A program of the Information Systems for EPI: Where do I want to be? And where do I start? Liz Peloso, Global Director IAIM Inaugural Conference, March

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A program of the

Information Systems for EPI:Where do I want to be? And where do I start?

Liz Peloso, Global Director

IAIM Inaugural Conference, March 3 - 4, 2015 Istanbul, Turkey


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Conduct a review of your program & current systems to identify problem areas

Denominator Issues

Supply Chain

Local Data Use

Delays in Data

Issues of AccessTypes of Data & Reports


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Understanding the issues helps to uncover the solutions

Denominator IssueImmunization registries, redefining immunization targets for areas with inconsistent populations

Local Data UseData use guides, video-based training, targeted supportive supervision

Supply Chain Use of barcodes, facility stock management tools, automated ordering based on inventory


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A Systematic Way of Assessing Options

• What functionality do we need to support our work?

• What are the primary problems we are trying to address?

Requirements

• Identify gaps.

• Develop plan for addressing gaps and other time constraints.

• Produce implementation plan.

Compare Options Plan for Implementation

• Compare requirements against current functionality (for existing system).

• Go to tender with your requirements.

Katie Waller

Can you explain why "Gap Analysis and Plan" comes after "Compare Options"? It seemed to us that they would be in the reverse order (going to tender with requirements after you have identified gaps and developed a plan for addressing them). But maybe there is something we are missing.

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Identifying Functional Requirements


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Identifying Functional Requirements• Start by recognizing the overall goals of

the immunization program, and the program’s immediate objectives

• Then compare this to what you do currently (by reviewing program reports). That will help you identify where the gap in information is.

• This must be done by those who understand the immunization program. This is not an IT task.

• One good way to document this is in workflow diagrams.


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Describing the Processes of EPI was based upon the principles of Collaborative Requirements Development Methodology (CRDM)1. CRDM enables health professionals with limited

knowledge of ICT to create functional requirements for information systems.

2. CRDM provides a way for many points of view to be heard, understood and aligned to produce a common way forward.

3. CRDM helps break down complex interconnected processes into manageable units.

4. CRDM provides a roadmap on how to define a process so that it can make sense to the common stakeholder.

5. CRDM enables countries to better understand the way things work and prioritize places where things could be improved.

This process was done and validated in several countries (Senegal, Ghana, Rwanda, Tanzania, Zambia). The resulting documents provide an excellent starting point for other countries to do their requirements.


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Defaulter Tracing5 Defaulter Tracing

Ann

otat

ion

Com

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ityH

ealth

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ter No

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3.Is there an active CHW in that area?This activity/decision varies widely by area. Some have good CHW coverage and rely on them as part of the team, others have the HCW do most of the follow up. If the child is in a village well supported by a CHW for routine immunizations- the HCW will often contact them to follow up. If not the HCW will follow up themselves.

4. Plan for follow up during outreach The HCW will add the defaulter information they have to their plan for outreach activities. When they are next in the child’s village/neighbourhood they will go to the home and find them.

5. Send defaulter information to CHW or clientContact info, missed antigen, and any other relevant data is sent to the CHW either in a written report, during a meeting, or via phone. Individual reminders could also be sent to clients

4. Plan for follow up during outreach

1. Determine if immunizations were missed

3. Is there an active CHW in

that area?Start

The objective of this process is to identify those who were due to come for vaccination and missed their follow up dates and are now past due. There is a significant amount of variability in how this follow up is done currently.

1 Determine if immunizations were missedCurrently the HCW reviews the registration book to look for months in which no information is recorded – they then determine (based on the data that is entered) if the child is now overdue for an immunization and which one. **This step could be automated by searching an electronic record based on specific rules (either an appointment given that was past, or a record that shows more than a predetermined time has elapsed between immunizations)

2. Record the necessary information for follow upCurrently the HCW will record the clients name, missed antigen and any contact info necessary to follow up.

.

2.Record the necessary info to

follow up

EndCom

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ity

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Wor

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or H

CW

8. Record the reason

5. Send defaulter information to CHW or client

7. Ensure child attends outreach and is immunized

6. Can the defaulter be located?The CHW or HCW will attempt to find the child by going to their home, contacting relatives or neighbours or any other means necessary. If they are reportedly in the area but not available at that time, the HCW or CHW will continue to try to reach them on subsequent days.

7. Ensure child attends outreach and is immunized The HCW or CHW will go to the home and either bring the child to clinic or immunize them in the home. 8. Record the reasonIf the child is missing for some permanent reason (such as they have moved or died) that info is recorded so that they are no longer considered defaulters for that area.

6. Can the defaulter be

located?

Yes

YesNo

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Requirements are derived from the activities


The activity and description lead to the requirements


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Defaulter Tracing: Information Requirements

•The client needs to know the date the next vaccine is due, and should be reminded close to the due date (see defaulter prevention).

