CME and Quality Tracker

Health indices in Haiti are some of the lowest ranking in the world. Despite a long tradition of medical education in Haiti, medical resources remain inadequate to meet the country’s needs. HIV/AIDS, nutrition, maternal and child health, reproductive health, and sanitation and hygiene are common, serious health issues which affect the Haitian populace but addressing these issues is limited by significant social constraints on the Haitian healthcare system.

Medical knowledge is expanding at a fast rate. Much of what community physicians learned in medical school can quickly become outdated. In the United States and other developed countries, this issue is addressed by requiring healthcare providers to regularly renew their knowledge through continuing medical education (CME) credits. However, in Haiti, no such nationally organized program exists. There are educational offerings by specialty societies like the Société Haïtienne de Pédiatrie but Haiti currently lacks the infrastructure or regulatory bureaucracy necessary to ensure CME, which makes tackling the health issues affecting Haitian citizens with current evidence-based clinical practices challenging. Haitian physicians have expressed a lack of access to professional development programs and continuing medical education activities, and a desire to obtain these services. An innovation and restructuring will provide a sustainable strategy to ensure high quality care and a competent evidence-based workforce for the entire Haitian population for years to come. We will need to implement a solution for the standardization of medical education and the introduction of timely and focused curricula into a continuing medical education system in Haiti. Everyone in Haiti will benefit from this innovative change to the health system. If all people are patients, then everyone in Haiti will benefit from this program. Rural and urban patients and providers will all benefit from this program. We will strengthen the Haitian health system by training current physicians in evidence-based medicine. Our program will positively influence the knowledge base of all primary care physicians in Haiti. Medical knowledge is expanding exponentially, and it is difficult for providers to keep up to date. Using a standardized system that encourages current knowledge and evidence-based practice is an opportunity to improve care for all patients throughout the country. By linking this with performance improvement we will be able to influence the delivery of health care for patients throughout the country.

Our solution is a strategy for healthcare improvement to help Haiti develop a Haitian compatible continuing medical education system that is standardized, evidence-based, and up-to-date to address Haitian health concerns. This will be a truly sustainable system that will touch the lives of all patients in all 10 departments across Haiti for years to come. It will be integrated into a computer platform system of performance improvement that uses an educational intervention as well as audit and feedback to improve practice.

We will provide standardized curricula and oversight to ensure the delivery of high quality, evidence-based care by a cadre of well-trained and competent providers in Haiti. We propose to strengthen the Haitian healthcare system by improving the delivery of evidence-based care by competent physicians by improving education and performance assessment with a tool linking to curricular content, assessment and feedback.

Our solution we will create a mechanism for creation and dissemination of the material for CME as a strategy to improve the quality of physician practices. We realize that different physicians will have different preferences for quality improvement in their practice as well as different time and fiscal constraints. This will be an innovative strategy, that builds off of the experience and expertise of our team. Our team includes experienced software developers with experience in a low-income country, and in particular Haiti, experts in primary care quality improvement, and Haitian physicians. Our goals are to improve and innovate continuing medical education in Haiti. Continuing medical education has a long history and demonstrated success as a way to improve health care delivery. However, it has never been implemented in Haiti. Our solution addresses a real problem by implementing a proven strategy to improve the delivery of primary medical care.

The computerized platform will be designed to measure the clinical performance as well as the knowledge base of the physician prior to completing the educational module and then assessed again in the same platform immediately after completion and again 6 months later. The immediate outcome will be an improvement in knowledge, a standard CME outcome. Importantly, we will also measure actual clinical performance 6 months after the completion of the educational module to see if a change in knowledge resulted in a change/improvement in care.

An example of how this would work is exemplified by the following. A particular problem in Haiti is uncontrolled hypertension and corresponding cardiovascular disease outcomes like stroke and heart attacks. So, the physician would work on a cardiovascular disease module. The first step would be to indicate a) if the practice has a registry of patients with hypertension, b) how many have uncontrolled hypertension, c) current management and treatment of patients with hypertension, and d) number of patients in the practice who have had strokes or heart attacks in the past 6 months. These would be in a standardized drop down box format. Second, a test of the knowledge base of the physician regarding cardiovascular disease would occur with multiple choice questions. Following the pretest knowledge assessment, the physician would complete an educational module on cardiovascular disease. At the end, a post-test educational assessment would be presented with a score.

Six months after the module the physician would be asked the same questions as before and indicate a) if the practice has a registry of patients with hypertension, b) how many have uncontrolled hypertension, c) current management and treatment of patients with hypertension, and d) number of patients in the practice who have had strokes or heart attacks in the past 6 months. This will allow feedback to the physician to see if practice and patient outcomes have improved. Our team has considerable experience working with US entities that deliver medical curricula to practicing physicians and evaluate their corresponding knowledge base. We will ensure that the curricular composition, and record keeping required for this venture is firmly established. We will follow previously demonstrated models for both general and specific education that addresses the needs of Haitian physicians.

