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
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.
This IT system has been able to facilitate the following:
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.
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.
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.
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:
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.