Client needs to know when vaccine is due

•Since immunizations can be given in a variety of places (market clinic, outreach, any health center), it is difficult to know if an appointment was actually missed, or done elsewhere.

• In order to know an appointment was missed the HCW needs to record in the system when an appointment took place.

HCW needs to identify when an appointment is

missed

•HCW needs to have contact information for each patient.

•The HCW/system should also know who the CHW is for each client.

HCW needs a way to contact client/caregiver

•The client needs to understand that if too much time lapses between vaccines they will not be appropriately protected (this is a general education issue).

Client needs to understand how important timing is

Def

aulte

r tra

cing


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Defaulter Tracing: Identify the Requirements

User story How is this solved today?

What MIS functionality would help us solve it better

Tools or functionality we have already

Is this functionality is in other systems?

Client needs to know when vaccine is due

Next appointment in Child Health Record

HCW needs to identify when an appointment is missed

Look in register

HCW needs a way to contact client

Some registers had parent contact info

Client needs to understand how important timing is

Counselling during CWC


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This information should be related back to improving program performanceExample: District-level coverage estimates. • How does improving defaulter tracking feed into improving district-level coverage?• What other programmatic factors tie into district-level coverage, and are those

being measured appropriately?

District Immunization CoverageMore than 90% cov-erage

More than 80-89% coverage

60-79% coverage

Less than 60% coverage

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Compare Options


Are there existing systems that may meet my needs?

Find options:

• Submit a request for proposal.

• Do some research through your peers or other sources.

• Hire an advisor.

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Assessing Complex Software Solutions

Other times you have an ICT need that requires a more complex software solution, like a customized build or significant modification to an existing system. More complex solutions, require more complex assessment processes.

Plan

the

Asse

ssm

ent The assessment of a

complex solution will cover many subject areas, including functional requirements, crosscutting requirements, and vendor fit. Create a work plan, documenting the timing and tasks for each area, as well as the desired outcomes.

Form

Ass

essm

ent T

eam

s Each assessment area requires different expertise. Form a team of experts for each area to carry out the assessment and issue recommendations to the key stakeholders who own the overall final decision.

Crea

te a

n As

sess

men

t D

ocum

ent Create an assessment

document to summarize the work carried out by all of the Assessment Teams, including observations, conclusions and recommendations.

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Assess Functional Requirements

• Request demonstrations for key scenarios.

• Request a sandbox or private environment for the advisors to use directly.

• Request to see how the functional requirements get met through different user interfaces and APIs.

• TIP: Don’t try to test for each and every use case if they are all variations of a theme. Think of test scenarios that represent the most common use cases, most critical use cases, and high-risk actors.

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Determine if the right products are being assessed.


Assess Crosscutting RequirementsEvaluate the quality of the system.

• Security: Does the system support the authentication, authorization, auditing, and data entitlement needs?

• Scalability: Does the system perform with growing number of users and data over time?

• Availability: Does the system allow for redundant deployments and off-site backups?

• Extensibility & Maintainability: Does the system expose appropriate modularity interfaces & APIs to extend documented scenarios?

• Interoperability: Does the system expose the right standards and profiles for expected transactions?

• Operations: Does the system provide monitoring, error logging, self-testing, updating, and migration?

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Assess the VendorFor complex implementations, a competent technical partner with adequate support and capacity building is critical.

• What is their business model and how does it align with the country needs, e.g. services, licenses, subscription

• How do they manage IP, e.g., content and code licenses, trademarks, IP developed while for-hire, etc.?

• Can they embrace and adapt to country needs, seeing• them as an opportunity not an obstacle?• What is their track record with regard to participating in integrated

initiatives?• What capacity building and support strategies do they use?

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Identify the gaps and make a plan

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Often you will need to select a proposal that does not meet all your needs This may be due to:

• Price

• Timelines

• Range of existing solutions did not meet all requirements

• Issues with the RFP process which failed to attract some proposals (they did not hear of it, there were specific restrictions they could not meet, insufficient time)

As a team you may need to review your options and come up with a plan. It is important to be clear what is of most importance, and where you can either make compromises, or phase in functionality.


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Your MIS plan will depend on your software model


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In ConclusionYou don’t have to go it alone—ask for help.

• Peer networking groups such as IAIM can provide valuable connections to those who have done this before and can help advise you

• Online resources:• http://www.technet-21.org/• http://www.aehin.org/• http://hingx.org/• http://bidinitiative.org/

http://www.technet-21.org/



http://www.aehin.org/

http://www.aehin.org/

http://hingx.org/

http://hingx.org/

http://bidinitiative.org/

http://bidinitiative.org/

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Documents

A program of the Information Systems for EPI: Where do I want to be? And where do I start? Liz Peloso, Global Director IAIM Inaugural Conference, March