Success Story: Harnessing E-learning capacity in HIV/AIDS training and aggregation of Paediatric HIV/AIDS information through Knowledge Management System and Web Portal

Gertrude’s Children’s Hospital embarked on an e-Health initiative to build capacity of healthcare workers by using Information Technology. The project was sponsored by Regional Aids Training Network (RATN) and Gertrude’s Children’s Hospital and the objective was to build the capacity of health workers who care for persons with HIV/AIDS and also improve access to information by building a knowledge hub and web portal for Paediatric HIV/AIDS information. The project, which is a partnership between Gertrude’s Children’s Hospital and Nanyuki District Hospital, comprised of 30 healthcare workers attending to a total of 7,400 patients. The project’s aim was to facilitate remote access to information and provide continuous training to the said clinicians in the provision of care, while removing the traditional constraints of geographical / physical distance and lack of enough time due to the busy schedules.

Goals and objectives 

  • To enhance training and reduce costs by embracing technology through virtual training.
  • To provide a knowledge hub for healthcare workers and allow them to share and disseminate information that would lead to better patient care.
  • To record, store and maintain accurate patient information so as to enable proper patient evaluation and monitoring by ensuring that the data is captured and utilized.

Execution of the programme

Through an e-Learning module, healthcare workers were trained on the various dimensions of HIV/AIDs care. Virtual classes comprising of video, data and voice were conducted via the Internet. Evaluations through Question and Answer (Q&A) sessions were used as follow up to confirm that the intended learning had been achieved.

Online video conferencing through Cisco Webex system made it possible for implicit knowledge dissemination to occur through coaching and mentoring sessions. Experienced consultants held sessions with younger doctors and trained them on how best to give HIV/AIDS-based care. The consultants, who  were based at Gertrude’s Children’s Hospital in Nairobi, held virtual sessions with participants in Githogoro and Nanyuki. Through a Knowledge Management System called the Gertrude’s LKM system, patient information is now captured and maintained on a web-based system. This information is available to the primary doctor in Nanyuki, who can now seek a second opinion from a secondary doctor at the Gertrude’s main hospital in Muthaiga, Nairobi. Despite the doctor’s location, the secondary doctor can provide expert advice and assist in providing the best treatment for the child. The healthcare environment is very dynamic and HIV/AIDS research and development is continuously carried out all over the world. A website has been made available to all clinicians to keep up to date as new knowledge and experience is captured. They are also trained on the use of social media tools such as Facebook, YouTube and Twitter so that they are able to follow the latest information and events related to HIV/AIDS.

Accomplishments

This IT system has been able to facilitate the following:

  1. Enhanced computer skills for all clinicians involved in the project – this included basic knowledge in computing, access to the Internet, use of Microsoft Word and Excel applications, and the use social media tools such as YouTube, Facebook and Twitter.
  2.  Since this Knowledge Management System encourages a paperless environment; there is now less manual entry of information and reduced duplication. Once registration of the patient’s demographics is completed, there is no need to repeat the same in subsequent forms. Also, reports are generated at the click of a button.
  3.  The IT system aims at clinical excellence by aiding the clinicians to follow up on patients through easy detection of patients who have missed their appointments and also detect defaulters.
  4.  Through the clinical dashboard interface, the system assists the clinician in the follow up and provision of care by providing patient information and progress.
  5.  Consultation on difficult cases with the consultants and fellow clinicians has been made easier and more effective.
  6.  Effective record keeping of patients’ data – this has reduced the number of lost or misplaced files to zero since they are recorded in the system. The files are not susceptible to damage and are also easy to access. There is a saving on physical space now that the records are stored electronically.

Impact

Ten (10) healthcare workers have so far been part of a virtual training process with Continuous Medical Education (CME) being easily conducted online. These CMEs have increased from once in two months to once a fortnight. Also, patient information is readily available and this makes the process of providing care more efficient.

Early detection of clinical issues is possible through real time reporting that highlights missed appointments and defaulters. The rate of detection has increased by 200%. Healthcare workers can now generate relevant reports every day and be able to quickly follow up such cases. Peer consultations help primary clinicians to be better placed to give care and consult when assistance is required.

