Transcript Phase 3: Systems Development in Clinical ART Settings

DELIVER
Annual Technical Meeting
Key Bridge Marriott - June 2005
Secure Technology Advancing Treatment
Application of
Biometrics / SmartCard Technology for
Anti-Retroviral Therapy (ART) in South Africa
John Wilson & Rovaro Bayard
JSI South Africa
THE OPERATIONAL PLAN FOR COMPREHENSIVE HIV AND
AIDS CARE, MANAGEMENT AND TREATMENT FOR
SOUTH AFRICA – November 2003
JSI requested by NDOH Chief Director
to survey what systems are available in South Africa
that can help with the ARV roll-out,
especially in terms of Logistics,
Patient Information Systems
and Program Monitoring
CRITICAL REQUIREMENTS:
• Must be ‘attractive’ to clinicians and healthcare workers
• Capable of tracking drug distribution to end user
• Will generate NDOH / Emergency Plan indicators (2-7-10)
• Confidentiality
• Authentication / Verification
• Data Security
• Responsive to the very high mobility of South Africans
• Can operate in an off-line environment (community outreach)
FINDINGS:
• Of the 9 systems reviewed that are currently in use in 6 Provinces of South
Africa only 1 system is sufficiently responsive to the mobility issue, and can
operate off-line in community outreach settings
NET1 Biometrics / Smart Card system used for
dispensing more than 4 million pensions and
social grants in 6 Provinces (began 1999), which
seemed to have applicability in an ART setting
NET1 “UEPS” system for pension payout
• More than 4 million
pensions & social
grants dispensed using
SmartCard/ Biometrics
in 6 South African
Provinces since 1999;
Pensioners receiving payouts from mobile unit
• This indicated potential
applicability to ART in
overcoming challenges.
STAT™ System Development
Phase 1: Conceptual Framework
Phase 2: Proof of Concept
Phase 3: Systems Development in Clinical ART Settings
Phase 4: “Live” Implementation in Diverse Field-Test Sites
JSI Partners Developing Biometric / Smartcard
Solution for Patient Information and
Drug Stock Control System
Phase 1: Conceptual Framework - Timeframe 4months
Phase 1: Conceptual Framework (2) – additional 2 months
STAT™ System Development
Phase 1: Conceptual Framework
Phase 2: Proof of Concept
Phase 3: Systems Development in Clinical ART Settings
Phase 4: “Live” Implementation in Diverse Field-Test
Sites
Phase 2: Proof of Concept – plus five months.
Patient Database Development & card to card data
transferability – the “Boardroom Demo”
Prototype
Smartcard readers
Fingerprint
scanner
POS
device
STAT™ System Development
Phase 1: Conceptual Framework
Phase 2: Proof of Concept
Phase 3: Systems Development in Clinical ART Settings
Phase 4: “Live” Implementation in Diverse Field-Test
Sites
Systems Development
in Clinical Community Outreach Setting
STAT™ System Development
Phase 1: Conceptual Framework
Phase 2: Proof of Concept
Phase 3: Systems Development in Clinical ART Settings
Phase 4: “Live” Implementation in Diverse Field-Test
Sites
Patient Registration
On “Live” system
STAT™ System for ART
• Based on existing RSA
Biometrics and Smartcard
technology
• ART patients retain their
cards
• Healthcare workers have
their own cards
• Cards hold 64Kb of data in
255 data wallets.
How STAT works in practice:
Patient ART Center Visit/Home Visit
Provider can print prescription, sign and store
in patient folder
Provider enters codes for drugs
prescribed, gives drugs to patient
and returns STAT™ Card
Coded data entry:
•Symptoms
•Weight
•Lab results
•Prescriptionif pharmacy
Alternatively,
available…
ARVs Dispensed in Pharmacy
OPTIONAL:
Patient gives
prescription to
pharmacist
Script
Rx
Rx
Rx
Pharmacist gives
drugs to patient,
returns Patient’s
STAT™ card
Pharmacist dispenses
drugs as prescribed and
recorded on patient card
Data Batch Upload to STAT Reporting Database
Data from Net 1 FTP’d
to JSI STAT™
Reporting database
server
Encrypted Data on Service
Provider STAT™ cards
uploaded to Net1 Switch by
dialup or broadband at end of
day
Features of the STAT™ System
• Patients can use their card at any STAT™ ART center;
• Ideal for home visits - Battery operated and portable
• STAT™ system functions off-line, with upload of data to
central database at end of day;
• JSI STAT™ central database runs on Microsoft SQL
relational database, hosted on a MS-SQL Server
incorporating SQL Reporting Services;
• Able to accurately record facility-level ARV inventory.
• Only the owner or proxy in exceptional circumstances of the
STAT™ card can use it to obtain treatment;
without
=
X
• Patients cannot receive more than the appropriate amount of
drugs in any month;
• Potential ARV leakage at ART centers minimized due to higher
level of accountability through use of provider STAT™ cards.
Electricity/phone line available availability:
• Since card readers powered by rechargeable batteries,
no electricity required during home visiting;
• Battery pack allows estimated 320 patient interactions
on single charge;
• Patient visits at ART centers can continue during
power outages;
• No need for constant online connection – dialup and
upload at end of day only.
ARV inventory control, security, & data management:
• Incoming drugs entered on pharmacist’s STAT™ card and
deducted from inventory on hand as drugs dispensed to
patients;
• ARV stock status uploaded daily to national STAT™
database;
• Precise consumption data generated to enable accurate
forecasting;
• Supervisors can check physical inventories against up-todate stock status data.
Verifying Private Provider Billing:
• Private practitioners can claim payment made through
data uploaded through Net 1 switch;
• Eliminates need for paper billing.
STAT™ Implementation
(FY 04 PEPFAR COP)
• Currently live field testing in
Hospital, Static Clinic &
Community outreach environments
( Target 2500 on ART, 4000 on Care
and Support)
• Uplink to STAT™ central database
went live April 8, 2005
Planned Implementation of STAT per FY 05 COP
•By end FY 05 funding, 5,700 patients on ARV's plus 38,000 patients on care
and support utilizing STAT™ in 23 CRS/SACBC sites in 8 of 9 provinces
•In addition, as appropriate, public sector sites in provinces (so far 4
provincial sites
•Testing of STAT Drug Inventory Module
•Development of TB, Pediatric, and Nutrition modules
SmartCard/Biometrics Readers
• Portable, rechargeable battery
operated card readers;
• Patient and provider cards
inserted in card reader;
• Built-in fingerprint scanner;
• LED screen to guide provider
through treatment protocol;
• Numeric keypad for data
entry.
Potential New Partners?
Broadreach
Aid for Aids
}
Absolute Recovery for Kids (ARK)
Malawi (Malswitch Reserve Bank)
Nigeria (FHI?)
Private GP
Service Providers
Billing /
Verification potential!!
Long Term Vision ??
•The Patient-Retained
Record System of Choice ?
•Reduced Shrinkage in Supply Chain
Management Systems ??
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