DELIVER Annual Technical Meeting

Key Bridge Marriott - June 2005

Application of Biometrics / SmartCard Technology for

Anti-Retroviral Therapy (ART) in South Africa

John Wilson & Rovaro BayardJSI South Africa

Secure Technology Advancing Treatment

THE OPERATIONAL PLAN FOR COMPREHENSIVE HIV AND AIDS CARE, MANAGEMENT AND TREATMENT FOR

SOUTH AFRICA – November 2003

JSI requested by NDOH Chief Director to survey what systems are available in South Africa

that can help with the ARV roll-out, especially in terms of Logistics,

Patient Information Systems and Program Monitoring

CRITICAL REQUIREMENTS:

• Must be ‘attractive’ to clinicians and healthcare workers

• Capable of tracking drug distribution to end user

• Will generate NDOH / Emergency Plan indicators (2-7-10)

• Confidentiality

• Authentication / Verification

• Data Security

• Responsive to the very high mobility of South Africans

• Can operate in an off-line environment (community outreach)

FINDINGS:

• Of the 9 systems reviewed that are currently in use in 6 Provinces of South Africa only 1 system is sufficiently responsive to the mobility issue, and can operate off-line in community outreach settings

NET1 Biometrics / Smart Card system used for dispensing more than 4 million pensions and

social grants in 6 Provinces (began 1999), which seemed to have applicability in an ART setting

NET1 “UEPS” system for pension payout

• More than 4 million pensions & social grants dispensed using SmartCard/ Biometrics in 6 South African Provinces since 1999;

• This indicated potential applicability to ART in overcoming challenges.

Pensioners receiving payouts from mobile unit

STAT™ System Development

Phase 1: Conceptual Framework

Phase 2: Proof of Concept

Phase 3: Systems Development in Clinical ART Settings

Phase 4: “Live” Implementation in Diverse Field-Test Sites

JSI Partners Developing Biometric / Smartcard Solution for Patient Information and

Drug Stock Control System

Phase 1: Conceptual Framework - Timeframe 4months

Phase 1: Conceptual Framework (2) – additional 2 months

STAT™ System Development

Phase 1: Conceptual Framework

Phase 2: Proof of Concept

Phase 3: Systems Development in Clinical ART Settings

Phase 4: “Live” Implementation in Diverse Field-Test Sites

Phase 2: Proof of Concept – plus five months.

Patient Database Development & card to card data transferability – the “Boardroom Demo”

Prototype Smartcard readers

Fingerprint scanner

POS device

STAT™ System Development

Phase 1: Conceptual Framework

Phase 2: Proof of Concept

Phase 3: Systems Development in Clinical ART Settings

Phase 4: “Live” Implementation in Diverse Field-Test Sites

Systems Development in Clinical Community Outreach Setting

STAT™ System Development

Phase 1: Conceptual Framework

Phase 2: Proof of Concept

Phase 3: Systems Development in Clinical ART Settings

Phase 4: “Live” Implementation in Diverse Field-Test Sites

Patient RegistrationOn “Live” system

STAT™ System for ART

• Based on existing RSA Biometrics and Smartcard technology

• ART patients retain their cards

• Healthcare workers have their own cards

• Cards hold 64Kb of data in 255 data wallets.

Provider can print prescription, sign and store in patient folder

How STAT works in practice:Patient ART Center Visit/Home Visit

Script

RxScript

Rx

Coded data entry:•Symptoms•Weight•Lab results•Prescription

Provider enters codes for drugs prescribed, gives drugs to patient

and returns STAT™ Card

Alternatively, if pharmacy available…

ARVs Dispensed in Pharmacy

Pharmacist dispenses drugs as prescribed and recorded on patient card

Pharmacist gives drugs to patient, returns Patient’s

STAT™ card

Script

Rx

Rx

Rx

Script

Rx

Rx

Rx

OPTIONAL:Patient gives

prescription to pharmacist

Data Batch Upload to STAT Reporting Database

Encrypted Data on Service Provider STAT™ cards

uploaded to Net1 Switch by dialup or broadband at end of

day

Data from Net 1 FTP’d to JSI STAT™

Reporting database server

Features of the STAT™ System

• Patients can use their card at any STAT™ ART center; • Ideal for home visits - Battery operated and portable• STAT™ system functions off-line, with upload of data to

central database at end of day;• JSI STAT™ central database runs on Microsoft SQL

relational database, hosted on a MS-SQL Server incorporating SQL Reporting Services;

• Able to accurately record facility-level ARV inventory.

• Only the owner or proxy in exceptional circumstances of the STAT™ card can use it to obtain treatment;

without = X• Patients cannot receive more than the appropriate amount of

drugs in any month;• Potential ARV leakage at ART centers minimized due to higher

level of accountability through use of provider STAT™ cards.

Electricity/phone line available availability:• Since card readers powered by rechargeable batteries, no

electricity required during home visiting;• Battery pack allows estimated 320 patient interactions

on single charge;• Patient visits at ART centers can continue during power

outages;• No need for constant online connection – dialup and

upload at end of day only.

ARV inventory control, security, & data management:

• Incoming drugs entered on pharmacist’s STAT™ card and deducted from inventory on hand as drugs dispensed to patients;

• ARV stock status uploaded daily to national STAT™ database;• Precise consumption data generated to enable accurate

forecasting;• Supervisors can check physical inventories against up-to-date

stock status data.

Verifying Private Provider Billing:• Private practitioners can claim payment made through

data uploaded through Net 1 switch;• Eliminates need for paper billing.

STAT™ Implementation (FY 04 PEPFAR COP)

• Currently live field testing in Hospital, Static Clinic & Community outreach environments ( Target 2500 on ART, 4000 on Care and Support)

• Uplink to STAT™ central database went live April 8, 2005

•By end FY 05 funding, 5,700 patients on ARV's plus 38,000 patients on care and support utilizing STAT™ in 23 CRS/SACBC sites in 8 of 9 provinces

•In addition, as appropriate, public sector sites in provinces (so far 4 provincial sites

•Testing of STAT Drug Inventory Module

•Development of TB, Pediatric, and Nutrition modules

Planned Implementation of STAT per FY 05 COP

SmartCard/Biometrics Readers

• Portable, rechargeable battery operated card readers;

• Patient and provider cards inserted in card reader;

• Built-in fingerprint scanner;• LED screen to guide provider

through treatment protocol;

• Numeric keypad for data entry.

Potential New Partners?

Broadreach

Aid for Aids

Absolute Recovery for Kids (ARK)

}Malawi (Malswitch Reserve Bank)

Nigeria (FHI?)

Private GPService Providers

Billing / Verification potential!!

Long Term Vision ??

LOGO ADVERTISEMENT

•The Patient-Retained Record System of Choice ?

•Reduced Shrinkage in Supply Chain Management Systems ??