report section Query interface. These
  ad-hoc reports may be useful for previewing data
  intended for a published standard report.
• Rules Rules may be added to the ZEPRS forms via
  the Administration sections web interface.
  Values entered into a form field that has a rule
  can trigger the creation of a problem, which will
  be displayed in the Problem listing. These
  problems can prompt the user to refer the patient
  to UTH, complete a form, or provide information.

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ZEPRS Administration

• Form-based Administration
• Create Form
• Editing Forms
• Adding a new field
• Editing a field
• Generating Dynasite source
• Application Updates

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ZEPRS Administration making changes

• Open ZEPRS project source code in Eclipse or Idea
• Launch local version of ZEPRS app via IDEs
  Tomcat instance to browse app and make form
  modifications via web interface
• After form editing is complete, click Generate
  Dynasite Source to generate java and xml files
  that manage form rendering and patient flow.
• In IDE, use the Ant task dist-zip to create a
  distribution of the ZEPRS war file and other
  related sql and installation files.
• SFTP files to the server.
• Run batch file which installs new version and
  updates any db schema changes.

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ZEPRS Summary - User AcceptanceEase of Use
More than 80 of respondents reported the
automated system as easy or easier to complete
(use) than the manual system.
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ZEPRS Summary - Patients in System More than
39,000 patients
5 Feb 2006 16 May 2007. Weeks include one-day
weeks at beginning and end of year, resulting in
54 weeks for 2006.
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ZEPRS Summary - Conclusions

• With some training, clinicians with no prior
  computer experience may adopt computerized record
  systems readily
• The value of a patient record database for
  monitoring and improving health status can help
  sustain an electronic patient record system
• The communications network is being used for
  several health programs
• Local staff can maintain and manage the
  communications network

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ZEPRS Summary - Major Correction Points
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ZEPRS Summary - Critical Success Factors

• Close collaboration with health workers and UAB
• Thorough testing
• Effective user training
• User acceptance and participation
• Reliability and performance of network
• Reliability of computers in facilities
• Project management
• Use of on-line tools, and IM for remote project
  support

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Questions Comments
RTI Development Team Eileen Reynolds, Project
Manager Chris E. Kelley, Senior Software
Developer Niamh Darcy, Senior Technical
Advisor Pablo Destefanis, Senior Networking and
Telecommunications Specialist Gordon M. Cressman,
Senior Project Advisor Lusaka Technical Support
Staff Dennis Nkula, Zambia Project
Coordinator Francis Banda, Technical Support
Specialist Jamie Mwanza, Technical Support
Specialist Center for Infectious Disease
Research in Zambia Dr. Jeffrey Stringer, MD,
Director, Co-Investigator Dr. Perry Killam, MD,
Project Advisor Harmony Fusco, Project
Manager Chafye Siulata, Project Assistant
UAB Team Dr. Robert L. Goldenberg, MD, Principal
Investigator Dr. Dwight Rouse, MD,
Co-Investigator Dr. Sten Vermund, MD,
Co-Invesigator Dr. Francis Nuthalpathy, Health
Informatics Advisor Dr. Alan Tita, Health
Informatics Advisor Zambian Medical Advisors Dr.
Moses Sinkala, MD Dr. Elwyn Chomba, MD Dr. Ben
Chirwa, MD Dr. Henri Phiri, MD Dr. Christopher
Ngandwe, MD Dr. Chipepo Kankasa, MD Dr. Macha,
MD Dr. Mpundu Makasa, MD For further
information www.idg-rti.org