This solution will benefit the entire population of Haiti, the poorest country in the Western Hemisphere. All patients, rich or poor, rural or urban will benefit from having a more competent and up-to-date primary care workforce. Moreover, tracking the physician practice and providing feedback in the context of advances in treatment will improve practice and thereby benefit patients.

Our team includes software developers in Haiti who understand technological constraints for a low income country. We also have physicians trained in Haiti who have served as government ministers who have a sophisticated understanding of the delivery of care in Haiti and the culture of medical practice in Haiti. Finally, the team has experienced primary care researchers who understand quality improvement in primary care.

This solution will provide a platform for primary care physicians in Haiti to access CME, input their performance and get feedback on their practice. The solution is scalable and can be continually updated with new curricula.

Our team is a multidisciplinary team composed individuals who have experience and expertise in the three relevant areas of 1) software development in a low-income country, 2) primary health care and quality improvement in primary care, and 3) medical practice in Haiti.

Turbo System, an experienced software development company based in Port Au Prince, Haiti has a long history of creating solutions consistent with the bandwidth and connectivity needs of Haiti and other low-income countries. ISO 9001:2015 certified, Turbo System is a leader in advanced technologies, successful system integration and implementation. He works with clients across a wide range of industries, business lines, technical specifications and platforms. Turbo System has already developed and implemented solutions for the improvement of the Haitian education system.

Arch Mainous III, PhD, is Professor and Vice-Chair for Research in the Department of Community Health and Family Medicine at the University of Florida. He has published more than 435 peer reviewed articles, has won lifetime achievement awards as a primary care researcher and is currently the Chief Editor of Frontiers in Medicine: Family Medicine and Primary Care. He has substantial expertise in solutions to improve the quality and assessment of primary medical care.

Stephanie Auguste, MD, PhD is a pediatrician who graduated from the medical school of the State University of Haiti in Port Au Prince, Haiti. In addition to understanding the experience of medical care in Haiti as a physician, she also understands it as a former head of Ministries in the Haitian government. She was the Minister of Labor under the late President Jovenel Moise. She is currently on the Cabinet of the Ministry of Health of the Population and Public in Haiti.

Madsen Beau de Rochars, MD, MPH is an Assistant Professor in the Department of Health Services Research, Management and Policy at the University of Florida. He graduated from medical school at the State University of Haiti in Port Au Prince, Haiti. He practiced obstetrics in Haiti. He has worked with the CDC and Carter Center on health issues in Haiti.

The prize of this challenge give us the opportunity to offer to Haiti, which is so often struck by humanitarian disasters and chronic politico-socio-economic instability, a system that would allow the people to benefit from better health care through continuous training of personnel responsible for primary health care.

For Haiti and similar low-income countries, a continuing education platform is an innovation. In countries where health systems are at the lowest level of performance, we suggest to starting with the basics, which is the continuous education of health care providers. This platform will not only allow to acquire or update knowledge, but it will also be a space for exchange between health professionals for the publication of the specific cases treated.

Impact Goals for the first year:

 To provide access to primary care physicians in Haiti to improve quality of care and evidence based medicine for key health problems in all 10 departments in Haiti.

To successfully distribute the CME and Quality Tracker into both rural and urban areas and respond to bandwidth and networking problems in a country with an unstable electrical grid.

Impact Goals for five years :

To decrease morbidity and mortality due to high impact conditions in Haiti. Cardiovascular diseases outcomes will be improved via the implementation of a cardiovascular disease module within the CME and Quality Tracker. Other high impact conditions will also be targeted for curriculum and practice change.

To integrate the CME and Quality Tracker into the disease surveillance activities of the Ministry of Health of Haiti.

Our Impact goals will address UN Sustainable Development Goals of Good Health and Well-being and Quality Education.

Our solution will be based on the long standing theories of continuing medical education as a strategy for quality improvement in the delivery of up to date medical care. We will also provide feedback in an audit and feedback loop comply with the theory of change.

We will implement a web and a mobile application to support our CME and Quality Tracker program

Following a strategy used by the American Board of Family Medicine, primary health care data will be collected by the solution with providers inputting data.

Our multi-disciplinary team includes Haitians and American citizens, men and women and Non-Hispanic Blacks and Non-Hispanic Whites

Our model for this solution is for a strategic health initiative that has the ability to be incorporated into the entire country. A potential customer for the solution would be the Government of Haiti.

Turbo System is financially sustainable. This new solution, created by working with our partners will allow us a new product that could be acquired by the Government of Haiti as well as governments of other low-income countries.

We are working in a very challenging environment where one needs to adapt quickly to change. One needs to be flexible, Agile in order to survive. Turbo System has been successful harnessing those principles.

We have a quinquennial Business Plan that we monitor periodically. We have monthly meetings with our Board of Directors to mitigate all the new risks identified which could represent a menace for the company. If the goal for one project or opportunity has not been reached, we identified the causes and a rescue team is affected for a solution.

 We constantly are looking for new markets, new segment, new products and new strategy in order to insure the sustainability of the company. This is the roadmap that Turbo System has been following for the last thirty three years and so far it works.

  The CME project is in its concept phase. It has been financed until now by our own funds. The prize of this challenge will allow us to move more quickly towards its realization.