背景:差异化服务提供(DSD)通过将客户从拥挤的ART诊所转移到社区进行护理,增加了撒哈拉以南非洲的抗逆转录病毒治疗(ART)的可及性。然而,DSD设置挑战提供商对复杂、慢性护理治疗指南,并有繁重的客户监测和评估系统(M&E),减少决策数据。电子病历系统(EMRS)可改善客户结果并减少M&E工作量。传统EMRS无法在电源不可靠且连接不良的大多数DSD设置中运行。
目的:本研究旨在详细介绍以人为中心的设计(HCD)过程,即在利隆韦开发基于社区的DSD服务的移动EMRS,马拉维。
方法:灯塔信托(LT)在利隆韦设有2个卫生部(MoH)诊所,马拉维,总计>35,000个ART客户。LT\的实时,护理点EMRS收集复杂的客户M&E数据并提供决策支持,确保遵守艾滋病毒和结核病综合指南,以优化客户和计划结果。LT的EMRS扩展到所有大型MoHART诊所。LT还实施了护士主导的基于社区的ART计划(NCAP),DSD模型,为社区中2400名稳定的LT客户提供ART和快速评估。LT,与合作者一起,来自华盛顿大学国际健康与技术培训和教育中心的合作伙伴,医生,使用开源社区健康工具包(CHT)和HCD来开发开源,离线优先,类似EMRS的移动应用程序,“基于社区的ART保留和抑制”(关心)。CARES旨在为NCAP的DSD客户带来类似EMRS的提供商利益。
结果:CARES设计花了大约12个月的时间,并使用了与提供商的高度参与性反馈会议的迭代过程,数据管理器,和M&E团队的投入,以确保NCAP和LT设置的关怀优化。CARES移动EMRS原型支持具有嵌入式提示和警报的NCAP提供商,以确保遵守集成的MoHART指南,旨在提高客户护理质量。CARES促进了NCAPM&E的数据质量和流量的提高,旨在减少社区和诊所之间的数据差距。CARES飞行员展示了手机的潜力,类似EMRS的护理点应用程序,可以使NCAP客户受益,提供者,和计划团队,提供集成的客户关怀和完整的M&E数据,用于决策。关心的挑战包括应用程序的速度,搜索功能以对齐纵向记录,并关心支持及时护理警报的EMRS集成。
结论:利用CHT和HCD流程促进了本地指定和优化的移动应用程序的设计,并有望为DSD设置带来类似EMRS的好处。从CARES原型转向常规NCAP实施应改善客户关怀并加强M&E,同时减少工作量。我们透明和描述性的过程分享了CARES设计和开发的进展和陷阱,帮助这个数字创新领域的其他人从我们现阶段的经验中学习。
BACKGROUND: Differentiated service delivery (DSD) increases antiretroviral therapy (ART) access in sub-Saharan Africa by moving clients out of congested ART clinics to communities for care. However, DSD settings challenge provider adherence to complex, chronic care treatment guidelines and have burdensome systems for client monitoring and evaluation (M&E), reducing data for decision-making. Electronic medical record systems (EMRS) improve client outcomes and reduce M&E workload. Traditional EMRS cannot operate in most DSD settings with unreliable power and poor connectivity.
OBJECTIVE: This study aims to detail the human-centered design (HCD) process of developing a mobile EMRS for community-based DSD services in Lilongwe, Malawi.
METHODS: Lighthouse Trust (LT) operates 2 Ministry of Health (MoH) clinics in Lilongwe, Malawi, with a combined total of >35,000 ART clients. LT\'s real-time, point-of-care EMRS collects complex client M&E data and provides decision-making support, ensuring adherence to integrated HIV and tuberculosis guidelines that optimize client and program outcomes. LT\'s EMRS scaled to all large MoH ART clinics. LT also implements a nurse-led community-based ART program (NCAP), a DSD model to provide ART and rapid assessment for 2400 stable LT clients in the community. LT, alongside collaborators, from the University of Washington\'s International Training and Education Center for Health and technology partner, Medic, used the open-source Community Health Toolkit (CHT) and HCD to develop an open-source, offline-first, mobile EMRS-like app, \"community-based ART retention and suppression\" (CARES). CARES aims to bring EMRS-like provider benefits to NCAP\'s DSD clients.
RESULTS: CARES design took approximately 12 months and used an iterative process of highly participatory feedback sessions with provider, data manager, and M&E team inputs to ensure CARES optimization for the NCAP and LT settings. The CARES mobile EMRS prototype supports NCAP providers with embedded prompts and alerts to ensure adherence to integrated MoH ART guidelines, aiming to improve the quality of client care. CARES facilitates improved data quality and flow for NCAP M&E, aiming to reduce data gaps between community and clinic settings. The CARES pilot demonstrates the potential of a mobile, point-of-care EMRS-like app that could benefit NCAP clients, providers, and program teams with integrated client care and complete M&E data for decision-making. CARES challenges include app speed, search features to align longitudinal records, and CARES to EMRS integration that supports timely care alerts.
CONCLUSIONS: Leveraging the CHT and HCD processes facilitated the design of a locally specified and optimized mobile app with the promise to bring EMRS-like benefits to DSD settings. Moving from the CARES prototype to routine NCAP implementation should result in improved client care and strengthened M&E while reducing workload. Our transparent and descriptive process shares the progress and pitfalls of the CARES design and development, helping others in this digital innovation area to learn from our experiences at this stage.