Akisyon A Yesu (The Compassion of Jesus) Presbyteria is a private, not-for-profit health facility of level HCII. It is located between Namaalu and Tokoora trading centres in Nakaale Parish, deep inside Nakapiripirit District. Since its establishment in 2001, the facility has primarily operated as an outpatient clinic and now serves an average of 50 patients daily. Currently, it also provides delivery services, recording an average of 5 deliveries per week, and runs a mini-maternity ward to provide after-delivery care for mothers and their newborn babies.

Problem

Since its establishment, the facility majorly depended on manual systems for process management of the Clinical, Finances, Procurement, Inventory management etc. Before stre@mline, the facility tried other digital systems and Electronic Medical Records Systems; however, they did not find satisfaction in how these addressed their challenges. Christopher Verdick, the hospital administrator, was excited to hear of the many unique features Stre@mline poses during a presentation by Stre@mline clinical lead Dr. Ian Spillman at a UPMB conference in Kampala, Uganda. The facility then went on to onboard stre@mline with the hope of solving their problems with major focus on the following;

1. Patient records storage and retrieval: The facility has been operating for over 20 years with a paper-based system which resulted in the accumulation of paper files making it difficult to retrieve the patients’ files, especially those that take a long time to visit the health facility. This also resulted in misdiagnosis and wrong prescriptions, especially for patients with chronic illnesses. According to a study done at Makerere University Hospital, paper files wear and tear over time. Digitising these records can reduce costs of paper, cabinets, etc.
2. Drugs and Sundries Management: Efficient tracking and usage of inventory were not possible with the paper-based system. The clinicians and inventory managers lacked real-time information on drugs that were about to expire or drugs that were running out of stock which resulted in the loss of money, loopholes for fraud, and a reduction in the desired quality of patient care given by the health facility
3. Human Resource and Remote Site Administration. Hospital administration in terms of access to staff performance metrics for appraisal was difficult. Additionally, supervisors could not easily monitor the progress of work when not on site. This limits the facility’s ability to maximise the potential of its available human resource.

Actions Taken

• Remote installation and setup of the Stre@mline EMR at the health facility was conducted on the 21st of February.
• Remote training was conducted focusing on the problem areas stated; hospital administrators on how to access the reports to assess staff performance, inventory managers on how to use stre@mline to efficiently track stock, and registration/triage nurses on how to easily access the patients’ files. The training also covered all essential areas needed to efficiently use stre@mline to serve the health facility and its patients.
• The Akisyon a Yesu Presbyterian Clinic team was able to set up its price lists, run stock counts, and perform initial stock reconciliations on Stre@mline.
• Akisyon a Yesu went live with the Stre@mline EMR on the 10th of March 2023.
• Physical support visit was conducted from the 6th June 2023  to 12th June 2023. During this visit, users were given in depth training on features of streamline. Answered all questions from users and helped them appreciate any missing details from their previous usage.
• Finance set up was conducted to enable them manage incomes, expenses, creditors, debtors, banks, Payroll and enable them to organise their finances.
• They were Introduced and given in depth understanding of streamline reports generation, interpretation and using these reports to plan, forecast and improve management of the facility.

Results

As of June 14th, 2023, Akisyon a Yesu has registered a total of 2,146 patients with 2,757 episodes created, 1,857 diagnoses recorded, 2,300 prescriptions ordered, 1,690 investigations recorded, 268 admissions with a total of 251 discharges. The hospital management of Akisyon appreciates Streamline for having supported them through the transition, and they note that with the onboarding of the system, there have been some changes to the running of the facility that they feel are helping them perform better and identify areas where they have been performing at average levels but could improve.