DHIS 2 enables you to collect, manage and analyse transactional, case-based data records. It lets you store information about individuals and track these persons over time using a flexible set of identifiers. You can capture information about anonymous events and cases as well. DHIS 2 lets you configure SMS-reminders, track missed appointments and generate visit schedules. You can create dynamic reports based on cases and generate on-the-fly statistical reports. For all programs you can easily create statistics and summaries on participation and completeness.
The DHIS 2 Tracker is an extension of the DHIS 2 platform and supports management, data collection, and analysis of transactional or disaggregated data. The Tracker shares the same design concepts as the overall DHIS 2 - a combination of a generic data model and flexible metadata configuration through the user interface that allows for rapid customization to meet a wide range of use cases.
Common for all the use cases is that the transactional data can be easily aggregated and fed into the main aggregated data warehouse in the same DHIS 2 system, making complicated inter-operability setups redundant.
In addition to being a powerful HMIS tool for following up health programs, DHIS2 Tracker is also a simple tool for sharing critical clinical health data across multiple health facilities. The DHIS 2 tracker currently does not aim at becoming an advanced EMR system to support clinical care, but rather a basic transactional system that is easy to set up and that builds on an existing and proven platform and available technical capacity. On a national level, one may wish to combine the use of DHIS Tracker for some facilities with more advanced EMR systems for other facilities.
- Collect transactional data - set up automated aggregation queries - populate the aggregated data warehouse directly - all in one system!
- Enroll individuals into longitudinal and chronic programs - schedule visits - set up automated SMS reminders - track missed appointments - improve retention.
- Define your own programs with stages - decide what to collect at each stage - all through the user interface.
- Generate daily or weekly visit schedules (work plans) for your facility or community health workers.
- Tools for tracking and following up patients who do not come to scheduled visits.
- Collect detailed ICD-10 codes for inpatient admissions and deaths to enhance data analysis of morbidity and mortality.
- Set up detailed maternal or neonatal death audits - analyse your data using the tabular reports with both case-based data and ad-hoc aggregation.
- Collect detailed health facility surveys (e.g WHO’s SARA) - link to aggregated indicators - analyse your results on maps, dynamic charts, and pivot tables
- Collect data using mobile phones - online in web browser or offline with java clients
Here are some use case descriptions outlining the possibilities of the DHIS 2 Tracker:
Use Case 1: Anonymous inpatient admissions and deaths with ICD-10 coding
As a natural extension from the aggregate summary reports on inpatient admissions and deaths the DHIS 2 can support data capturing of the registers directly. With the aim of providing better statistics on causes of admissions and deaths as well as basic hospital ward patient flow it makes sense to simply collect this data as anonymous events, where there is no implicit link between each line in the registry. This simplifies the setup as no patient registration or information is required and therefore also no need to worry about privacy issues with the data. For each event at the inpatient ward you typically would like to capture date of admission, date of discharge, Primary and Secondary Diagnosis using ICD-10 codes (available in a searchable drop-down menu), the type of discharge (alive, dead etc.), and you could also consider collecting medical insurance status. From this information one could do ad-hoc aggregated analysis like top 20 diagnosis (with ICD 10 codes or groups) for admissions or deaths, percentages of patients insured, average length of stay etc. Any of this aggregate data could be scheduled to be exported over to the aggregate data warehouse e.g. on a monthly basis (generating your monthly summary data) or for any other frequency. Then the data will be available as typical aggregate data and can be analysed and disseminated through all the well known analysis tools in the “aggregate world” of DHIS 2.
Use Case 2: Longitudinal tracking of women through pregnancy, delivery and postnatal care
Use the DHIS 2 Tracker to improve retention in your longitudinal programs. DHIS 2 can support your work in tracking women through antenatal care, delivery, and postnatal care and send out automated SMS reminders to women that miss their scheduled appointments. You can set up your own customised health programs through the Tracker user interface. Define the types of visits (stages) an enrolled woman must go through, what to collect at each visit, the ideal frequency between the visits and the details you would like to capture at registration. Stages can be pre-defined as a rigid program or defined ad-hoc according to the special needs of the patient. You can also for each stage define SMS reminders, when they are sent out, and the contents of each reminder message.
