Knowledge Platforms in Clinical Care
Currently, 2000 men, women and children a day die of HIV-related conditions in Sub-Saharan Africa.
Through the '3by5' initiative in what is arguably one of the most ambitious public health interventions in recent history, WHO and partner organizations have united in catalyzing action to provide care and prevention of HIV to millions who did not previously have access.
As an intervention of this size for a condition this complex has never been attempted, and therefore has little precedence from which to learn, WHO has adopted the slogan 'learning by doing' to emphasize both the urgency of immediate action, but also action which informs our current strategy. But this begs the question, how does one actually 'learn by doing?' What is the methodology?
Knowledge Platforms for Clinical Care provides the environment, technology platforms and learning methodologies that make 'learning by doing' in public health possible.
What is the Knowledge Platforms Initiative?
In August of 2004 in Nairobi, Kenya, WHO convened a meeting of developers of Electronic Medical Record systems (EMR), members of National AIDS Control Programs from five African countries, clinicians and learning experts to discuss what are the issues around improving HIV care at the clinical level, and more specifically, what is WHO's role in assisting this work and helping transfer good practice to the widest possible best effect.
The group recognized:
- in order to improve care, you have to measure it;
- given the rate of scale up of anti retroviral treatment in Africa, as HIV transitions to chronic care, no paper system will be adequate to handle the volume of information required to care, monitor and report HIV data;
- no current 'off the shelf' EMR system developed in the North is appropriate to most African settings, both in terms of infrastructure and support of care. Local development and adaptation is required;
- development and implementation of EMRs in Africa has resulted in numerous small projects without data content or data exchange standards, running the risk of creating a fragmented and chaotic information environment in which national data reporting and mobile patient tracking would be severely impaired;
- current health informatics capacity in African health systems from the clinic to the ministry must be strengthened;
- beyond implementation of EMR systems, methods of knowledge sharing and facilitated improvement must be encouraged and introduced.
To address these issues among others, the group called upon WHO to:
- work with partners including African Ministries of Health, the CDC, developers of EMR systems used for Africa, and clinicians to establish basic standards to allow interoperability, mobile patient tracking, and the possibility of national and cross national data mining. These standards include electronic information exchange standards, agreement on the approach to core minimal data sets, and the establishment of a common data dictionary;
- work with African Ministries of Health on their Knowledge Management strategies with an emphasis on improving patient care and better use of data applied to decision making at all levels of the health system;
- target investment in promising EMR and clinical learning systems encouraging the transfer of promising technologies to other country settings;
- provide access to basic HIV reference knowledge to clinicians.
What has the Knowledge Platforms Initiative done?
- WHO, working with the local National Aids Control Programs, CDC, Indiana University, Partners in Health, the Institute for Healthcare Improvement and other partners, has been invited by the ministries of health of Kenya, Uganda and United Republic of Tanzania to provide demonstration implementations of African developed EMR systems specifically designed to improve care as well as introducing or strengthening continuous improvement techniques. Implementation has begun with on going training and follow up throughout 2006.
- In August of 2005 in Geneva, WHO convened its second meeting on EMR development in Africa. At this meeting, participants which included developers of many of the most promising EMR systems designed for work in Africa, agreed on an HL7 implementation guide to better ensure accurate transfer of health data in Africa, and agreed to implement it, the construction of a common data dictionary freely available to all systems to be housed at WHO, and the creation of an 'action network' to better share effective practices coordinate efforts to accelerate the development of appropriate EMR and learning systems throughout the continent.
- At the request of several ministries of health, WHO has begun to support active scale up strategies of such systems in East Africa, and is beginning work in other regions as well.
- 750 HIV knowledge cases containing core reference material are currently being prepared and shipped to clinics in over 19 African countries.