Business Processes and Workflows

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HIVFHIRIG, published by intellisoftkenya. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IntelliSOFT-Consulting/HIV-FHIR-IG/ and changes regularly. See the Directory of published versions

Business Processes and Workflows

Overview of key HIV business processes
Business process symbols used in workflows
Registration Business Process
HIV Enrolment Business Process
ART Initiation Business Process
Clinical Visit Business Process
Discontinuation Business Process
Re-enrolment Business Process
Following Up and Contacting Clients
Aggregate Reporting and Data Use

A business process, or process, is a set of related activities or tasks performed together to achieve the objectives of the health Programme area, such as registration, counseling, and referrals.

Workflows are a visual representation of the progression of activities (tasks, events, and interactions) that are performed within the business process. The workflow provides a story for the business process being diagrammed and is used to enhance communication and collaboration among users, stakeholders, and engineers.

Overview of key HIV business processes

	Process Name	Process ID	Personas	Objectives	Task set
	Title	ID used to reference this process throughout the DAK	Individuals interacting to complete the process	A concrete statement describing what the process seeks to achieve	The general set of activities performed within the process
A	Registration	HIV A	Client HRIO Data Clerk Peer educator	To identify and register a HIV positive client to receive the care and treatment services	Starting point: Client arrives at clinic Identify the client to be registered and do a quick check that the client doesn’t exist in the EMR/Client Registry. Navigate to registration icon on homepage Click on create a new patient to access the registration form Capture all the client’s bio data Save to complete the registration process
B	HIV Testing Services	HIV B	Client HTS provider	To diagnose individuals with HIVand facilitate their engagement in care and ART initiation as early as possible, as well as to counsel HIV negative clients and link them to prevention and other services.	Starting point: Client has been registered at the health facility (Process HIV.A) and called in for testing. HIV testing may be integrated with other care, such as ANC or family planning. Screen for eligibility and refer for testing if eligible Provide pre-test counselling Test, following national testing algorithm Provide test result, post-test counselling, and information on prevention services or If positive, refer to second tester for confirmatory test Counselling on ART initiation if final result is positive. Offer index testing services and elicit for contacts Determine follow-up requirements Provide or offer integrated services Link or refer to prevention, care or treatment
C	HIV Enrolment	HIV C	Client HRIO Data clerk	To enrol a HIV positive client to the HIV program to receive the care and treatment services.	Starting point: Client has been registered and is ready to be enrolled Search for the client in the EMR If the client doesn’t exist, register the client as described in HIV A above. If the client is in the EMR after searching, select the client. Navigate to patient profile page and access HIV program Click on enroll button to access the HIV enrolment form Update the HIV enrolment with patient type, patient source, unique patient number, ART history and treatment supporter details Click on enter form to save the HIV enrolment form.
C	ART Initiation	HIV C	Client Clinician	To start a client on the antiretroviral medication.	Starting Point: A confirmed HIV +ve client visits the facility seeking care and treatment Services Search for the client within the EMR ART preparation is done and documented to assess readiness Client is started on ARVs by selecting the regimen, regimen line and date started Save the data
D	Clinical Visit	HIV D	Client Data clerk HRIO Peer educator Triage Nurse Clinician	To review a HIV positive client and offer care and treatment services	Starting point: A confirmed HIV +ve client visits the facility seeking care and treatment services Search for client within the EMR If client doesn’t exist in EMR, register the client as described on HIV A If the client exists in the EMR, select the client and check them in to start a visit Queue the client for triaging Client vitals and anthropometrics are taken and documented Queue the client for clinical review Clinical review done and findings recorded on clinical encounter form Book the client and assign a return to care date Prescribe drugs - both ART and any other drugs based on findings Check out the client to end the visit
E	Discontinuations	HIV E	HIV +ve client Clinician HRIO Peer Educator/ Social worker	To care end or terminate a HIV +ve client from the HIV program because of; Death, Interruption in treatment with unsuccessful trace, stopped treatment or transfer out	Starting point: A HIV +ve client who is no longer accessing care and treatment services at the primary facility Search for the client and select their record Navigate to patient profile page and access HIV program Click on discontinue button to access the HIV discontinuation form Record the actual discontinuation date Update the reason for discontinuing client as; Transfer out, died, lost to follow or stopped treatment Indicate the effective discontinuation date (This date represents the date when the client is excluded in the active on ART list) If died, document date of death, cause of death and the specific cause of death If transferred out, document the facility transferred to and date transferred out. Upon successful confirmation of the transfer, update the verification status and date verified If lost to follow or stopped treatment, document the effective discontinuation date Click on ‘Enter form’ to save the HIV discontinuation form
F	Re-enrolment	HIV F	Client HRIO Data clerk Peer educator	To bring back the discontinued HIV+ client to receive care and Treatment services.	Starting point: A returning HIV+ve client who was previously accessing care and treatment services in this facility but were discontinued due to: transfer out, lost to follow or stopped treatment. Search for the client who’s returning to continue receiving care at this facility and select their record. Navigate to the patient profile page and access the HIV program. Click on the enrol button to access the HIV enrolment form. Select Re-enrolment (Re-activation) under patient type. Update entry point Click on enter form to save the re-enrolment details
G	Follow up and Contacting clients	HIV G	Peer educator/ social worker	To follow up by contacting clients to ensure they are receiving services, to increase retention and adherence and, ultimately, to improve patient outcomes	Starting point: A HIV +ve client enrolled in a certain health facility and requires follow up on their care and treatment services. Identify a client for follow up. Attempt to locate the client via call or home visit. Record the outreach and outcome. The outcome is recorded as; client is returning to care, the client reported transferring, a client has died, the client could not be located, etc. Update defaulter tracing history with the outcome reached. Update the appointment date for clients still active on treatment. Update discontinuation form for clients confirmed to have transferred out and those confirmed dead Continue tracing those not reached
H	Aggregate reporting	HIV H	HRIO Data Clerk	To aggregate client-level data into validated reports, use the data and submit reports from the facility level	Starting point: A health facility implementing EMR and reporting from EMR

Business process symbols used in workflows

Symbol	Symbol Name	Description
	Start/End	Symbol indicating the beginning and conclusion of an activity.
	Pool	A pool represents different participants or user types involved in a business process.
	Swim Lane	Swim lanes are designated areas for specific users to document their activities in a process.
	Activity, process, step or task	Tasks labelled with verbs that describe actions performed by a user.
	Subroutine	Represents activities with detailed subprocesses on another diagram.
	Decision Tree	Used to show a decision point, often with two output arrows for different outcomes.

	Sequence Flow	Arrows showing the flow direction from one process to another.