Through a person dashboard you can follow the progress of each registered woman, schedule new appointments, collect detailed data from each visit, enter text notes on the patient, send out manual SMS reminders, and view the health care history of the woman.
You can define aggregation queries that process the transactional data from each visit and generate aggregate monthly summary data, e.g. “ANC 1st Visit”, “ANC 4th Visit, “Malaria in pregnancy”, and “Live births”. These aggregated data elements already exist in the same DHIS 2 system and a scheduled aggregation process can populate the aggregated data warehouse automatically. If the full ANC, Delivery and PNC registers are computerised and collected through the Tracker, you can completely replace the aggregate data entry process for these programs.
Use Case 3: Neonatal and Maternal death audits
Tracker can also be used to collect a lot of details about one vital event e.g. a maternal or neonatal death. This will allow you to capture a lot more details about these events than through aggregated data collection. You can pull up all the deaths in the tabular reports tools and define your own filter criteria to look for commonalities across the events, or use the ad-hoc aggregation feature to e.g. aggregated numbers like the top 5/10 direct causes of death etc. It is also possible to enter these data using a mobile phone, which can provide an immediate data entry at the point of incident.
You can choose whether to capture the personal details about the deceased or to leave the cases anonymous. Through the custom data entry designer you can prepare your tailored data entry tool to mimic the paper-based audit forms. Validation rules can be defined to check the consistency of the data during the data entry process.
You can also define fixed aggregation queries and schedule key aggregate data to be generated for analysis in the powerful aggregated data analysis tools in DHIS 2 like Data Visualizer, the Web-based Pivot Tables and in the GIS, or set up your own dashboard displaying your favourite charts.
Use Case 4: Educational events in the community
As part of your family planning program you might do educational activities outside the health facilities to increase the uptake of contraception in a targeted area. You can define a multiple event program with one stage (type of event) that captures all the necessary data about the event, e.g. ”Event type” (options could be “speech”, “role play”,”school visit” etc.) and “Number of participants”. For these events you can also register the exact location using geo coordinates. In such a program it would be the educator that enrols into a program and the list scheduled and completed events become her work plan and work history.
Very soon (planned for 2.13) this event data can be displayed directly on a map in the GIS module. Then you can do analysis of the family planning uptake from your Family Planning program in Tracker or from aggregated HMIS data and compare these rates with the location of educational events promoting family planning, analysing the effect of your educational program.
Use Case 5: Facility surveys (e.g. the WHO SARA)
The transactional data does not have to be about a person, it can also provide a detailed status of a health facility at at given point in time to strengthen your facility registry in DHIS 2. You can set up facility surveys like the WHO SARA (Service Availability and Readiness Assessment), collect the data as Tracker data elements, do raw data analysis across facilities in the tabular reports, and automatically feed into aggregated indicators like "% of facilities with emergency obstetric care".
Through the user interface you can define data elements (the “questions”) and option sets (the “answers”), group these into sections in the form and build up a full survey. A data element can be “Family Planning Services provided in the last 12 months” linked to an option set with the possible values, “Yes”, “No”, “Unknown”. Another data element could be “Emergency Obstetric Care” with possible values “Basic”, “Comprehensive”, and “None”. The possible values (options) appear as drop-down lists in the data entry form.
To analyse the data you can analyse raw survey data across multiple facilities, e.g. create a filtered table showing all facilities in a district that provides Family Planning Services, or all facilities with access to clean water and has a stable electricity source.
To do analysis at a higher level, e.g. compare availability of obstetric care across all districts in a country you can define aggregated data elements like “No of facilities with basic emergency obstetric care”, and “No of facilities with comprehensive emergency obstetric care”. On top of these numbers you can also define indicators like “% of facilities with BEOC” and “% of facilities with CEOC”. These aggregated data elements and indicators can be analysed together with the routine HMIS data (service data) and strengthen the data analysis process. You can for example look at monthly reported maternal deaths from facilities and availability of emergency obstetric care together. To make the analysis even more interesting you bring in numbers on the different direct causes of maternal and neonatal deaths generated from your death audits (use case 3) and suddenly you can see all the lives that could have been saved with better coverage of emergency obstetric care. These powerful correlational analysis you can do using maps in the GIS module, with charts in the Data Visualizer, or using the Web-based Pivot Table tool.