E-DRUG: HMIS reform

E-drug: HMIS reform and drugs
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Beverley Snell wrote:

I have worked in essential drugs programs in developing countries for 15
years. Therefore I will address HMIS from the essential drugs
perspective:.

Beverley:

Thanks for the input regarding the relationship between disease patterns
and treatments. This is just one of the many issues regarding HMIS that is
often overlooked in current HMIS methodologies. In a previous response I
mentioned the term "multi-functional" in defining the role of routinely
collected data. I would like address the issue regarding treatment patterns
within the multi-functional context of HMIS.

Multi-functional relates to the outcomes and utilization of data collection
and its relationship to data requirements. Specific data elements should by
some means be related, or linked, to other data elements. Within the
context of treatment patterns, or drug utilization, an efficient data
collection methodology will link:

1) Outcome
2) Treatment(in this case Rx)
3) Diagnosis
4) Physician or other HCW
5) Vital Signs
6) Referral Source
7) Fees Paid
8) Patient Data (Demographics such as: Sex, Age, Community, etc.)
9) Historical Rx and Dx, i.e. health profile

The IMPACT methodology specifically links outcomes and treatments to each
specific Dx, which in turn is linked to other specific consultation data,
such as vital signs. This is all linked to patient specific demographic
data as well as any historical medical data. This is all done without the
need for multiple disease registers or manual drug dispensing tallies.

I doubt that I need to emphasize the value of relating data in this manner.
The issues that you raised, as well as many others, are addressed through
this comprehensive methodology. Consultation data, not summary reports, are
passed up each level for evaluation and processing. This integrated
approach greatly simplifies issues of accountability and HCW evaluations -
all within the context of the data collection process. Each of the above
data elements either exists in the patient record at the time of the
consultation, or needs to be entered. It might as well be linked at the
time of entry. As the saying goes, "If it's not written down.it's not
done".

The multi-functional concept also deals with other entities as well. As you
will notice from the above, the IMPACT methodology collects data on every
Dx. Why? Because treatment patterns need to be evaluated, and inventory
(Rx) needs to be controlled through its link to Dx. The epidemiologist may
only want data on specific diseases, but the clinic manager needs to
control the inventory, the district health trainer needs to know who is in
non-compliance with recognized treatment protocols, the HCW needs access to
historical data, the FP nurse wants to know who are the new FP acceptors,
the referral hospital wants a tally of referrals, and the clerk needs to
reconcile finances at the end of the day. The data collection methodology
must take into consideration every entity requiring data and it should do
it in such a way as to not burden the HCW with additional reporting
requirements from each of the entities.

At the level of collection the Dx "inventory" must be all inclusive in
order to satisfy the recording needs of service delivery personnel. A data
collection and recording system cannot be designed around specific high
risk groups or specific diseases. It should take into account every
possible Dx and then specific high risk groups or diseases can be extracted
from the core data. This satisfies the need of service delivery personnel
to record patient specific data while at the same time meet any reporting
requirements from the sub-district, district, provincial or national
levels.

Your comments are appreciated.

Cheers!

Bill

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William Billingsley
mailto:wbillingsley@aztechcon.com

IMPACT Web Site: http://www.aztechcon.com/impact/impact.htm

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