Technology to support effective monitoring of trichiasis surgery - Trichiasis tracker

Why monitor?

To reduce visual loss from trachomatous trichiasis (TT) and move towards elimination of trachoma as a public health problem it is important to:

  • Know how many people have been identified with trichiasis and where they are located?

  • Identify who has been treated and how? And know which patients need follow up visits.

  • Understand the results of treatment (how surgeons are performing) and support improvement as needed.

  • Create a clear and accessible data set of all surgery activity in a country.

Various monitoring systems for trichiasis surgery have, in the past, been developed by national trachoma elimination programmes and donors. But different data management and reporting systems for different purposes make things difficult for surgeons, their supervisors and programme managers.

The World Health Organization recognised the challenge and convened a meeting in 2015 to discuss the development of a common system to track TT patients through the steps of surgical intervention. In response, Sightsavers developed the Trichiasis Tracker (TT Tracker).

Who needs the TT Tracker?

The information and reports collected and managed in the TT Tracker are needed by trichiasis surgeons, their supervisors, trachoma programme managers, the ministries of health, and supporting partners.

Stages of data collection to manage the process flow

High Level Process flow

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Information collected on phones

Surgical teams enter patient information into Android-based electronic forms at each stage of the patient’s journey:

Registration and evaluation. Demographic information, TT diagnosis, recommended intervention

Surgery. Type of operation/sutures, name of surgeon, related complications.

Follow-up (at 24-hours, 7-14 days, and 3-6 months). Surgical outcome assessment and actions required to address complications.

Screenshots of 3 TT tracker forms - surgery record form, 7-14 day follow up form, 3-6 month follow up form

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Reports generated by the system

TT tracker screenshot of a list of patients due for follow up in one district showing the surgery record form, 7-14 day follow up form and 3-6 month follow up form

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List of patients due for follow-up in one district, as seen on a smartphone. Patient ID, name, eyes operated (R/L) and procedure - epilation (E), surgery (S), referral (R) and refusal (X)

Days Since Surgery (DSS) are shown on this summary page, which is searchable by Name and Patient ID. Surgeons can click on the name to see full patient history and fill out additional follow-up forms as needed. NB: Names listed here were created for training purposes and are not real patients.

Patient follow-up lists. After surgery, patients are automatically placed on the appropriate follow-up list; lists can be accessed on the phones, online or via email by programme staff and officials approved by the Ministry of Health.

Screenshot of a TT tracker dashboard with 5 panels displaying information on: the number of patients and eyes operated on each month, numbers of patients and eyes operated on by sex, surgeries by outreach type, total surgery activity by sex, number of TT interventions for confirmed TT by patient

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Surgical performance. The TT Tracker generates performance assessments for each surgeon so supervisors know when further supervision or training is needed. Surgeons also receive personalised emailed reports including their individual outcomes and their contribution to the national elimination effort

Surgical Performance

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Reports. The TT Tracker includes an online reporting tool which analyses data automatically. These reports include three dashboards: Surgery and Follow-up Completion, Outcome Assessments and Session Activities, and a Data Quality Assessment page. Reports are updated daily.

Reports

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Online reports can be filtered by time and location. Here we see part of the Surgery and Follow-up Completion report.

How is the system managed?

All national trachoma programmes are invited to explore use of the TT Tracker. Sightsavers supports technical elements of the TT Tracker (platform hosting, reporting tools, emailing systems), offers training to administrators and field teams and provides support during implementation. Implementing partners and Ministries manage field activities and use.

Who owns the data?

Data are owned by Ministries of Health. Sightsavers trains an administrator from each Ministry of Health.

The TT Tracker is being used in Benin, Guinea, and Nigeria, with plans underway for use in Ethiopia, Senegal, Zimbabwe and Pakistan.

For more information visit: https://www.tttracker.org

As you read this article, consider what are the practical opportunities that this technology can provide against what is already in use, in your setting?

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Eliminating Trachoma

London School of Hygiene & Tropical Medicine

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