ROMANIAN EXPERIENCE IN ELECTRONIC TB RECORDING AND … · ROMANIAN EXPERIENCE IN ELECTRONIC TB...
Transcript of ROMANIAN EXPERIENCE IN ELECTRONIC TB RECORDING AND … · ROMANIAN EXPERIENCE IN ELECTRONIC TB...
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ROMANIAN EXPERIENCE IN ELECTRONIC TB RECORDING AND REPORTING
Cristian Popa, Elmira IbraimNational TB ProgrammeMarius Nasta Institute of PulmonologyBucharest - Romania
Geneva, April 27th 2011
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ROMANIA
Total area: 238 391 km²41 counties + Bucharest (6 sectors)
Population: 21 431 298M: 48.8% F: 51.2%Urban: 53.3% Rural: 46.7%
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TB endemic – 2010
• New cases + Relapses = 19 395• Notification rate = 90,5%ooo
• New cases = 16 021 • Pulmonary SS+ = 9 111 • MDR-TB: 2.9% of new cases
11% of retreatments• XDR-TB: 9.9% of new MDR-TB
11% of retreated MDR-TB• TB incidence rate in children =
27.2%ooo
• TB mortality rate (2009) = 7.1%ooo
• Success rate in new pulmonary SS+ cases (2009) = 81.4 %
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History of TB recording and reporting
• 1881 – 1900: estimates of TB mortality from TB deaths reported
• Beginning of XX century: TB morbidity estimates from TB cases diagnosed in hospitals or ambulatories
• 1938: mortality and point prevalence (at the end of year)
• 1950: incidence rate of new cases
• 1965: global notification rate (including relapses)
• 1968: incidence rate of pulmonary smear positive cases and rate of bacteriological confirmed cases
• 1997: outcomes registered and reported
• 2001: all re-treatment cases (other than relapses) notified
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• 2000: reporting of the TB cases in electronic format (epi info) in paralel with paper
• 2004-2005: development of the new electronic system for TB (SQLS database); use of the electronic system in parallel with paper (Global Fund support)
• 2005-2007 equipment of the TB units with computers & internet
• 2005 →→ trainings for the staff involved in electronic reporting and recording
• 2009: paper based system dropped
Steps in development of the electronic reporting and recording system for TB
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- central servers- all (189) TB dispensaries- all penitentiary (3), army (1) and police (1) TB units- MDR-TB centres (2)- all (41) counties TB unit + 6 sectors of Bucharest + equivalent(3) of ministries - 68 of 165 TB laboratories
2006 – TB recording and reporting electronic system (RO-NTBSy) operational and functioning:
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Purpose for the creation of the TB electronic recording and reporting system
• TB monitoring tool for central, county and facility level
• Surveillance of drug resistance
• Reports for the NIH, MOH, WHO …
• Data for drug management
• Individual data about TB patients for clinician
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40000067%
8000013%
12000020%
software developmentequipmenttrainings
Costs (in USD) of TB electronic recording and reporting system
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National TB Surveillance Unit
TB dispensary
County TB unit
MDR-TB centre
Architecture of electronic web based TB case reporting system
TB laboratory
Special units (police,army, prisons)
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Access to electronic database limited to authorized staff -protected by password
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“Search” module
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“Search” module
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Registration of TB cases in each TB ambulatory (189)
Bacteriological results registered in the laboratories; matching of data
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Registration of TB cases
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Recording of hospitalizations
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List of hospitalizations
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Registration of bacteriological exams results
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List of bacteriological results
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Recording the treatment
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Recording the treatment
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Recording the treatment – adverse reactions
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Recording the treatment – adherence
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Recording the treatment – surgical intervention
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Treatment outcome
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Registration of transfer
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Registration of transfer
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MDR-TB module
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MDR-TB module
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Matching of bacteriological results from dispensary and from laboratory
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Validation of treatment outcome
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Preformed reports
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Custom defined reports
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Examples of preformed reports
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Examples of preformed reports - aggregate reports
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Examples of preformed reports – graphs
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Examples of preformed reports – aggregate data
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Examples of preformed reports – line listings
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Examples of preformed reports – MDR-TB
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+ user friendly+ huge amount of information+ security of data+ validation of data+ use of automatic alerts+ avoid duplications+ no delays in data transmission + flexibility to allocate rights to
users+ cases from penitentiary, police,
army in the same database
- limited access to data at different levels (periphery)
- need of technical support inside and outside NTP
- financial sustainability of the system- sources of data only ambulatories &
MDR-TB centers & labs – no hospitals
- module for drug management functional, but not used
- need of good internet connection- maintenance - difficult upgrade (still version I -2005)
Characteristics of TB software application
and some Challenges
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+ MDR-TB registry part of the general TB registry
+ double entry of bacteriological data (labs and ambulatories)
+ users have permanent contact each other and with staff in National Surveillance Unit
+ feed back from central level+ data entry at source + various reports (preformed or
custom)+ TB registry permanently updated
- MDR-TB data have to be redefined and updated (date of registration as MDR-TB case etc)
- need of periodic training- few preformed reports- delays in data entry- missing of links with other
databases (pharmacies, NIH, HIV etc)
- data collected to be used for the monitoring of the program performance
Characteristics of TB software application
…and other Challenges
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