One of the limitations highlighted by NTP is the need to improve the data collection processes at the facility level. To streamline this, procurement, distribution and maintenance of the required data entry equipment like laptops, mobile/tablet devices should be done on an urgent basis. Improving the current infrastructure at the facilities is crucial for a complete transition to digital notification.

Tentative timeline: Month 0-3

The NTP has already established Cam TBMIS as the national notification platform and has the required infrastructure in terms of database and deployment. It has also built the eTB manager expertise and capacity which acts as a strong foundation for executing the vision of implementing a comprehensive and integrated real-time case-based TB surveillance and notification system.

It is recommended that this existing capacity is leveraged for expanding the Cam TBMIS app (in the enhanced version). The application should be further expanded to include monitoring of the entire continuum of care for both DR and DS TB, including presumptive screening, referral, treatment initiation, treatment adherence & outcome, and contact tracing in real-time.

The solution architecture should support adding the additional components in phases, supported with versioning to ensure seamless upgrades and continuity.

Some of the existing program templates being used by other countries such as WHO’s prevent TB tool or other tracker-based systems can be explored for fast-tracking the software development processes.

Tentative timeline: Month 0-12

The NSP (2021-2030) clearly highlights the importance of strengthening the TB Notification information system for improving all the TB service provisions.

Cambodia is using version 2 of e-TB manager for TB notification commonly referred as Cam TBMIS. To ensure that there is a seamless integration of data with Cam TBMIS, from multiple data sources like Lab information systems, CLM platform and other data sources like excel files maintained at facilities without any data loss, the data upload / export API should be explored.

There may also be some other distributed data collection systems and processes which are existing, and it might be difficult to replace them, in such a scenario data can be extracted, transformed and loaded into the central database.

While transformation and data export options offered by the current systems can be used for this other source ETL tools over Postgres DB and/or WHO powered XMart ^[10] which can be installed within the current environment can also be considered.

Tentative timeline: Month 6-12

Implementation of data collection via mobile app to ensure ease of use and real time reporting

NTP is seeking help in building a TB MIS app which is embedded with the national TB MIS system and has an enhanced UI and dashboard features that will improve data entry at facility level. This would help in tackling challenges like inconsistent data connectivity/network issues which delays reporting of cases, and an inconsistent availability of hardware for data entry. One effective way to overcome this is to support the current data collection processes by introducing a mobile application for the health facilities.

As is already envisioned by the NTP, a pilot on using android technology (mobile app) to encourage real time data entry and its further scale-up is required for mitigating the infrastructure and internet challenges at the facility level.

Other advantages of a mobile application include better performance, effective use of device features like in house system updates, offline data entry, usage of location, security measures and tracking user patterns and issue log mechanisms and other analytics measures.

Several mobile solutions for real time case-based notification can be explored for local adaption and building the mobile counterpart for eTB manager. Open source technologies like DHIS2 Mobile App, ODK and KOBO are some notable examples. ^[11]

Tentative timeline: Month 0-12

Packages to train health professionals on eTB manager use and workflows.

Any national scale roll-out will have its own capacity and training challenges which requires development of a comprehensive eLearning module allowing all health staffs involved in data collection process for training not only on the eTB manager application but also on the latest manual of procedure and continued medical education on TB care.

To address the challenges with periodic training of facility level staff to orient them on using eTB manager for direct data reporting, the MOH must engage in development of a comprehensive eLearning module for app training.

Training tools like Moodle ^[12] built on standard LMS framework can be reviewed for application rollouts.

Additionally, for training and updates on the latest manual of procedure and continued medical education on TB care, modules can be developed for TB Health providers, administrators at facility and district level to develop and enhance M&E competencies for ensuring a consistent program oversight, especially for the case-based tracker roll out within the existing applications.

Guide TB platform developed by WHO Philippines is a good example of eLearning module for health staffs involved in TB care.

Tentative timeline: Month 0-3

Planning for capacity building includes workforce assessment, ranging from ICT professionals to health workers providing care services. Since the application requires regular updates and adaptations, the system support team requires trained personnel on the technology stack in use.

Strengthening the NTP team with trained system administrators will help in reducing costs (in seeking technical support) and improving and expediting the planned implementations.

Tentative timeline: Month 6-24

Establishing a direct and secured mechanism for engaging with patient has potential for drastic improvements in tracking lost to follow-up patients.

Auto generation of notification and messaging by the system through communication channels like Social Media channel, IVRS and SMS outbound messages should be explored. Open source applications like Open MRS can be used for these activities. ^[13]

Tentative timeline: Month 6-24

The NTPs plan clearly emphasizes on the importance and need for improve data use. This can be made possible by making case-based TB data across systems more real time and useful.

Building on the current eTB manager and DHIS2 visualization modules that offer a comprehensive dashboard for reviewing of program and data indicators, additional features of pivot table , event reports which support dimensions , data aggregation reports and individual line lists are extremely useful.

To strengthen and expand the data visualisation scope and making effective use of data for predictive modelling, data science and for advanced analytics, it is recommended to use best of the breed tools like Tableau , Power BI which offer these features. APIs can be generated and connected with these applications, and these can be used as an extended analytical component of the data analysis framework. ^[14]

Tentative timeline: Month 6-12

As part of the standard practice, the application(s) / solutions should follow a set of standard data quality mechanisms or the Data Quality Assurance (DQA) framework which would help in improved data credibility and use.

UIC Code : Having a centralized Unique Patient ID system or leveraging existing national ID supported with an improved search functionality can help drastically reduce the duplication of case-based records.

This should be generated automatically through the new case-based TB surveillance system that is already being planned.

Data access control is one such DQA measure that will regulate user’s access to only relevant metadata. It will involve the principle of least privilege (POLP), i.e., user’s access will be determined based on their role in the project. POLP will define and limit what data they have access to and who has that access.

Tentative timeline: Month 6-18