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Health Information Systems

It is widely recognized that the analysis and use of information for decision making are essential components of a functioning health system. Unfortunately, in many countries, health information systems are extremely weak, and often contribute to the fact that health services are not delivered in the most optimal manner. Health Systems 20/20 works with government counterparts at the national and local levels to strengthen information systems through the development of guidelines, improved tools, and capacity building.

Antiretroviral Therapy Information System (ARTIS)

In many developing countries, patient tracking systems in hospitals are underdeveloped. The data collection and reporting systems in hospitals often times do not exist or do not function optimally. Generally this problem is more pronounced in bigger institutions than in the smaller institutions. With the scale up of HIV/AIDS programs, health care facilities now need to strengthen their patient tracking for HIV/AIDS services such as antiretroviral therapy (ART), prevention of mother-to-child transmission (PMTCT), and voluntary counseling and testing (VCT). ARTIS was designed to track individual patients receiving ART, so as to provide more personalized care. The application of ARTIS covers: patient enrollment, assessment, recruitment, management, and treatment outcomes.

Implementation Guidelines

ARTIS can be implemented in two forms: paper-based and computer-based systems. Each hospital involved should have the desire to participate in the activity, provide its patients with more personalized care, and maintain the system once implemented. Furthermore, hospitals selected for the computer-based ARTIS must have working computer networks and employees with prior computer experience.

Within either form of ARTIS, the system is composed of four major components: Pre-Art Register, ART Register, Comprehensive Care Clinic Card, and two standard summary reports (Monthly Summary Sheet and Cohort Sheet).

The Pre-ART register is an institution-based module in which all patients referred for HIV care are entered. The purpose of the pre-ART register is to:

• Provide facility-based information on the status of patients upon entry into HIV care
• Provide a facility-based record on patient outcomes while in Pre-ART care
• Assist in facility-level program evaluation

The ART Register is an event-based module for patients receiving ART. Information is recorded for enrolled patients on each visit, which may be different from patient to patient. The purpose of the ART register is to:

• Provide record of patient outcome
• Provide a track record of patients from the initiation visit for ART through the monthly visits
• Serve as a source of information on patient drug mix
• Serve as a data source for reporting and aggregation

The Comprehensive Care Clinic Card is used to serve as a detailed record of clinical diagnosis and treatment. It also serves as a transfer document and basis of continuity of care.

ARTIS also has two standard reports that are submitted at the end of each month by all ART centers: the Monthly Summary Sheet and Cohort Sheet. These provide a summary of information on Pre-ART and ART services provided by the institution and extract a group of patients from the ART Register at intervals of 6, 12 and 24 months, in order to assess program success, respectively. The information collected can then be submitted to Ministries of Health and other government officials for reporting and policymaking purposes.

Application and Results

ARTIS has been implemented in Zambia and Kenya. The system was implemented in ten pilot facilities providing ART, in each country. The Pre-ART and ART registers, Comprehensive Care Clinic Card, Monthly Summary Sheet and Cohort Sheet were developed with respect to the individual country’s health care system, health services, and reporting needs. Once developed, the hospital staff from the pilot sites were trained in ARTIS and the system was installed at the facilities. Specific hospitals were chosen to implement the paper-based system versus the computer-based system using the above-mentioned criteria. Implementation of ARTIS in both Zambia and Kenya continues.