Posted by Dennis Feehan
The staff at Bayalpata Hospital keep meticulous records of each patient’s visit to the facility. These records allow us to improve clinical services, track simple measures of activity, forecast future clinical needs, and fulfill our reporting requirements to the government. They also give us a window into the health and epidemiology of the population in the surrounding area.
The data are first generated on paper by members of the clinical staff over the course of a patient’s visit. Later, they are entered into a computer database which organizes and archives the hospital’s clinical history.
Clinical Record Keeping
A patient who arrives at the hospital for the first time is entered in the General Register, which contains basic demographic information such as name, age, sex, and village. The patient is also assigned a unique identifier, called an IP number, which is included on all of his or her records. The staff member in charge of registration then determines where to direct the patient. The majority of people who visit the hospital are managed as outpatients and sent to see a clinician (a doctor, health assistant, or an auxiliary nurse midwife). Once a clinician has reached a diagnosis and decided upon a treatment plan, he or she enters that information into a form called the OPD ticket.
If the clinician requires lab tests in order to determine the diagnosis, he or she fills out a Laboratory Requisition Form, which is sent to the lab so that the appropriate tests can be performed. The lab personnel record the results of the tests on the form, which is sent back to the clinician.
Because not all of the hospital’s visitors are outpatients, there are other special forms for Emergency Visits, Inpatient Visits, and Antenatal Care Visits. There are also registers for patients who must be tracked over time, such as TB patients and malnourished children.
After the day’s patients have been seen, the general register and OPD data that have been generated are entered into an MS-Access database that has several tables roughly corresponding to the forms and registers used to collect data on paper during the day. (For a description of another MS-Access database used at the hospital, read the blog post about the Inventory Supply Database.) Typically, a health assistant uses the registration computer to enter the days OPD information, while the lab technician and pharmacist enter the information from their registers on databases stored in the appropriate computers. The result is a detailed electronic summary of the clinical services provided by the hospital that is then available in the database for analysis.
Community Record Keeping
If a clinician indicates that a patient requires follow-up after being treated at the hospital, the patient’s name and address will be given to a Community Health Worker who later visits the patient’s home to ensure that the treatment is progressing well. Ideally, this would happen for every patient who requires follow-up, but the current budget only supports four CHWs. Until we can expand the CHW program, the data we collect on patient follow-up is restricted to those patients who live in the these CHW catchment areas (approximately 16,000 people).
Once a week, the CHWs meet at the hospital and report a set of summary measures detailing the number of households and patients they visited since the last report. They also keep track of the number of community members they referred to the hospital, and the number of iron pills and packets of anti-dehydration powder they distributed. These data are then entered into our computer system by the auxiliary nurse midwife in charge of the CHW program, Gauri Sunwar. The CHWs also report on specific patients in a separate database, where the results of the follow-up can be linked back to the patient’s clinical records, allowing us to understand and evaluate the entire course of therapy.
In the future we intend to continue improving our data collection and management systems, as well as our methods of analyzing existing data. MS Access allows us to perform simple analytical tasks, like computing totals and retrieving individual records for review. To answer more complicated questions, we can use a statistical package like R or Stata. A more in-depth look at the data we collect will allow us to better evaluate our services and identify the need for new interventions.
We also intend to more thoroughly consider issues of patient confidentiality. Although we restrict access to the database files and use the IP number in of the database tables except the General Register, future versions will use more sophisticated measures to ensure that specific patient details are not revealed.