Savecare - EHR HIV/AIDS System

Development of a Prototype for Data Analisis and Collection

Nuno Rocha

, Carla Esteves

, Emanuel Catumbela

1,2

, Tiago Silva-Costa

1,2

and Alberto Freitas

1,2

CIDES – Department of Health Information and Decision Sciences, Porto, Portugal

CINTESIS – Center for Research in Health Technologies and Information Systems, Porto, Portugal

Keywords: EHR, Data Collection, HIV, AIDS, Health Indicators, Quality Assessment.

Abstract: Human immunodeficiency virus treatment demands constant monitorization and evaluation and tracing

tools are important weapons against this epidemic. SaveCare stands for System for HIV/AIDS Virtual

Evaluation. It is our goal to develop web-based tools which can motivate the HIV/AIDS patients’ data

collection adjusted to both Portugal and Angola. As a result is presented a prototype with a module for

HIV/AIDS patients personal and clinical data collection; a module for the performance and quality of

healthcare evaluation, that uses a set of indicators and has as output printable reports; and an additional

module for configuration purposes. Clinicians find the many features of the prototype very usefull, but

additional modules are in need.

1 INTRODUCTION

Amongst the infectious diseases, human

immunodeficiency virus infection and the acquired

immunodeficiency syndrome (HIV/AIDS) epidemic

are severe worldwide health problem (Sorensen et

al., 2008), nowadays accounted as the main death

cause for the adult population and were accountable

for more than 20 million deaths in the past two

decades (Jazayeri et al., 2003).

HIV/AIDS treatment demands constant

motorization and evaluation (Sorensen et al., 2008).

In order to now thy enemy, evolution monitoring

tools for the infected patients, as well as epidemic

trace tools, are important weapons in the war against

this strong adversary that is the HIV virus epidemic.

In 2009 there were 42000 people living with

HIV/AIDS in Portugal and in 2010 the highest rates

of AIDS diagnosis in Europe, were also in Portugal

(ADVERTing, 2012).

A low prevalence of HIV cases in Angola, is due

to the armed conflict which limited the movement of

populations of the respective areas of residence.

The storage media expenses, such as paper and

film, per unit of information differ dramatically from

that of electronic storage media whereas all related

processes regarding data analysis can be simplified

with the use of electronic health records (EHR) in

addition to residual paper-based records.

Regarding the development of EHRs for HIV/AIDS

patient records, were cited three priorities (Nucita et

al., 2009, Kanter et al., 1997):

 The research tools;

 The health infrastructure and communication;

 The clinical care of patients.

In Portugal, as from December 2012 the

hospitals should be submitted in the system

SI.VIDA in terms of notification, registration

information and documentation of outpatient

medication dispensing, including situations of post-

exposure prophylaxis, relating HIV/AIDS patients.

A tool that allows the registration of the

HIV/AIDS patient clinical data storage episode by

episode and to carry out along these episodes

evolution evaluation represents an optimization of

patient follow-up service.

2 AIM AND MOTIVATION

This paper was based on a previous systematic

review on informatic systems for HIV/AIDS

motorization and a literature review on HIV/AIDS

indicators, and reflects the work behind the

development of a tool, called SaveCare – System for

HIV/AIDS Virtual Evaluation.

The objective is to develop a set of web-based

370

Rocha N., Esteves C., Catumbela E., Silva-Costa T. and Freitas A..

Savecare - EHR HIV/AIDS System - Development of a Prototype for Data Analisis and Collection.

DOI: 10.5220/0004247703700373

In Proceedings of the International Conference on Health Informatics (HEALTHINF-2013), pages 370-373

ISBN: 978-989-8565-37-2

 2013 SCITEPRESS (Science and Technology Publications, Lda.)

tools, which can help and motivate the error proof,

practical, accurate, validated, automatic HIV/AIDS

patients’ data collection adjusted to both Portugal

and Angola, in order to better know the disease

behavior.

3 METHODS

In this prototype implementation, it is intended to

use Open Source technologies in both the database

and the prototype development, such as PHP,

HTML, CSS and JavaScript, as well as open source

packages like JQuery User Interface and others.

Since in Portugal, the framework is already working

with Oracle, the system should be prepared to work

with it as well.

This study is structured in three distinct phases:

requirements analysis, prototype development and

quality assessment by final users.

3.1 System Requirements Analysis

The requirements for the prototype were defined

according to the review made on other used IT

systems used in data analysis for HIV/AIDS patient

records. In addition to the typical basic

functionalities of any EHR registration and query

users, appointments registration and scheduling must

be included specific characteristics for the treatment

of patients with HIV/AIDS. Accordingly, this

prototype must be user friendly, safe and secure and

allow interoperability, modular development and

offline mode.

Figure 1: SaveCare simplified UseCase diagram.

The system is intended to be used upon patient

consultation and for posterior patient evaluation

consultation. Figure 1 represents the physician

usecase of the system.

3.2 Indicators Definition

Initially, the authors just considered the indicators

proposed by the European AIDS Clinical Society

and the HHS Panel of the Office of AIDS Research

Advisory Council (OARAC). With the advance of

implementation this tool also collects data for

performance indicators.

 Patient quality indicators – Indicators that

measure the disease spread in a set of patients. E.g.

Number of HIV-positive pregnant women who

received antiretroviral to reduce risk of mother-to-

child-transmission.

 Performance Quality Indicators – Indicators

that measure the healthcare quality provided. E.g.

Proportion of patients who had CD4 count measured

at least once during the last 6 months.

3.3 Forms Definition

In order to collect the required information for the

indicators calculation, improved forms were in need.

