SmartCare System

1
SmartCare System

• Training Manual Deployment Framework

2
Roadmap to SmartCare

• The Roadmap to SmartCare is composed of the Big 5
• National Training
• Provincial Trainings
• Deployment
• Installation
• Maintenance

3
Roadmap to SmartCare
Deployment
Maintenance
National Training
Provincial Training
Implementation

• Teach use of new PMTCT paper system, and how
  SmartCare works with it
• Describe the vision of SmartCare within the
  national health system
• Provide leadership, expertise, and ongoing
  support to users maneuvering through the Roadmap

4
Roadmap to SmartCare

• vNational Training DONE
• Provincial Training You are doing it
• Deployment Pending
• Implementation Pending
• Maintenance Pending

5
Roadmap to SmartCare
Deployment
Maintenance
National Training
Provincial Training
Implementation

• Continue to distribute District Health office
  equipment updated Manuals
• Complete instruction for the Facility Deployment,
  Implementation Maintenance processes
• Coordinate Provincial Deployment Calendar
  priorities (Facility Deployment)
• Review data protection/confidentiality
  (Implementation Maintenance)
• Review routine data use (reports) and local
  feedback (Maintenance)

6
1st Site Facility Deployment

• The 1st facility to be deployed in each Province
  will begin Facility Deployment after the
  Provincial training

7
Roadmap to SmartCare

• Timeline
• Site Selection
• Site Preparation Checklist
• Operations Analysis
• Baseline Study
• Educate Facility Staff
• Install SmartCare Equipment

8
Roadmap to SmartCare
Deployment
Maintenance
National Training
Provincial Training
Implementation

• SmartCare Key Concepts
• Software and Paper Forms
• Backlog Data Entry
• Information Use
• Data Management
• Equipment Maintenance (establish process)
• Inventory Management (establish process)

9
Roadmap to SmartCare
Deployment
National Training
Provincial Training
Maintenance
Implementation

• Ongoing quality improvement for system and
  operations
• Daily Data Entry Backups
• Regular Facility by Facility Data Merges
• Regular Reporting Use
• to Improve Patient Outcomes
• to Improve Facility Management
• to support HMIS Policy Level Use
• Maintain Equipment (continued good practice, SIF)
• Maintain Inventory (continued good practice)

10
Provinical Training Objectives

• Particpants will be able to
• Teach use of the SmartCare system to future
  trainees at District level.
• Describe the vision of SmartCare within the
  national health information system to trainees.
• Teach the proper use of SmartCare
• to improve the quality of clinical care
• provide for continuity of patient care and
• as a monitoring and evaluation tool that supports
  HMIS, and other related health information
  systems.
• Provide leadership, expertise, and ongoing
  support in the training, administration, and
  management of the SmartCare system to facility
  staff within your district.

11
Participants Packet

• Agenda
• Pre-test
• Users Guide (DRAFT)
• Procedures Manual (DRAFT)
• with Appendices
• Trainer of Trainer Methodology Manual
• Training Manual
• Facility Level Training Manual

12
SmartCare Training Format

• Trainer Presentations
• Using SmartCare forms software
• SmartCare concepts
• Training Exercises
• Post Test
• Discussion

13
Training Norms

• Classes will be interactive and participative
• Participants will provide frank feedback to the
  facilitators on
• the training,
• the presentation of materials,
• The functionality of the SmartCare system
• Participants and facilitators will respect the
  times
• Respect participants and facilitators (no
  parallel discussions)
• Parking lot issues will be recorded on
  flipchart and participants are encouraged to add
  to list
• Cell phones will be turned to vibrate calls
  received outside of the classroom

14
Facility Deployment Framework

• Moving Facilities from Paper to Electronic Health
  Records Systems
• Road Map 3
• Procedures Manual

15
Facility Deployment
Learning Objectives

• To understand the process by which the SmartCare
  system will be rolled out to facilities
• To gain an understanding of basic facility
  deployment tools

16
Facility Deployment Landmarks
DHIO facilitates entire Deployment
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Facility Deployment Landmarks
Facility Deployment
6 Baseline
Provincial Training
7 Educate Facility Staff

• Timeline
• Site Selection
• Site Preparation
• Operations Analysis

• Using the Ops Analysis
• Baseline Study
• Educate Facility Staff
• Installing Equipment

18
Landmark 1 Timeline

• Each District draws up their Deployment timeframe
  with partners and stakeholders for their first
  site
• Sync schedules for technical assistance
• Sync schedules with facility

19
Landmark 1 Timeline Exercise

• List the tasks you have to complete in the next
  month on your calendar.
• When do you have time to complete the Deployment
  landmarks?
• Confer with stakeholders to see if these dates
  work for them

20
Landmark 2 Site Selection

• Ideally, one site will be chosen in each Province
  to begin their 1st Facility Deployment before the
  Provincial Training
• Consider
• Location of the site
• Services provided by the site
• Complexity of implementation
• Amount of technical assistance needed to Deploy
  you 1st site

21
Landmark 3 Site Preparation

• Assesses whether the site meets minimum
  requirements for Implementation and Maintenance
• Use Site Preparation Checklist (see Procedures
  Manual Appendix C)

22
Landmark 3 Site Prep Exercise

• Discussion
• In this example, what does this facility need to
  do before it will be considered a SmartCare
  candidate?
• Is there anything that you think is essential to
  have in the facility, something that would not
  allow for SmartCare which is not addressed on
  this checklist?
• Questions Answers

23
Landmark 3 Site Preparation Exercise

• Chose a convenient site in your District you know
  well
• Complete Site Preparation forms
• What changes need to be made?
• How would you make those changes?

