Information Systems for TB: Patients Diagnosis & Follow-up Forecasting, Quantification, and Early Warning Tool for TB Medicines supply & Logistics

Transcription

1 Information Systems for TB: Patients Diagnosis & Follow-up Forecasting, Quantification, and Early Warning Tool for TB Medicines supply & Logistics Support Joel Keravec

2 Results Chain Framework- Information for decision making Inputs Policy framework, financial resources, infrastructure, human resources Processes Systems and process for data acquisition, processing and management Outputs Information products to support decision-making at all levels Outcomes Improved decision-making strengthened health systems Impact Improved health indicators & outcomes

3 Key challenges and gaps in TB field Fragmented approach to information for decisionmaking Parallel development of MIS each tailored to programspecific needs, products and services, or focused on PSM / logistics independently of key programmatic issues like in country quantification / patient follow-up / resistance monitoring / drugs management Limited tools interoperability Poor linkage of developed systems to other programmatic or non-pharmacy and larger HMIS Limited capacity to share and use information / no career of information management within the HS

4 Best Practices- Information for decision-making I Key steps : pre-lmis Tools needed for planning and financing at country/program level Logistics Management Information Systems platforms for processes support and data sharing Comprehensive approach to information for effective support to decision- making e-health Architecture Role of standards Data triangulation- Support supervision data, special surveys Improving accessibility and availability of strategic information Creating capacity for strategic information and data sharing/exchange- Partners, MOH departments and agencies

5 Best Practices- Information for decision-making II Improving capacity for information acquisition, management and use at all levels Data for decision-making in-service training targeting lower and central levels including mentorship and on-the-job trainings Capacitating facility (DOTS and DR-TB/PMDT) and health management teams Use of innovative solutions to overcome common barriers to effective data collection, information dissemination & use SMS gateway (mobile technology) Web-based systems like e-tb Manager, OpenMRS, OpenXdata Interactive PDF forms- ex: treatment outcomes, drug supply and inventory, ADR & Poor quality products reporting

6 Key recommendations Various approaches used to address evolving information needs- Important to identify best practices Need to build on existing systems to address emerging challenges integration, information exchange &linkages, decentralization of information use and innovation Need for increased country-leadership and involvement in information acquisition, management and use

7 Many systems are available...

8 E-TB Manager : A comprehensive web based tool conceived for strenghtening TB programs by integrating case management, medicine control and surveillance information into a single platform Case notification and management Medicines supply and stock control Epidemiological surveillance / Reports Information Access the demo: 8

9 Overview of e-tb Manager: Patient Centered Info System LAB e-tb M can be used for TB and / or DR-TB Programmatic Management TB suspects TB cases DR-TB suspects DATA ENTRY IN ONE SINGLE WEB-BASED SYSTEM LAB COMMODITIES MANAGEMENT 1st + 2nd LINE DRUG MANAGEMENT AT ALL LEVELS OF THE SUPPLY CHAIN DR-TB cases Epidemiological surveillance / NTP Management Health Unit (HU) Easy online and real-time information sharing + data consolidation among different levels within one user-friendly platform Notification of lab results + sample management (diagnosis / Smear, culture + sensitivity test ((all techniques including new LPAs), HIV status) data can be encoded by Lab or Health Unit and validated at central level Comprehensive medicine management and control with an automated patient based quantification tool for ordering process at all levels + a demand /forecasting tool Ensures patient data confidentiality and database reliability through a central level validation process Developed with open-source solutions (no license required) that can be fully customized to address specific country needs Aligned with WHO recommendations for DOTS and DR-TB programs, including WHO standard forms for reporting and recording

10 e-tb Manager: Multiple Reports to support lab / clinical / medicines / programmatic management / epidemiological

11 OpenMRS: a modular, open source, EMR platform Collaborative project of PIH, the Regenstrief Institute, Indiana and South African MRC Uses concept dictionary for data storage Modular design simplifies adding new functions and linking to other systems Supports multiple languages and multiple data standards Released with open source license (April 2007) Core of paid programmers, growing community support Main site: Courtesy of Hamish Fraser Partners In Health Regenstrief Institute Medical reseach council SA

12 OpenMRS-Google Maps Mobile Health Integration Karachi, Pakistan Credit: Owais Ahmed, Aamir Khan

13 GDF procurement process is only a small share of the overall procurement system NTP Procurement & Funding planning 12 to 24 months 75% NTP assess stocks & shelf life NTP surveillance data collection: enrollment rates, etc Current TB Supply Chain Process NTP calculates theoretical drugs requirements If Drugs in stock + immediate payment NTP funding plan & request NTP Final Drug Quantification + Payment Mechanism GDF Supply Chain NTP Procurement planning If late payment, delayed PO => production GDF supply chain = 1/4 From 1 to 12 months 25%

