Manivasagan Naicker

Centers for Disease Control and Prevention-South Africa

mplementing ETR.NET for TB
and TB/HV Surveillance
Outline
Background
System description
System architecture
Data model
Main features/functionality
Security and confidentiality
Structure and information flow
Status of implementation
HV Surveillance
Adapting ETR.NET
Summary
Background
First Electronic TB Register (TBREG)
was developed in Botswana, 1995
Objective : to provide timely and
accurate TB management information
Developed using Epi nfo 6 (DOS)
menu-driven, user friendly, requiring
minimal previous computer exposure
Provide National TB Programs simple
way to
Collect patient data in a systematic
manner at district level from hand
written paper based registers
Perform automated analysis of data
in a consistent, more accurate and
less time-consuming way
Background.
Based on UATLD/WHO recommended R & R definitions
Case Finding, Sputum Conversion, Treatment
Outcome
Allow TB program management at all levels
Focus on district level
Focus on usage of data
Evolved to generic software adaptable to any country with
a well functioning TB program, 1999
mplemented in several countries in southern Africa
Botswana, South Africa, Lesotho, Swaziland, Namibia,
Tanzania, including Philippines and many unknown
countries
System Description: ETR.NET
ETR.NET:
Successor to
TBREG/ETR (BOTUSA)
Developed in consultation
with TB program managers
Phased implementation in
RSA
Regional:
Botswana (Nov 2005)
Tanzania scaling up
quarterly since June 2006
RSA based programming
and support
System Architecture
Development language: Visual Basic.NET (updated
to .NET v 2.0)
Developed using an n-tier architecture, i.e.
presentation, business, data access and DBMS
layers
Database: MS Access and MS SQL Server
(MSDE/SQL Server recommended at high volume
levels)
Designed using the Data Access Object Factory
pattern (developing modules to access other
database systems will not affect the rest of the
functionality)
System Architecture.
ETR.NETs n-tier design also facilitates
possible future extension to the web (for
relevant features)
ETR.NET Regional (Global) designed to be
as flexible as possible (e.g. users can
rename dropdown items and show/hide
fields, etc.) customization for different
countries (National Setup Wizard)
ETR.NET Data Model
Can support a variety of
functions, program monitoring
and reporting
Allows for data to be exported
for OR in standard formats for
further analysis in analytical
and statistical packages
Allows for, or can easily
expand and support other
languages (Fr, Port.)
ETR.NET Features
Personalized access control
(user/administrator)
Data import from existing
systems
Add/edit/move facilities
Enter/edit/search patient
records
Validations (data entry checks,
listings)
Data dispatch in XML
ETR.NET Features.
Archiving of data and cohort reports
Sort and filter data
Automatic report generation in HTML
Graphs and Maps
Secure and encrypted database
Application Updater patch
Security and confidentiality
Database
MS Access security features (e.g. database password and workgroup
administration security)
Custom developed features on top of Access security include 256 bit
Rijndael encryption algorithm
GUD: last user, date, time that recorded was edited
Software login
Assigning user permissions (DEL, HL) and login functionality
User types: administrator, user, and user with HV permissions
Backups and dispatches
Created in XML, compressed & encrypted (Rijndael encryption)
HV data
Various levels of access to either enter, view patient-level data vs
aggregate reports only
Other
Data checks/listings which display patient identifiers are deleted when
the application is closed
Structure and information flow
National
Level
Niddle
Levels
Data Entry
Level
!nstallation Disk !nstallation Disk
Dispatch File
Dispatch File Patient Records
Setup and maintain
Distribute application
Load data
Summaryfdetail reports
Load data
Summaryfdetail reports
Dispatch data
Data entry
Detail reports
Dispatch data
Status of implementation
South Africa- all nine provinces
>200 installations (sub-districts, regional,
provinces, national)
>1000 000 records in active dataset (national)
HV components still in assessment phase in
limited areas
Botswana- 24 districts
Tanzania- 8 regions
Philippines (MMC & Phil CAT), Swaziland, Namibia,
Lesotho- Q1 2007
HV surveillance in ETR.NET
mplementation of Comprehensive Plan offers renewed
impetus to accelerate VCT and access to HV services for TB
patients
ETR.NET process is opportune time to integrate HV data
elements into software
Challenge: HV test data has not been part of routine
collection in many countries
TB/HV surveillance module piloted in RSA, tools for R & R
are being revised
mplemented in Botswana (routine policy on HV testing)
mplemented in Tanzania
Co-developed in Philippines
TB/HV Surveillance: data elements
Adapting ETR.NET
National Setup Wizard (v 1.0.6)
Set-up Login Screen Details
Set-up Lookup tems
Set-up Available Fields/
Features
Set-up Facility Tree
Set-up Captions
Set-up Login Screen Details
Allows for customization of
country logo
nsert contact details of TB
program manager
nsert contact details of TB
Data Manager
nformation for user support,
technical enquiries, and
development support
Set-up Lookup tems
Allows in-country
customization of a choice of
data variables
Allows customization of
dropdown combo boxes
Set-up Available Fields/Features
Allows country to select from
a list, different options for
TB/HV collaborative
activities (HV testing, ART,
CPT, PT)
Allows data entry screen to
display selected data
elements, password
protected with user access
Set-up Facility Tree
Allows country to set-up
reporting hierarchy (5 levels)
Levels link by GUDs instead of
codes
Validation for duplicate facility
Facility level data includes
contact details (useful when
patient is transferred out)
Facility can be
decommissioned (data not
deleted)
Set-up Caption
Allows customization of 3
optional data variables
Data labels are renamed
according to user preference
Summary
E-systems such as ETR.Net can be valuable tools
to collect and analyze TB and TB/HV surveillance data
to monitor basic program management performance as
well as the expansion of HV services for TB patients
ETR.Net offer flexibility to enhance analysis as TB and
TB/HV care evolves
ETR.Net is not a Gold Standard, require lots of work (esp data
analysis/use), but increase accountability for full outcome
reporting
Sufficient human resources at district level are a prerequisite
to realise the benefits of this tool.
Continuing and ongoing dialogue among int'l and country
partners will be useful to guide future developments
Acknowledgments
CDC/GAP Atlanta
(William Coggin, Charles Wells)
South Africa NTP (Carina dema )
Wamtechnology (Paul Maree, Stefan Buys, Tom Welch)
BOTUSA Project (CDC Botswana)
MRC (Chris Seebregts)
For further enquiries
ETR.NET@sa.cdc.gov
Thank you
Thank you
Live Demonstration
ETR.NET & Overview of National Setup
Wizard
Date : Saturday 4 November 2006
Room : 326/327 M
Time : 14H00-16H15