24
Landmark 4 Ops Analysis

• Used to incorporate SmartCare into facility
  operational processes
• Describe facility operations
• Analyse operations and SmartCare procedures

25
Landmark 4 Ops AnalysisDescribe Operations

• Patient Information Flow Chart

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OperationsAnalysis

• Patient Document Flow without SmartCare
• ANC example

27
OperationsAnalysis

• Patient Document Flow with SmartCare
• ANC example

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Landmark 5 Ops AnalysisUsing the Ops Analysis

• Analysing the Patient and Information flow is an
  art meaning there is no one right answer and
  creativity is required
• The analysis will help facilities to determine
  the best way to incorporate SmartCare into the
  facilitys current processes

29
Landmark 5 Ops AnalysisCase Study

• Directions The facilitator will divide the
  larger group into smaller groups and distribute a
  case study exercise for you. Read through the
  case study. You will be expected to fill out a
  site prep checklist form, and complete an ops
  analysis.

30
Steps to complete the ops analysis include

• Draw the physical layout or the floor plan of
  the facility.
• Draw a Flow Chart for current facility operations
  (see example on previous slides)
• List the staff and their responsibilities in
  terms of operations on the flow chart you
  developed in step 2.
• Determine which SmartCare configuration (E-First,
  E-Fast, E-Last) is appropriate for you facility
  based on type of service and resources
• Consider which computers will be on a LAN, and
  whether
• one wants a client server solution, or if
• one is willing to do frequent merges
• Revise Flow Chart for operations that include
  SmartCare forms and software in the flow

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Discussion of ops analysis pre-SmartCare

• DHIO will have to work with facility staff to
  develop the floor plan and data and patient flow
  charts.
• Be sure to assign who is responsible for each
  task identified on the flow chart.

32
SmartCare Configurations

• Which configuration is best for you?
• E-First
• E-Fast
• E-Last
• Factors to consider
• Results from Site Prep Checklist
• Needs of clinic
• HR at clinic
• Resources and capabilities of clinic

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Revise Patient and Data Flow Diagrams based on
SmartCare configuration

• After choosing SmartCare configuration that best
  suits the facilitys needs revise patient and
  data flow chart with SmartCare represented.
• Assign responsibilities of staff to the revisions
  that are made
• Revise floor plan if necessary

34
Discussion

• Review findings with group
• Discuss what kinds of revisions did each group
  make to the original data and patient flow charts
• Compare the different groups ops analysis for the
  case study

35
Homework assignment

• Using todays sample as an example, choose one
  site in your district that you are thinking on
  deploying and are familiar with.
• Complete a Site Prep Checklist for that facility
• Draw a floor plan to depict the physical layout
  of the facility
• Draw a patient and data flow chart for the
  facility

36
Landmark 6 Baseline

• An baseline survey will need to be completed
  before SmartCare Implementation to determine
  where facilities are before the project begins
• The same questions will be asked again
  periodically to compare before and after
  responses to determine whether or not SmartCare
  is achieving its objectives and to what extent

37
Landmark 6 Baseline

• The Baseline will measure availability of
  access to information as well as utilization of
  that information for
• Patient level data
• Management level data

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Landmark 7 Education
Deployment
6 Baseline
7 Educate Facility Staff

• Continuing Education of Facility Staff
• Learning what SmartCare is how it will affect
  their operations
• Deployment may include portions of Implementation
  such as introduction of paper forms

39
Landmark 8 Installing Equipment
Deployment
6 Baseline
7 Educate Facility Staff

• Installing SmartCare equipment into a facility
  marks the end of Facility Deployment and the
  beginning of Implementation
• Initial equipment installation will be conducted
  by SmartCare central while subsequent
  installations will require more DHIO
  responsibility

40
System Improvement Form

• Provide Feedback (PLEASE!!!)
• Systems malfunctions
• Ways in which the system interferes with duties
• Ways to improve the system
• Forms available during the training
• Take a couple empty forms
• Fill forms out when an idea strikes you

41
Deployment Framework Post-Test

• Will every site be able to use the SmartCare
  system?
• Yes b) No
• What is the purpose of the Baseline Survey?
• Diagram and analyse processes procedures
• Determine whether a site is ready for deployment
• Plan how to operate a new system
• Understand where the facility started from to
  compare to later

42
Deployment Framework Discussion

• Questions or comments about Facility Deployment

43
Implementation

• How to put SmartCare into practice

44
Learning Objectives

• To understand the steps necessary after SmartCare
  deployment and to implement these steps at a
  facility.

