What do I do? It’s an easier question to answer than “What are you going to be doing in
I work for the Canadian Society for International Health (CSIH) on their Public Health Strengthening in Guyana (PHSG) project. I work at
The PHSG project has been in existence for about four years. The project has four official focuses: HIV/STIs, TB, home based care and a health information system. The project has worked with the Ministry of Health, the Georgetown Public Hospital Corporation and associated clinics (Genito Urinary Medicine Clinic, TB Chest Clinic, and Dorothy Bailey for mother/child care), the University of Guyana and with various hospitals and clinics in other Health regions. The scope of the project ranges from lab equipment and training, clinic refurbishing and organization, manuals and guidelines for treatment and diagnosis, and training and hiring of staff ranging from administration, field outreach workers, lab techs… I could go on. Everyday I learn something new that the project has done, every little bit helps! The one part of the project that I should know more about is the health information system. Officially I am a Health Information System Trainer intern, but I haven’t actually done any training (shh…) I have received an introduction to the system and witnessed training at the clinics, but most of my knowledge of the system is from my own exploring and creating imaginary patients. A health information system (HIS) is a complex database that records everything – demographics, medical history, immunizations, allergies, contacts, encounters (doctor’s visits), signs/symptoms, orders investigations from labs and forwards prescriptions to pharmacies… and that’s just a snapshot. If your doctor or nurse has asked you about it, it is in the system. It’s beautifully organized so it’s not surprising that I love it.
Unfortunately, though the system is on version 1.1 (0.1, 0.2, 0.3…) and has been around for a few years, it is still not used consistently. In theory, the system should be used in real time and paper should only be used as backup when there are blackouts or computer problems. It is still instinct for health care workers (HCWs) to reach for the paper. Some do both. Everyone has their reasons for why they don’t use the system and I have my own ideas, but that could take an entire entry itself.
When I first started, there was a team of students (by students, I am referring to the fact that they will be recent graduates of the pharmacy program and Dr Plummer taught them at UG) that visited the clinics, trained staff and answered any questions. They finished the end of October and essentially, HCWs have stopped using the system. I should clarify that there are those users that are firm believers in the system, use it and use it well, but they are the minority. I went to the clinics a couple of times with the team, but most of my time has been at the office.
The project is coming to an end this year having accomplished the goals set out initially. There are certain items that were promised to the MoH connected to the HIS… which is a bit of an introduction into what I have been working on.
Like any computer software/system, there are manuals. Installation manual, system administrator manual, clinical coordinator manual, user manual – if you have a question, it will be answered in a manual. I have been working on and off on the clinical coordinator manual. It is interesting situation to be in because the first draft of the manual was part of my introduction to the system and with a better idea of the responsibilities of the clinical coordinator manual, I have determined where there are holes in the manual that if I were the clinical coordinator manual, I would have questions about. It’s a long process and I’ve reached a point where I need help because I don’t know enough about the system. Still waiting…
Another product that MoH wants is a paper version of the system to be used during black outs and where there is no computer access. I reduced one big form into separate forms and created flowcharts on how to use which form and where. As part of condensing the system to paper forms, I am currently supervising the aforementioned students (hired back for another month) to pilot the paper form and test its efficiency compared to the current paper forms.
One of the great things about the HIS is that once it is used on a regular basis, and used well, then it will be able to generate reports on the raw data. There are certain reports programmed currently, but one of the complaints along the lines is that it doesn’t generate the reports that they need. The problem is that they haven’t told one person. And the other problems are that they are complicated reports to program, or are essentially useless – producing reports to use paper, but have no real value. I am trying to talk to everyone who creates reports about what they want from the system to see what is doable. So far I have talked to one clinic director who fortunately is a huge fan of the system and happy with what is produces.
The office is slowly, but surely, condensing in size. Currently there are three people in an office that from my understanding had held up to eight. At the end of this week we are moving into a smaller office and next week there will only be two people in the office. Wallis leaves just as the HIS programmer comes from
See? I’m keeping busy! That’s just a snapshot. I’m hoping that when the project ends that MoH will still keep me busy and not forget about me.
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