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

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.