(EMR_SITE) Number of PEPFAR-supported facilities that have an electronic medical record (EMR) system
This indicator can be used as a cross-sectional indicator at Q4. It can be used to better understand PEPFAR’s investments in Strategic information and to support a broader understanding of data quality challenges for other indicators. Timely access to up-to-date patient information plays a vital role in the provision of effective clinical care by health professionals. Diagnosis and treatment can be improved if health professionals have easy access to accurate and comprehensive medical records of patients.
Number of PEPFAR-supported facilities that have an electronic medical record (EMR) system within the following service delivery points: HIV Testing Services, Care & Treatment, Antenatal or Maternity Services, Early Infant Diagnosis or Under Five Clinic, or TB/HIV Services
How to calculate annual total: N/A. Data is reported only once annually at Q4
How to collect:
Definition of an Electronic Medical Record (EMR):
An EMR is a longitudinal electronic record of an individual patient's health information that can assist health professionals with decision-making and treatment. Data found in a record may include patient demographics, past medical history, vital signs, examination and progress notes, medications, allergies, immunizations, laboratory test results, other test results. It can also support the collection of data for other uses such as quality management, public health disease surveillance and reporting. EMR can include real-time point-of-care data entry as well as retrospective data entry. An EMR is a digital version of a paper chart that contains key information in a patient’s medical history from one service delivery point or site.
The implementing partner should indicate whether the PEPFAR-supported service delivery areas have implemented and are actively using an electronic medical record system to assist clinical service provision or patient/program monitoring and reporting. Specifically, for PEPFAR reporting a minimum of 6 months of retrospective data should be included in the EMR. (For example, an ART EMR set up in September 2018 to contain at least 6 months of retrospective data (current patients that have been enrolled on ART) could be counted in the reporting at FY18 APR.
Individual service delivery area/point EMR versus Integrated Health EMR:
EMRs are typically for all health areas, but PEPFAR is interested in better understanding whether EMRs are available for the service delivery areas where PEPFAR focuses its work. If a service delivery area is incorporated in a larger integrated health EMR, then it should be included this indicator. If two or more service areas are in an integrated EMR, both areas should be included in this indicator. A site service delivery area should be reported under this indicator if the EMR is on site (i.e., server and computer entry screen or there is a central server at a hub facility, that includes all data from all the “spokes” for that facility’s catchment area. As long as the data for patient management and reporting comes from the EMR system as one source.
For example, if services are integrated, for example EID service delivery is integrated into treatment services, then as long as EID data is captured in the treatment services EMR (or a separate EMR for EID is available within these services), then the EMR could be counted under both the treatment and EID service delivery areas.
Some sites maintain types of e-Registers (which might provide basic functionality like reporting, default tracing, etc.). However, if these e-Registers do not capture longitudinal clinical information, they should not be included in this indicator.
How to review for data quality:
If a site does not report for a specific service delivery area (e.g., the site is not a PEPFAR- supported ART site reporting TX_CURR), then it should not be included as having an EMR in that service delivery area (e.g., EMR for C&T services – N/A should be selected in this case).
Reporting Level: Facility by service deliver point (or area)
Disaggregate descriptions & definitions:
Service delivery area:
- HIV Testing services: includes counselling (pre-test information and post-test counselling); linkage to appropriate HIV services; and coordination with laboratory services to support quality assurance and the delivery of correct results.
- Treatment services: includes services where ART is initiated and monitored.
- Antenatal/maternity services: HIV Testing and treatment in an ANC and/or maternity setting
- EID services: HIV testing and care for infants of HIV positive women, often linked to <5 children services and/or maternity services, but can also be part of an ART clinic, but with its own EMR EID
- TB/HIV services: includes routine screening, diagnosis, treatment, and prevention of TB among PLWHA or routine HIV testing and counseling and appropriate referral in persons with TB
Answer recorded separately for each service delivery point (or area)
Indicator changes (MER 2.0 v2.3 to v2.4): None
PEPFAR Support definition:
The PEPFAR support categories of DSD and TA-SDI do not apply to this indicator. To report results for this indicator, it is expected that PEPFAR provides support to the HIV service delivery area. PEPFAR did not have to support the development of the EMR in order for it to be counted. EMRs supported by other donors or Ministries of Health should be included in this indicator. It is highly recommended that service delivery areas that have functional EMRs use these both for patient management as well as reporting.
What is a PEPFAR supported site for the purpose of this indicator?
“PEPFAR supported site” for the purpose of this indicator should include any facility in the PEPFAR master facility list in DATIM which also reported any programmatic target or result during the same reporting period.
What is a PEPFAR-Supported Service Delivery area at a site for the purpose of this indicator?
PEPFAR-supported facility-based service delivery area uses PEPFAR funds to provide HIV-related services at service delivery points within the facility. It offers one or more HIV- related services including but not limited to: HIV testing and counseling; prevention of mother-to-child transmission of HIV (PMTCT); anti-retroviral treatment (ART) and TB/HIV services. Examples include different HIV services within clinics, hospitals, health facilities and community-based organizations (government, private or NGO). These can also include fixed locations and/or mobile operations offering routine and/or regularly scheduled services.
Guiding narrative questions:
- In the narrative, implementing partners should describe the primary EMR(s) in use for each the service delivery areas within the sites they support. Indicate the platforms that these EMRS were created on and who the primary partner, developer, or donor is that is responsible for maintaining these EMRs at the sites.