Clinicians are constantly under a coaching and mentorship program with a consultant, which helps to increase the level of expertise and skills and ultimately translates to better care for the patients. It also means that more health workers can be trained so as to meet the growing expectations of HIV/AIDS patients for primary care.

Implementation

The project implementation commenced in June 2012 and it took 8 months to complete the setup. The training session comprised of basic computer knowledge, access to Internet and its use, use of the e-learning module, use of the Cisco Webex system for video conferencing and data entry into the patient portal. A total of 30 healthcare workers were trained.

The training involved formal (classroom) sessions every two months and also practical sessions where the trainees were expected to demonstrate use of acquired skills. Champions from each profession were sort, that is, nurses, doctors and counsellors, whose goal was to spearhead the project implementation and guide their colleagues.

During the first three months, system requirements gathering, gap analysis and actual development was carried out. In the fourth month, testing and actual use was done. In the fifth month, users were trained on how to use the e-learning, web portal and Knowledge Management System modules, and the modules’ suitability was assessed based on key user requirements. The penultimate stage was marked by full system adoption, mentorship and support. Finally, the users were at a stage of using the Gertrude’s LKM system without the need for ICT support.

Sustainability

Gertrude’s LKM system can readily be replicated to other RATN member institutions. The MIs will only be required to meet the implementation cost and the Internet/data connectivity expense. The MIs can also customize the system to include additional features such as a mobile interface.

There are no further financial requirements other than the aforementioned. By hosting the system at Gertrude’s Children’s Hospital which has a fully-fledged ICT department, all support issues are addressed internally and resolved with speed.

Replicability

The pilot project was carried out in partnership with Nanyuki District Hospital, which is a public hospital. The success of this pilot project is a good indication that the same can be done with other public institutions. The fact that the system is web- based makes it easily accessible by any hospital which has Internet access.

The project can also be replicated to other countries in the Eastern and Southern Africa region so as to address the common health challenges, which includes capacity building of health workers through virtual training. Standardisation of templates, reports and information, based on Ministry of Health requirements, has enabled the IT system to meet the needs of all public hospitals without further customization.

The system would be “plug and play” in the sense that it is ready for use with minimum training required. However, it would be pertinent to ensure that the recipient institution has Internet connectivity and computers. Also, replicability can be enhanced by introducing a mobile platform. In this case, the doctors and nurses would obtain information on the go. This would further increase adoptability and use of the system while availing information to the clinician irrespective of his/her physical location.

Challenges and Constraints

Some of the challenges experienced were: low computer literacy among medical workers in the beneficiary hospitals, low system adoption rates and continuous need for training and handholding before users were able to comfortably use the system. Of note is that Internet costs are still quite prohibitive, especially for a system that requires full time connectivity.

Way forward and recommendations

The recommendations are as follows:

  1. Monitoring and evaluation with key indicators will be vital to ensure that milestones and deliverables are achieved on a quarterly basis. Some of the indicators would include: number of new patients in the system, number of clinicians trained through virtual training, number of consultations held via the Cisco Webex system and the percentage of the system that is fully utilised.
  2. Replication and sustainability by introducing the system to other public institutions would certainly lead to significant improvements in capacity building for these institutions.
  3.  Development of a mobile application for the system would significantly improve its use. This is an element that was not included in the system scope due to budgetary constraints but would form a fundamental improvement to the system in its entirety.

Lesson Learnt

Use of Information and Communication Technology (ICT) translates to reduced costs relating to travel and training. More training opportunities that have been created translate to more healthcare givers being trained within the same period, leading to a higher rate of capacity building and knowledge & skills transfer.

Caregivers are able to achieve more with limited resources, expand their services, and conduct timely consultations with their peers or consultants without the need to physically meet with them.

Knowledge dissemination and empowerment helps to give new ideas in the quest to deliver better patient care. Ultimately, ICT provides simple methods which have a big impact in the fight against the HIV/AIDS scourge.

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