The NSP (2021-2025) clearly highlights the importance of strengthening the TB Notification information system for improving all the TB service provisions. ^[3]

Vietnam has already developed and deployed a case-based TB notification VITIMES and e-TB manager for DS-TB and DR-TB respectively. Both the systems have been rolled out in 713 District DS-TB Units and 30 high burden DR-TB sites. The presence of the system lays a strong foundation for executing the vision of creating a comprehensive and integrated real-time case-based TB surveillance and notification system.

Currently VITIMES and e-TB manager are in process of upgradation and needs to be integrated into one system. Additionally , the architecture and infrastructure needs to be extended to support integration with external systems like GeneXpert ,TruNat, Digital X-Ray outputs, Pill Boxes and other digital adherence tools which help in use the data effectively for the patient continuum of care and as a vision of an integrated Health Information Management System (HMIS).

These data exchanges can be made seamless with API feature offered by both the platforms.

Additionally , other recommended data exchange/ ETL tools like Talend, Informatica[10] ^{[10.1] , [10.1]} makes systems data management task much easier and simultaneously improves data warehousing. These exchange tools also comply with FHIR, GDPR standards for more secured and seamless data exchange.

Tentative timeline: Month 0-6

The NSP 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.

In the existing dashboard there is a strong need to strengthen and expand the data visualization scope and making effective use of data for predictive modelling, data science and for advanced analytics it is also recommended to use best of the breed tools like Tableau , Power BI ^{[11.1] , [11.2]} which offer these features. The current e-TB manger platform offers APIs which can connected for these applications and be used as an extended analytical component of the data analysis framework.

This would help to collate compare and review data across eTB Manager & DHIS2 systems.

Tentative timeline: Month 6-12

One of the challenges highlighted by NTP is the leveraging the data collected from the multiple sources like e-Tracker into the main DHIS2 systems as a central warehouse for effective use.

To ensure that there is a seamless integration of data from multiple data systems like e-Tracker and other data sources like excel files maintained at facilities without any data loss , the DHIS2 data upload / transformation 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 ^[12] which can be installed within the current environment can also be considered.

Tentative timeline: Month 6-12

One of the challenges reported by the NTP during the data collection processes is inconsistent data connectivity/network issues which delay reporting of cases.

The advantages for a mobile application include better performance , effective use of device features like in house system updates, 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 notifications can be explored for local adaption. Open-source technologies like DHIS2, Mobile App, ODK and KOBO are some notable examples. ^{[13.1] , [13.2] , [13.3]}

Tentative timeline: Month 0-6

Any national scale roll-out will have its own capacity and training challenges which requires development of a comprehensive e-Learning module allowing all health staffs involved in data collection process for training not only on the new VITIMES and e-TB tracker-based 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 VITIMES and e-TB for direct data reporting, the MOH must engage in development of a comprehensive e-Learning module for app training.

Training tools like Moodle ^[14] built on standard Learning Management System (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 1-4

Planning for capacity building includes workforce assessment, ranging from ICT professionals to health care workers. 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, IVRS and SMS outbound messages should be explored. Open-source applications like Open MRS can be used for these activities. ^[15]

Tentative timeline: Month 6-24

One of the limitation 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 0-1

The recommendation is to integrate and include the data currently collected from applications like ACIS application via APIs and also expand the additional modules on Contact Tracing and Presumptive Screening, LTBI in VITMES to actively find the cases and determining the possibility of contacts being infected with TB would reinforce contact investigations by enhancing prioritization so high-risk contacts can be focused on first.

The additional modules can be built on by leveraging on the existing platform of VITIMES and expanding it with new upgraded version of the application.

Tentative timeline: Month 12-24

There may be duplication of data since multiple systems are used for data entry. This also results in missing out some crucial information to track and follow up the patients.

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

It would also ensure that patients are tracked, monitored and followed up throughout the treatment journey.

Tentative timeline: Month 0-6

As expressed by the NTP, the national TB notification and surveillance system should have also consider data integration with their current social media channels and also explore use of ready-to-use open source CLM platforms like One Impact.

Tentative timeline: Month 12-24