Homa Bay hospitals find safe harbour for patients’ data

Ms Millicent Akinyi has been on antiretroviral drugs for the last five years. But due to stigma, she has kept her status under lock and key.

One day, on her clinic day, she met her neighbour at the facility where she had gone to pick her drugs. Given that they had both gone to pick their drugs, she made a drastic decision and changed the facility.

She moved to a facility far away where the possibility of meeting anyone she knew was zero.
However, she did not have a referral letter from her previous facility,  and she was not able to tell what regimen she was in. She lied to a health worker at the facility that she had just known her status and wanted to start taking drugs.

All the processes were followed including HIV testing, counselling and testing of the CD4 to get to know what regimen to be placed on. Ms Akinyi was on a second line regimen, which means she had failed the first line regimen. She was again placed on the same drugs. Given that the hospital had no idea what drugs she was taking, they started treatment afresh.
When one is transitioning from one facility to another, a referral letter is normally written by the previous hospital with the patients’ history so that when he/she gets to a new facility, they continue with the same regimen they were  in.

New drugs

However, for Ms Akinyi, this did not happen and after two months, she was not responding well to the new drugs. A  drug-resistance test was done —  she had developed drug resistant HIV.
From the test, health workers were able to determine which HIV medicine Ms Akinyi was not responding to and she was placed in a new HIV treatment regimen.

She is now responding well to drugs. Ms Akinyi represents thousands of HIV patients who, because of stigma, have had to change facilities where they were previously taking drugs, while others have discontinued.
This in return affects how they react to the drugs and even their viral load suppression journey.

But with the Cloud Electronic Medical Records (Cloud EMR) concept recently introduced by Elizabeth Glaser Pediatric AIDS Foundation in Homa Bay County, it is easy for facilities even without a referral letter to get the details of patients as long as they had started their treatment at one point.
The concept supports 165 facilities within the county —  both private and public health facilities.

“Before the concept, we would filter volumes of files that had stayed here for years looking for a client’s file and with high volume facilities, clients would spend even four hours at the facility before being attended to,” said Ms Sharlick Akinyi,in charge of Rachuonyo District Hospital. 

She told the Healthy Nation that before the introduction of the concept, they were losing track of many patients who were defaulting  on ARVs and not coming back to the facility. It was not easy to trace them going through the heap pile of files.
Mr Brian Korir,  a clinical officer at Matata Nursing Hospital, also had praises for the new way of storing data, “With this, all we need is to check and get to know who is defaulting, who is due for viral load, laboratory tests and who is adhering well or failing.

“We are able to access data faster, segregate the information according to age groups and give adhering percentage of the patients,” he said
Ms Beatrice Bikeri, EGPAF focal person, observed that the concept has integrated services in many facilities and reduced paperwork for clinicians. In the past, there were too many registers for documentation on a single clinic day for every patient.

The concept starts right from the field. Apart from using papers to document details of the patients, peer educators have been provided with tablets, where they are able to relay information to the health facilities immediately.

"While visiting the patients, all the details are transmitted directly to the system at a click of the button. Previously, we would use papers and after every visit, we would go back to the facility and key in the details. This was slow when it came to decision making and at times when it rained, we would lose the clients’ details —  it was not safe. But this new concept is safe," said Electrine Osewe, adherence counsellor with EGPAF 

Previously, she said, hospitals would take time to respond to donors' questions on data since there were a lot of files and it was thus hectic given the minimal timelines.

“We have improved how we gather patient data and analyse it,” she said.

They are also able to monitor patients while results from laboratories are received faster; improving communication and interactions among primary care providers, patients, and other providers involved in treatment and care.

Since the adoption of the Cloud EMR, the hospitals are able to keep the details of patients private, errors have reduced while efficiency, safety and quality of work has  improved.
 
Ms Bikeri clarified that patient data is not transmitted through public internet since they are using private connection linked to data centres for county and sub-county health facilities. 

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