For this prototype, patient data was separated of

the episode data, so that some of the information

was kept static, whilst the non-static one is recorded

episode after episode. Thus, two types of forms were

created. The Patient Data forms (PD), record such

information as, date of birth, gender, race, the last

preformed AntiHIV 1 and 2 test dates, first

consultation date, last negative analysis date, first

positive analysis date and WHO’s and CDC

infection stage classification.

The Episode Data forms(ED), collect different

data, and group the episode by date. ED form collect

clinical data, such as weight, height, age at the time,

physical examination, laboratorial results, diagnoses

code according to the ICD 9-MC, and therapeutics

prescription.

FORMS

Patient

Episode

REPORTING

Indicators

DashBoard

MANAGEMENT

Content

Managm ent

Content

Managment

AccessControl

Figure 2: SaveCare module’s flow.

4 RESULTS

For each module in this structure, VCSaveCare

Savecare-EHRHIV/AIDSSystem-DevelopmentofaPrototypeforDataAnalisisandCollection

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prototype, there is controlling layer (PHP),

responsible for communication functions; a

modeling layer (PHP inc files), responsible for data

modeling, and a viewing layer (HTML .tpl files),

responsible for data presentation.

4.1 Savecare Prototype Forms

The prototype consists of different forms for the data

collection, divided in 2 categories, patient data forms

and episode data forms.

Figure 3: Prototype printscreen – Patient Data.

For example in Figure 4, it is presented the

patient data form for administrative data collection.

Specific information relevant for HIV/AIDS must

be collected in this form.

4.2 Episode Schedulle

It was needed a module where the physician, could

evaluate the patient evolution on previous episodes

in order to improve profitability and productivity of

doctors themselves. To facilitate visualization of the

patient’s evolution by the physician, it shows up on

the screen of forms, a list (Figure 5) with a summary

of several patient episodes, chronologically sorted.

Figure 4: Table with last patient’s episodes.

This table presents information graphically

through the means of symbols. For example the pill

symbol, intended to illustrate the therapeutics under

taken by the patient.

4.3 Patient Condition Summary

It is also required a patient condition evaluation on a

glance, thus it was developed a summary table of the

patient condition in the present day (Figure 6).

Figure 5: Patient condition summary.

This summary presents such information, as patient,

age, therapeutics, next appointment date, and a set of

warnings relating various issues.

4.4 Savecare Prototype Indicators

As a Reporting Module, it was defined a module

where users can make and view preconfigured and

other type of reports, adjusted to their needs, based

on the proposed predefined indicators.

Figure 6: Indicator Table - Total of HIV/AIDS patients

with chest X-Ray exam preformed.

Figure 7: Benchmarking table – Total neutrophil count.

In addition, the lists allow the user to check the

occurrences of different values in a field, and sort

these values by name or total of occurrences.

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5 CONCLUSIONS

The feedback obtained from final users so far,

reveals that this tool offers great advantages over the

others in use. As key attributes stand out, the fact

that it prevents errors that were common in other

applications such as different types of introduction

by each physician. A great feature on the reporting

module is how it presents the results with different

colorations, allowing simple and direct reading of

values more relevant.

This solution is prepared to two distinct

countries’ realities and it’s capable of being easily

used in due to its data model based largely minimal

data sets, common in large part of health care

systems worldwide, it is only necessary adjustment

for use in languages other than Portuguese. Being a

tool of indicators that can be easily fed by new data,

also allows an analysis in near real time the

evolution of the indicators, as the data is loaded into

the application.

5.1 Future Work

Temporarily it is intended to network install this

prototype in Portugal and Angola, to start as soon as

possible the data collection and detection of possible

bugs, as well as adjust the forms to its users.

As future work, to be carried further in the next year,

will be implemented the other indicators and define

other correlation sets. By implementing these

indicators is intended to compare the results from

the two countries where the system will be deployed.

Addition to these, is under study to implement other

indicators, namely in data quality, which will aim,

Additional modules are already under team’s

consideration. It is intended to develop the following

modules:

Laboratorial Module in which will be recorded

and documented all patient examinations;

Medication / therapy module, which may be

accompanied by the prescription of treatments to

patients including the prescription of antiretroviral

therapy.

ACKNOWLEDGEMENTS

The authors would like to thank to the Department

of Health Information and Decision Sciences

(CIDES) in the Faculty of Medicine, University of

Porto.

REFERENCES

Adverting. 2012. European Hiv And Aids Statistics

[Online]. Available: Http://www.Avert.Org/Hiv-Aids-

Europe.Htm [Accessed 3 September 2012.

Jazayeri, D., Farmer, P., Nevil, P., Mukherjee, J. S.,

Leandre, F. & Fraser, H. S. F. 2003. An Electronic

Medical Record System To Support Hiv Treatment In

Rural Haiti. Annual Symposium Proceedings / Amia

Symposium., 878.

Kanter, A. S., Spencer, D. C. & Steinberg, M. H. 1997.

Development Of An Hiv Clinical And Research

Database For South Africa. Methods Of Information In

Medicine, 36, 144-148.

Nucita, A., Bernava, G. M., Bartolo, M., Masi, F. D.,

Giglio, P., Peroni, M., Pizzimenti, G. & Palombi, L.

2009. A Global Approach To The Management Of

Emr (Electronic Medical Records) Of Patients With

Hiv/Aids In Sub-Saharan Africa: The Experience Of

Dream Software. Bmc Med Inform Decis Mak, 9, 42.

Sorensen, T., Rivett, U. & Fortuin, J. 2008. A Review Of

Ict Systems For Hiv/Aids And Anti-Retroviral

Treatment Management In South Africa. Journal Of

Telemedicine And Telecare, 14, 37-41.

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