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Roadmap to SmartCare
Deployment
Maintenance
National Training
Provincial Training
Implementation

• SmartCare Key Concepts
• Software and Paper Forms
• Backlog Data Entry
• Information Use
• Data Management
• Equipment Maintenance
• Inventory Management

46
Who is involved in Implementation?

• DHIOs
• Facility staff end users
• Other SmartCare technical staff (e.g. SmartCare
  HQ, PDMS, implementing partners)

47
Reinforce SmartCare Key Concepts for Facility
Staff

• System Security Policies must be outlined prior
  to implementation (during operations analysis) in
  order to ensure proper procedures during
  implementation.
• Security policies must address all known data
  access and data integrity conditions.
• Other security concerns
• Physical security of equipment
• Software Security
• Data security backups

48
Key concepts (continued)

• Three guiding principles for security procedures
  for end users
• Informed User Responsibility All users are held
  responsible no access is provided to persons who
  didnt sign the appropriate security paperwork
• Need to Know System access is limited to the
  one person or very small number of persons who
  need to know patient information in order to
  provide services. Viewing patient records in
  absence of a patient visit has limited legitimate
  purpose (with exception of delayed lab reporting)
  and all such events are logged into the system
  for review.
• Separation of Powers System access and use
  rights are partitioned among different users
  this reduces risk and simplifies oversight

49
SmartCare Software and Paper Based System

• Develop a training schedule for staff
• Registration and login
• Service modules (e.g. ANC, VCT, ART)
• Practice data entry from paper system
• Provide updates for any new developments

50
Backlog Data

• There should be a strategy developed on how to
  enter existing data into the system without
  affecting facility services.
• You will want to sit down with facility staff and
  make a plan on how to best accomplish this task.
• Backlog Data will need to be entered into system
  for ART and PMTCT/MCH services

51
Recommended Backlog Approaches for ART and
PMTCT/MCH Services

• ART
• Within one reporting cycle (1 month) of
  implementation try to register all existing
  backlog patients and ideally capture all
  information
• PMTCT/MCH
• Start backlog with first visit of pregnancy
• (at beginning of the month)

52
Information Use

• Patient health records
• Inform clinicians in decision making bout patient
  care
• Reports
• Inform district, province and national level
  about management and policy issues

53
Data Management

• SmartCare system data must be managed
  responsibly, routinely and with care according to
  the following processes
• Supervisory/management
• Quality checks
• Updates
• Individual patient records only accessed at
  patient interaction during a health service
• (lab is delayed- patient details are not pulled
  up just able to enter lab info)

54
Equipment Maintenance

• Establish norms for basic care of equipment
• Computer
• Touchscreen
• Keyboard and mouse
• Card Reader
• Troubleshooting of equipment

55
Facility Inventory

• Ensure budget has accounted for new items
  needed for SmartCare
• Assure planning has been made for continuous
  supply of necessary items

56
Sample inventory for facility

• Ream Paper
• Hole Punch
• Dust Covers (For computers)
• Permanent Markers
• Folders for Paper Records
• Printer Cartridges
• Copy (1) of User Guide and Procedures Manual
• Other stationary as required
• Flash Disk (district)
• Smart cards and sleeves

57
Develop Timelines for..

• Training of staff
• Hardware
• Software
• Security
• Data entry (back log)
• Supervision and guidance
• Necessary processes
• Information use and data management

58
Implementation markers

• All facility staff are trained in their
  respective roles and are functionally using
  SmartCare
• All targeted patient data is being entered on a
  daily basis at clinic
• SmartCare software is being used to produce and
  utilize reports to improve care/services
• Equipment is in good working order

59
Maintenance of SmartCare System

• How to keep your system in good working condition

60
Roadmap to SmartCare
Deployment
National Training
Provincial Training
Maintenance
Implementation

• Ongoing quality improvement for system and
  operations
• Daily Data Entry and Back Ups
• Regular Facility by Facility Data Merges (Regular
  Reporting)
• to Improve Patient Outcomes
• to Improve Facility Management
• to support HMIS and policy level use
• Maintaining Equipment
• Inventory Management

61
Data Entry

• Ensure daily data entry procedures are occurring
• Make adjustment to data entry systems if
  necessary
• E-First, E-Fast, E-Last
• Personnel
• Services provided in facility

62
Facility by Facility Merge

• Ensure that merges are occurring regularly
• Facility level
• The merged data has the value of allowing the
  district to make de-duplicated counts where in
  the past this was not the case

63
Regular Reporting

• Ensure timely reporting structures
• Facility provides DHIO with aggregate patient
  data for HMIS
• District provides PHO with HMIS aggregate
  facility data
• Province provides the national level with HMIS
  aggregate provincial information to make
  decisions

64
Equipment

• Ensure continued good care of equipment
• Timely report of and address any equipment
  problems
• Use point of contacts at all levels
• System Improvement Form

65
Inventory management

• Use experience to determine appropriate buffers
  for all consumables

66
Beyond Maintenance Functional Growth of the
SmartCare System in a Facility

• New report identification and design
• Improved service linkages
• Further streamlining of ease in data capture
• Identification of labor saving implementations
  and functions
• System upgrades
• Refinements to security
• New service modules (OPD,etc.)