iDART

iDART has been developed in colaboration with the Desmond Tutu HIV Foundation and funded by the Doris Duke Charitable Foundation.

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System Overview

Features of the iDART System

iDART was developed in conjunction with the Desmond Tutu HIV Centre as a result of a doctor’s request for a solution to help manage and monitor ARV drug stock and patient therapy dispensing. The challenges identified by the doctor which Cell-Life has addressed included:

  • A need to monitor ARV stock levels at any given time

  • A need to be alerted whenever a specific drug level was low

  • A need to be notified when any drugs were about to expire

  • A need to be notified when patients defaulted on their treatment collection

  • A need to have an electronic patient history

  • A need to help manage large numbers of patient numbers on ART simply and effectively

  • A need to monitor a patients' packaging, dispensing and monitoring of drugs

  • A need to reduce costs associated with dispensing chronic medication

  • A need to save time in the process of report creation

 

Key Benefits 

  • Accurate tracking of patient treatment

  • Comprehensive patient history pertaining to treatment

  • Accurate ARV stock control management

  • Time saving of pharmacy dispensing through faster processing 

  • Reduces and identifies loss of ARVs 

  • Operates through clearly identifiable, multi-lingual bar-coded labels which are created for each and every drug and patient package

 

Technology

iDART is developed using open-source technologies and has been developed to run on any windows or linux based platform, allowing users to access and operate the system in a familiar and easy to use way. The choice for using open-source software is that there are no proprietary licensing costs associated with the use of the software. The use of open-source also allows for people to take the software for free and use it at their sites should they have the necessary skills to manage its operation. Each iDART installation operates with a bar-code label printer connected to the PC which allows for each and every drug which is packaged to be clearly labelled. The labels which are printed upon dispensing can also be created in a range of languages depending on the ART site. The labels make for easy drug information and label packaging and eradicate many of the errors that occur through hand-written dosage instructions.The Reporting Tool:

One of the more important functions of iDART is in the various reports that the software makes available. The reports range from basic stock control management and monitoring reports to specific patient defaulter lists which allow for the easy management and follow-up of patients. iDART also keeps the entire patient history of a patient in its database and allows for accurate tracking of patients receiving treatment from ART sites. It is important to note that Cell-Life believe strongly in addressing the needs of each specific site and the technology used is flexible enough to include numerous other reports. Cell-Life believe that the technology implemented needs to assist the existing processes in place at sites and therefore looks to adapt the technology to best suit these needs.


Down Referral or Decanting to remote clinics


One of the great features of iDART is that it also allows for the decanting of packages to remote clinics and dispensaries that do not hold stock of ARVs. iDART allows a central ART site or pharmacy to prepare packages for a patients belonging to remote clinics and will trace the entire process until the patient collects their drugs. Feedback is then provided via the network to the central pharmacy to signal that the package was collected and the pharmacist is then allowed to package drugs for the patient in the next month. The diagram below illustrates the system configuration used for down referral / decanting.

 iDart_Overview_Diagram2

 
Sites

DTHC Pharmacy and Masiphumelele, Cape Town & Ocean View, Western Cape

The Desmond Tutu HIV Centre (DTHC) has been involved in dispensing ARV drugs to patients living in Masiphumelele since June 2004. Masiphumelele (meaning "We Will Succeed" in Xhosa) is an informal settlement situated in Ocean View, 40km south of Cape Town. A clinical study is under way to establish the HIV prevalence in this township, but current estimates have been high. One pharmacist works at the central pharmacy at DTHC, housed at the Medical School of the University of Cape Town, 30km from Masiphumelele. The pharmacist uses iDART to dispense monthly ARV drug supplies to patients visiting this remote ARV clinic. Two doctors, two nurses and two study coordinators work at this health care facility. In March 2005, the prototype system was installed and was used for 10 months.

Then, in January 2006, the first installation of the clinic application of iDART was successfully launched at Masiphumelele. In April 2006, 350 patients are actively being monitored on the system. All clinical staff is involved in the scanning in of pre-packaged drug supplies, and scanning out of these packages to patients. Accurate reports are now accessible to the staff working at Masiphumelele, and to the pharmacist working at DTHC.

DTHC Pharmacy and Hannan Crusaid Centre, Gugulethu, Western Cape

The Hannan Crusaid ARV Treatment Centre is situated in Gugulethu, 20 km outside of Cape Town, and was the first dedicated ART Centre in the Western Province. Today it actively serves more than 2000 HIV+ patients on ARV therapy. Initially, the pharmacist working at the central pharmacy at DTHC created monthly ARV packages for all patients at the Hannan Crusaid Centre, in the same way as patients from Masiphumelele. But, patient loads increased dramatically over the initial 12 months, resulting in dispensing moving to the pharmacy at the Hannan Crusaid Centre.

