Health Cards (4)
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Merrick Zwarenstein wrote:
Before developing a card of this sort, would it not be worthwhile
conducting a systematic review of the effects of such hand carried
information on patient health?
[ ... ]
Merrick:
I appreciate your response to my request for sample data instruments
regarding the design of a hand carried comprehensive health card(CHC). I
am afraid that I should have given Afro-Nets some background information
regarding IMPACT and a more detailed explanation of the use of CHCs. I
sent the request for samples to Afro-Nets, as well as to many PVOs and
others that I have been dialoguing with for the past year. Most of them
understand how the CHC would be utilized within the context of IMPACT.
I apologize for not supplying to Afro-Nets a more informative basis for
the request.
IMPACT (acronym for Integrating Medicine's Preventive And Curative
Therapies) is an information system for primary health care which links
census-based data from community, primary care and secondary care to
impact monitoring and assessment. It was developed at Hospital Albert
Schweitzer over a three year period while I was the Director of
Information Systems. The IMPACT methodology incorporates both manual
and automated processes in the collection and dissemination of health
related data. The CHC is just one of the instruments used within the
system. It also utilizes computerized software that allows demographers
and other HCWs to have access to community and patient profiles. The
system is also capable of providing all of the core health indicators
suggested by WHO, CDC and USAID. A full hard copy presentation of the
IMPACT system is available upon request.
Now in response to your concerns. I am currently working with World
Vision Relief and Development(WVRD) and BASICS to set up a pilot site
for the implementation of IMPACT, including the use of a CHC. The
purpose of this pilot site is to evaluate the effectiveness and impact
of this unique information system. Your concerns are well founded and
as you can see we will be addressing the effects of the cards on patient
health, HCW utilization, and cost effectiveness with a pilot site. Also,
although we did not utilize the type of CHC mentioned previously in
Haiti, the IMPACT methodology significantly impacted the health care
system at the development site. Those who have already worked with the
system, as well as those who have evaluated the documentation have not
been able to refute the methodology. It has been presented to many well
respected individuals within the health care sector in the U.S.
including Johns Hopkins School of Public Health, CDC, Management
Sciences for Health(MSH), WVRD, and CARE, and it has generated a
significant amount of interest and support. We have yet to receive any
negative feedback.
The following is a preliminary draft describing the design and use of a
CHC. Any additional comments would be appreciated.
Thanks for your input.
Bill
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"Hand Carried Comprehensive Health Cards"
William R. Billingsley
Systems Analyst, IMPACT Systems
DRAFT
The concept of a hand carried comprehensive health card is not new.
Several industrialized nations including France and Germany, utilize a
standardized "life book" health card. It is sometimes referred to as a
life book because it contains health information on the individual from
birth until death, including the patient's biological mother's prenatal
visit data.
The "card" is carried by the patient at all times and is presented at
each encounter for physician documentation. Every health care provider
is required by law to document in the card all diagnoses, vital signs,
treatments (including medications) and any other pertinent health
information regarding the patient. The main purpose of this card is so
that health care professionals irrespective of geographical location,
service or institution can have immediate access to the patients health
history. I have seen a copy of the French version and was quite
impressed with the layout and forms in the card. There is also
educational information in the card to assist a parent if a child
becomes ill.
Most CS projects require several health oriented pieces of
documentation. Some of these include: Road to Health Card, Immunization
Card, Women's Health Card, Tetanus Toxoid Card, Family Planning Card
and Vitamin A Card. Some projects have a mixture of the above, include
several other types, or may have all of the above depending on
governmental requirements. As most know when working in project areas
this document fragmentation can be quite confusing.
There are many inherent problems with this document fragmentation.
Among them is the obvious fact that a great portion of the population is
without any type of documentation at all. This includes men and school
aged children. Also, even though these cards are hand carried by the
patient and are available to HCW they do not contain any historical
diagnosis or treatment data that could assist them with the current
consultation or finalizing a cause of death.
Recommendation
It is recommended that a comprehensive health card be designed and
utilized in all impact areas as follows:
1) The health card would actually be a health book. It would have a
plastic or water proof cover and the pages would be water resistant yet
would retain the ability to absorb ink without smearing. WHO has such
paper.
2) The card would be the method of assigning each newborn or new
resident a permanent ID number. This would assist in ensuring that each
new pregnancy would come in for registration, as well as immigrants. The
requirement would be that all health services rendered require the
presentation of a health card. The card could be distributed by various
HCWs at a variety of locations. This would include village health care
workers during home visits and health posts, nurses and physicians at
stationary and mobile clinics as well as government distribution
centers, if applicable.
