Summary

Baobab will develop a point of care electronic data system (EDS) for TB and PMTCT, establish a national

data warehouse for the Ministry of Health (MoH) and develop robust electronic transfer mechanisms for

patients receiving ART as they move between care sites.

Background

Baobab, a local NGO, is dedicated to improving the delivery and management of HIV/AIDS care in Malawi

through continued development, enhancement and support of information systems used in real-time by

clinicians at the point of care. Baobab has been working with the MoH to incubate, design and deploy IT

applications in healthcare. In Malawi, paper-based registers have traditionally been used to record

patient/client data. This data is commonly transcribed and subsequently manually aggregated by staff with

little or no training in medicine or clinical terminology. When attempts are made to retrospectively enter

patient-level clinical data into computers, data entry errors are numerous, resulting in data that is generally

incomplete and inaccurate. Baobab's strategy to improve data quality is to replace traditional paper-based

data collection with point-of-care systems. Such systems, when appropriately conceived, augment

clinicians' abilities to solve problems and make decisions related to clinical care, while transparently

collecting complete and accurate clinical data as a by-product of system use.

Among the main challenges in Malawi in strategic information are: 1) addressing the issue of poor

completeness and accuracy of routinely collected data; 2) facilitating the sharing of patient/client level data

between sites (e.g. ART patient transfer between sites, TB and ART programs, ancillary services such as

lab, pharmacy, x-ray and the clinical providers; and 3) generating and maintaining routine and ad-hoc

reports. With USG Emergency Plan (EP) funding, Baobab will: 1) develop point-of-care EDS solutions for

TB and PMTCT, 2) establish a national data warehouse for ART data, and 3) develop robust electronic

transfer mechanisms for patients receiving ART as they move between care sites.

Activity 1: Develop Point-of-Care EDS Solutions for TB and PMTCT

With USG EP funding, two new modules will be created in FY 2008 as part of the broader suite of software

applications created by Baobab to address HIV/AIDS care and treatment in Malawi. Both modules will be

developed to share pertinent information with existing Baobab modules (e.g. HTC, ART, lab, x-ray), and

existing modules modified to accommodate this integration. These new modules will be piloted at the

Lighthouse Clinic/Martin Preuss Center, Kamuzu Central Hospital and Bwaila Hospital. However, it will

leverage software tools previously developed for Baobab EDS systems, currently being utilized for HTC.

Expected results with FY 2008 funds include the introduction and integration of a point-of-care TB module,

which is expected to improve the management of co-infected patients receiving TB treatment as well as

increase uptake of patients starting ART, and facilitate a more holistic management for both HIV and TB.

Introduction and integration of a point-of-care PMTCT module is expected to increase the uptake of mothers

and children starting ART. An improved mechanism for transferring patients between ART sites is expected

to improve continuity of care and minimize silent transfers (patients who unofficially switch care sites,

sometimes starting treatment from scratch at a new site). And finally, the creation of a data warehouse for

patient-level HIV data will facilitate meta-analysis of data across multiple sites.

Activity 2: Establish a National Data Warehouse within the MoH

To date, MoH keeps only aggregate data from sites in electronic form. With the introduction of EDS

systems at sites it is now feasible to keep patient-level data and, over time, build a large repository of

longitudinal patient-specific information. The data warehouse will be populated with data from sites using

EDS for ART. The number of sites will be dependent on the level to which the Baobab ART system (BART)

has been rolled out across Malawi. This is a new activity. However, it will leverage previous work done in

developing HL7 messaging for transferring patient-level data in Malawi.

Activity 3: Develop Robust Electronic Transfer Mechanisms for Patients Receiving ART Moving Between

Care Sites

The system will be piloted at MoH sites using BART. The number of sites will be dependent on the level to

which BART has been rolled out at that time. This is an ongoing activity that will leverage previous work

done in developing the HL7 messaging system for electronically transferring patient-level data in Malawi.

Indigenous Baobab employees will conduct all activities in collaboration with an international counterpart.

This approach is intended to build capacity within Baobab to both develop and support EDS systems in

Malawi in an effort to ensure maximum sustainability.

Baobab has focused on improving the integration of electronic systems currently used in HIV care and

treatment. To date (end of FY 2007) these systems have included HIV counseling and testing, managing

patients on antiretroviral therapy, laboratory specimen management and the management of radiology data.