14 MDR-TB Current TB Supply Chain Process Order is placed and Payment received Order is processed by manufacturer Product is manufactured Product is inspected Product is dispatched Country receives product ~6 months SRS Limited quantities of medicines are available in the Strategic Revolving Stock Pile for emergencies Lead Time = 55 days

15 Key forecasting and quantification challenges for TB Rapid changes in TB programs, especially in PMDT Rapid diagnosis technologies PMDT expansion Lack of tools connecting actual and forecasted cases with medicines pipeline data (stock on hand, expiry data, variable consumption rates, etc.) Need to forecast and quantify for different scenarios, variables, and trends Planned vs actual case enrollment Phase-in/phase-out of regimens and medicines Costs of regimens, orders, services, sources of funding

16 QuanTB key features Free, downloadable for PC and Mac, customizable Forecasting for any type of TB treatment regimens or combination of medicines (including TB/HIV co-medication) Quantification based on a combination of morbidity and consumption methods Scenarios for different case enrollment trends, phase-in/phaseout of medicines/regimens, etc. Early Warning - summary tables and a simple dashboard to timely alert NTPs of impending problems with TB medicines supply (stock-outs, over-stock, expiry)

17 QuanTB inputs TB medicines, regimens Current cases enrolled on treatment by month by regimen (or by % of use of each TB medicine) Expected cases to be enrolled by month during the forecasting period Stock of TB medicines on hand Number of units by batch Expiry dates of batches Stock on order Lead time, required buffer, desired minimum/maximum stock Prices of medicines Additional costs, fees, etc. Adjustments to changes in TB program: e.g. expansion, attrition

18 QuanTB outputs (1) Reports: summary, medicines, cases, order, dashboard Months of available stock based on actual cases and expected enrollment, and rational stock (not averages) Regular order per each medicine and combined Accelerated order if required, and time it must be placed to avoid stock-outs Full cost of order(s)

19 QuanTB outputs (2) Detailed information on consumption by month, by regimen, by each medicine Signal when at/over minimum or maximum stock levels Alert about impending stock-outs or losses due to expiry Last date to order medicines to avoid stock-outs

20 Summary tab transforms entered variables into a display of key forecasting and quantification information, such as: Estimated months of stock for each medicine Last day to order for each medicine Estimated consumption and quantity likely to expire during and after lead time Quantity needed for regular and emergency ordering

21 QuanTB summary table

22 QuanTB dashboard

23 Planned Enrollment Updated (slow enrollment) Updated (fast enrollment) Dashboard displays key information about stock on hand (green bars), stock out (red bars), and stock on order (yellow bars) for each medicine. Used in a regular basis can monitor cases and stocks, and alert users of risk of stock out and overstocking (depending if the green bar goes inside or outside the minimum/maximum months of stock ( pink area ).

24 Strategic interventions & new tools to avoid stock outs / overstocks Flexible Procurement Fund & Strategic Stockpile (FLDs / SLDs / Diagnostics) On-going discussion with TGF and donors New Forecasting Tools + Early Warning Stockout System: GDF and its partners are developing new forecasting systems to quantify needs for the coming years and these systems are continuously being improved upon, esp. for SLDs Promoting M&E systems inter-operability for better data exchange and SLDs consumption at country and global level Information sharing and in country partners leveraging: closer monitoring model of in country supply chains information being implementing with RSOs, and partners collaboration (WHO, TBTEAM, rglcs, Donors funded programs like TB CARE, Technical Agencies, NGOs, Regional Association, Private sector

25 Expand Market SLDs challenges GDF + Scale-UP Public + Private partners Procurement Fund + Strategic Stock Pile Avoid payment delays Reduce lead times Increase orders size Allow better planning Reduce costs Easier Forecast Smoother demand Monitoring Tools Standardize Demand Standard Products with Harmonized Regimens Reduce regulatory burden / bottlenecks Monitoring Tools / LMIS Access Strategies New products Higher volumes DEMAND SUPPLY TA Quantification Planning GDF Foster Supplier engagement / Meetings Demand visibility / Volumes APC Data Mngt Scale-Up Information Systems Early Warning Stock-out System Access Strategies Public + Private Sector Orders trends Diagno stics Global Forecast Monitor Support API monopoly situation / capacity Vertical integration risks New API sources PreQ of API and FFP New products / forms / packaging

26 Discussion 26

27 Drugs Forecasting and management is key Selection of a set of key variables Simple to set-up User friendly Integrated Modules (casesdrugs-reports) System Web-based / Stand alone Data collection routines & users profiles SOPs + QA Open standards selection / integration Open source No license Easy report creation /data export tools

28 Where e-tb Manager is... Assessment: Swaziland Turkmenistan Pilot: Bangladesh Cambodia Namibia Nigeria Uzbekistan Roll-out: Armenia Azerbaijan Indonesia Ukraine Vietnam Follow-up: Brazil Philippines