3) Would contain educational information pertinent to all patients
regardless of age or gender. Examples would be information on family
planning methods, STD and HIV prevention, personal hygiene, treatment of
diarrhea, ORT Training , pneumonia and malaria recognition and other
health related issues related to the area or country.
4) The front of the card would contain the personal information on the
patient and have enough space to show the necessary changes in address,
name or marital status, names and dates of birth for all children,
person to contact in case of emergency etc.
5) Cards for new conceptions would be issued to the mother by a local
health care facility so that prenatal data can be entered into the card.
6) If cards are assigned, as well as a permanent ID number, to the
pregnant mother, then pregnancy outcomes are more readily identifiable.
Tracking is done through the issuance of the permanent ID number. This
makes the fetus "personally identifiable" at the time of conception and
therefore the ability to track the outcome is initiated.
7) A value of some sort must be associated with the issuance of the
card as well as the ongoing presentation of the card at the time of each
encounter. Rewards and consequences should be standardized according to
local customs. Perhaps a 5 to 10 year calendar could be made available
within the card, or a financial section for recording micro or small
business loans supported by the project.
8) Every HCW regardless of profession would be required to document in
the card all diagnoses and treatments. From the volunteer HCW, or the
parent, at the household level documenting a case of diarrhea to the
physician performing surgery at the district hospital, adequate
documentation regarding the encounter should be made in the card.
9) A section of the card would be designated to allow a parent or other
literate household member to document illnesses not treated at the
clinic or by another HCW.
10)Data from the cards will also be entered into the central database for:
a) statistical reports
b) rosters
c) notifications
d) replication of card if damaged or lost.
11)Outline of possible card contents:
I. Personal Data
A. Health ID number
B. Family Number
C. Last Name
D. First Name
E. Date of Birth
F. Sex
G. Mothers Health ID number
H. Mothers first and last name
I. Fathers Health ID number
J. Fathers first and last name
K. Place of Birth - Locality
L. Address - Street/Road and house number (initial address)
M. Community/Locality
N. Locality Code
O. Distance to local health center ( time to walk)
P. Successive address changes (up to 7 or 8 )
II. Prenatal Data - this patient
III.Road to Health Card ( on perforated page if removal is desired
later in life)
IV. Immunization Schedule (all immunizations for all ages/gender)
A. Date
B. Vaccine
C. Lot
D. Dose
E. HCW
V. Micronutriant Schedule ( Could be recorded as a routine Rx treatment)
VI. Encounters data by HCW including:
A. Date
B. Amount paid (verified by HCW and/or stamp, acts as a receipt)
C. Diagnosis
D. Treatment (medication, etc.)
E. Outcome - (Well, referred etc.)
F. Follow-up - Date for follow-up visit. (acts as a prompt)
VII.Parental observations / treatment
A. Date
B. Problem
C. Treatment (ORS etc.)
VIII. Vital Signs for each visit(date)
A. Temperature
D. Height
E. Weight
F. Respiration
G. Blood Pressure
H. Pulse
IX. Laboratory
I. Date
J. Test
K. Results
X. Radiology
A. Date
B. Test
C. View
D. Result
XI. Women's Health Issues
A. Children
1) DOB
2) Sex
3) Health ID Number
4) Last Name
5) First Name
B. Health Chart - following weight for each birth
XII. Information on Health Risks - specific to country
A. Identification and treatment of:
1) Malaria
2) Malnutrition
3) Diarrhea
4) Tuberculosis - DOT
5) ARI
B. Personal Hygiene
C. Importance of Immunizations
D. Family Planning
E. Breastfeeding protocol
F. HIV/AIDS Prevention
XIII. Training
A. ORT
B. Breastfeeding
C. Hearth or Nutrition Foyer Training
D. Other pertinent training
XIV. Cause of Death - For submission to "Central Data Base"
Publication and Funding
I have a sample card and will be seeking price quotes from local
printers here in the Green Bay, WI area. As we all know paper and
printing costs drop significantly when large quantities are ordered.
Ideally they should be printed in the host country. Perhaps PVOs could
get WHO, the host country or some other organization to fund the
publication and costs involved if they were implemented country wide. As
you can see from the above recommendations they would be very useful for
monitoring and evaluation as well as service delivery related issues.
--
William Billingsley
Impact Demographic Health Surveillance Information Systems
Application Software Technologies, Inc.
1841 South Ridge Road
Green Bay, WI 54304, USA
Tel.800-992-0533
Tel. +1-414-499-0533
Tel. +1-414-655-3962 (Cell)
Fax +1-414-490-3218
Tel. +1-715-823-6375 (Home)
mailto:wbillingsley@aztechcon.com
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