Online Program

Addressing data quality gaps to ensure quality of care in a large HIV program in rural Haiti

Sunday, November 3, 2013

Jean-Gregory Jerome, MD MPH, Monitoring, Evaluation & Quality, Zanmi Lasante, Haiti, Boston, MA
Matthew Peckarsky, MS, Monitoring, Evaluation & Quality, Partners In Health, Boston, MA
Valery Cesar Lucmane, Monitoring, Evaluation and Quality, Zanmi Lasante, Haiti, Boston, MA
Brittany Eddy, MPH, Health Information Systems, University Hospital, Mirebalais, Haiti, Boston, MA
Jean Paul Joseph, MD, Zanmi Lasante, Haiti, Boston, MA
Michael Seaton, BS, Partners In Health, Boston, MA
Daniel Chiu, BS, Monitoring, Evaluation & Quality, Partners In Health, Boston, MA
Philip Garrity, BA, Monitoring, Evaluation & Quality, Partners In Health, Boston, MA
Evan Waters, BS, Medical Informatics, Partners In Health, Boston, MA
Louise C Ivers, MD MPH, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
Lisa Hirschhorn, MD MPH, Department of Global Health and Social Medicine, Harvard Medical School, Partners In Health, Boston, MA
Background: Zanmi Lasante (ZL), sister organization of Partners In Health (PIH) in Haiti, has provided care in Haiti to over 24,000 HIV patients in 12 clinical sites. In 2002, an electronic medical record (EMR) system was implemented to improve HIV care and program surveillance. Infrastructure and other challenges compromised data quality, preventing full realization of these goals. We describe outcomes of a data quality audit (DQA) designed to increase EMR utility for surveillance and improvement in our HIV program.

Methods: Concordance between paper and electronic records was evaluated on selected key data elements, including patient status, date of last visit and last medication pickup and last CD4 result. Paper records were considered the “gold standard”. Discordance rates were measured and EMR data were corrected based on the paper chart.

Results: As of April 2013, the DQA was completed on 22,434 patient records (87% of ever-registered patients). 8,704 (38.8%) patients had a discordant status, compared to only 7.5% of patients for last visit date and 4.3% for last CD4 count. Based on improved data quality, targeted outreach driven by EMR data was initiated for patients at risk for default and those in need of CD4 count monitoring.

Discussion: An up-to-date EMR with quality data is crucial for a large scale HIV program to have real-time access to accurate patient data for care and program surveillance to rapidly identify individuals in need of additional services. Only by measuring and improving data quality can EMR's realize their full potential in these dual roles.

Learning Areas:

Communication and informatics
Implementation of health education strategies, interventions and programs
Public health or related research

Learning Objectives:
Describe efforts to evaluate data quality of an EMR used for HIV care in rural Haiti Demonstrate the importance of electronic data in effective program management and addressing burden of HIV

Keyword(s): Data/Surveillance, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Director of Monitoring, Evaluation and Quality Improvement for Zanmi Lasante/Partners in Health, Haiti. I am a medical doctor and hold a Master's in Public Health. I lead strategy and decision-making for data collection, analysis and dissemination of operational research for the HIV program and other clinical services in Central Haiti.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.