A major challenge in dispensing ARVs in South Africa is the lack of human resources. Patient loads at the Hannan Crusaid Centre are extremely high and staff work under high stress conditions. Presently, there is one pharmacist and 2 pharmacy assistants employed at this facility. It takes a considerable amount of time to pre-package a set of drugs for a large patient load. For this reason, we have modified iDART so that pharmacists can dispense directly to patients visiting the clinic.

Through out 2006, Cell-Life (in a partnership with eInnovation) have developed iDART 2.0. This updated version will be used at government clinics from early 2007 as the dispensing module for the electronic patient record system (eKapa). As the pilot site for this project, the Hannan Crusaid Centre recently had an installation of this version. In December 2006, the staff at this facility underwent training and are now using iDART 2.0 for their dispensing and managing of both patients and drug stock levels.

The Taung Treatment Centre, Bophirima District, North West Province

The Taung Treatment Centre is based at the Taung District Hospital and is the largest ART site in the North West province. In June 2006, iDART was successfully installed in this busy pharmacy who service over 1800 patients every month. Our two iDART users had little prior computing experience, but are now completely comfortable with the system and use it on a day to day basis. A number of new features were identified at this site, such as the identification through out the application of short cuts that if used, shorten the time it takes to dispense to a patient. The Taung Treatment Centre is the first (of five) ART sites in South Africa, that will receive the iDART system (both hardware and software) from Cell-Life free of charge. This donation is possible through a generous sponsorship from the Elton John Aids Foundation.

The Hillbrow Community Health Centre, Johannesburg, Gauteng

Cell-Life teamed up with the Reproductive Health Research Unit (RHRU) to expand the features and capabilities of iDART. In October 2006, Cell-Life installed the first release of this system at the Hillbrow CHC, and the pharmacist and pharmacy assistant started using iDART from that time. In December 2006, Cell-Life returned to Hillbrow to install the final version which incorporated all the required changes specific to their needs. Of particular interest at this site, was the identification of a number of new reports required by funders such as PEPFAR and local government.  This pharmacy actively serves over 1300 HIV+ patients receiving ARVs and iDART has been used to assist the monitoring of stock levels and patient tracking. 

The Galeshewe Day Hospital, Kimberley, Northern Cape

In March 2007, ARV pharmacists working at the Galeshewe Day Hospital used iDART for the first time to dispense ARV medication to their HIV+ patients. This is the second site identified for the Cell-Life project sponsored by the Elton John Aids Foundation. This site was also the first clinic to receive an iDART computer having the Ubuntu operating system (instead of the standard Windows). This is in line with governmental recommendations of using open-source software at government facilities. This choice of operating systems has resulted in Cell-Life spending less time supporting and maintaining the computers on which iDART is installed (e.g. virus and spyware attacks).

The Tshepong Wellness Centre, Klerksdorp, North West Province

In April 2007, the ARV pharmacy at the Tshepong Wellness Centre became the third Elton John Aids Foundation sponsored health care facility to receive the iDART system. In collaboration with the Klerksdorp Hospital, the Tshepong Wellness Centre is involved in a comprehensive down-referral system that is currently servicing over 6000 HIV+ patients. When iDART was introduced at this facility, a decision was made to manually enter every new patient onto the system (in previous implementations, we had used the import functionality of iDART). To assist with the initial couple of months of patient capturing, a second computer was loaned to the facility. This was the first time that two interconnected PCs were using iDART, accessing the same database. This is a great step forward, especially when looking at the suitability of iDART for larger facilities (such as government hospitals). After only two months of operations, iDART users at this facility have seen a reduction of up to two hours in the amount of time they spend at their place of work! This is a remarkable, quantifiable achievement highlighting the effectiveness of the iDART system in busy public health care pharmacies.

 
Screenshots

iDART
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Patient Packaging
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Reports
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Add Prescription
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Welcome Screen

 
Downloads

iDART is released under GPL and as such you are free to dowload it and use it. Detailed installation instructions are available in the iDART Windows Installation Guide.

Please note that although this guide is for Windows users, iDART has been tested and will run on Linux (and is actually partly developed on Linux, too). The installation procedure requires the same steps. To see iDART in action on Linux, install the Sun JRE (1.5 recommended) and PostgreSQL according to the instructions for you platform, then perform steps 3 and 4 in the Installation Guide.

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