Release Notes 1.4

Accessing UAT environment for Bahmni Release 1.4

These are the environments that can be used for UAT:

https://endtb-msf.mybahmni.org/bahmni/home/

https://endtb-pih.mybahmni.org/bahmni/home/

https://endtb-ird.mybahmni.org/bahmni/home/

Note: the MSF server is located in Paris, the third server is hosted in India and the PIH server in Boston and IRD in Mumbai. Please use the server located close to your location for optimum performance

User credentials:

User Name-->password

superman --> Admin123

msfuser1, msfuser2, msfuser3, pihuser1, pihuser2, pihuser3, irduser1, irduser2, irduser3 --> endTB12

Deployment steps:

The steps for deploying the release 1.4 build for endTB are available at this link.

What’s New:

NOTE: There was no planned upgrade from 1.2 to 1.3. The text in blue are the features being released as part of 1.4. The text in black were part of release 1.3. The text in green are UAT feedback addressed as a part of release 1.4.

Following are the new features available as a part of this release.

SAE Data Import:

SAE Import allows the user to import data in the SAE forms of treatments. The SAE data is received from the PV unit in a digital format. The end-user can upload this file in endTB instead of entering the data manually per treatment. The result of this would be equivalent to entering the data for each SAE from the UI.

If SAE form is already filled for a patient, only then an import can be performed. Each Serious Adverse Event for a treatment is uniquely identified by the Date of Onset and the SAE term (‘Other SAE term’ in case of SAE term is ‘Other’). Date of onset and the SAE Term cannot be overwritten through an import. Any other data in the uploaded file will overwrite the data in the existing SAE form. For instance, importing a form with SAE related to TB drugs as FALSE, will overwrite/remove any other drugs that have been entered in the form. This is done assuming that the data from the PV unit is verified data.

The detailed documentation on this feature can be found here.

Restrictions on data entry:

Since some of the forms can only be filled once per treatment this restriction has now been programmed into the system. The baseline, treatment initiation and outcome form can now only be filled once for a treatment. Also the monthly treatment completeness form can only be filled once per month per treatment.

The date of SAE report cannot be before the date of SAE onset.

Hain and Xpert table on patient summary:

We have the Hain and Xpert results added to the patient summary. They would be shown side by side and would have the test results per sample.

Data Quality Dashboard:

This feature is to ensure data quality on specific variables. Based on a rules for data, a scheduled background run yields a list of patients for whom the data is incomplete/erroneous according to the rules.The results are displayed on the Data Quality Dashboard. This dashboard would list all the data inconsistencies, based on defined rules in the system and provides the end user a link to fix those inconsistencies.The search field on the page has also been made configurable. The implementers can choose to configure on which columns they would like to search. For e.g one can configure to search along the Facility and Treatment Reg number.In case the form has not been filled out for any listed patient, the data quality dashboard would highlight this and the link will direct the user to the patient dashboard. Further documentation on the same can be found here. The steps for configuring the dashboard can be found here.

The new rules implemented in this release are:

Consent for New Drugs: all the patients who have been prescribed either Bdq or Dlm and do not have the answer to the question “Consent form signed” as “yes” will be listed as per this rule
Consent for endTB Obs Study: All the patients who have been prescribed either Bdq or Dlm and do not have the answer to the question “endTB consent form signed” as “yes” or “no” will be listed as per this rule.
Treatment start date missing: All patients who have been prescribed TB drugs and do not have a treatment start date or a treatment initiation form filled will be listed as per this rule.
Outcome missing:
All patients patients without an outcome, and who have started treatment at least 27 months ago (24 months of treatment + 3 months for culture results), will be listed according to this rule.
End of treatment date missing:
All the patients with an end of treatment outcome but no end of treatment date will listed as per this rule
Case definition is missing:
All the patients without full case definition information (WHO registration group, site of disease, MTB confirmation) or without a Baseline form will be listed as per this rule.
Culture status at start missing: All the patients with confirmed MTB but without a culture result before the date of start of treatment or within 1 month of treatment start date, will be listed as per this rule.
Baseline firstline DST missing: It would list all the patients who have confirmed DRTB (on baseline form), and do not have any of the following test results for Rifampicin and Isoniazid before the date of start of treatment or within 1 month of treatment start date, will be listed as per this rule:

- Rifampicin : Xpert Rif resistance/ HainMTBDRplus (HAIN Rifampicin)/ DST ( Rifampicin)
- Isoniazid : HainMTBDRplus (HAIN Isoniazid) /DST( isoniazid 0.2)

Baseline secondline DST missing: It would list all the patients who have confirmed DRTB (on baseline form), and do not have any of the following test results for injectables and Fluoroquinolone before the date of start of treatment or within 1 month of treatment start date, will be listed as per this rule:
- Injectables - HainMTBDRsl ( MTBDRSL injectable) / DST (ofloxacin/ levofloxacin/ Moxifloxacin)
- Fluouroquinolone - HainMTBDRsl (MTBdrSL fluoroquinolones) / DST (Capreomycin/Amikacin/ Kanamycin)
Adverse event onset date is missing: This rule would list all the patients with AE reporting date but no adverse event onset date.
SAE onset date is missing: This rule would all the patients with SAE reporting date but no SAE onset date in the SAE form.
SAE date became serious is missing: This rule would all the patients with SAE reporting date but no “Date event became serious” in the SAE form.
Less than 4 TB drugs in a patient taking Dlm or Bdq: This rule would list all those patients who receive either Dlm or Bdq and have less than a total of 4 Active TB drugs prescribed.

Data Quality Dashboard is a new and generic Bahmni feature and can be extended by an implementer by plugging in additional rules.

Enhancements to the Observations UI:

The observations page (forms entry) has been modified to improve the performance and to support more convenient data entry into the forms.

A few highlights of the enhancements are:

A new left pane has been introduced, where the user can see all the forms that have been added in that session.
When the user selects a form from the form selection pane at the bottom this form would get added to the left hand panel and open in the right form.
Clicking on the form in the panel, opens the form. Only one form opens at a time.
This will avoid the confusion of multiple forms being open and also ensure better performance of the application.
Also this would resolve the issue of the end user being lost when the forms are saved.
When save is triggered an error symbol on the forms in the left panel indicates the forms that have errors.
Clicking on the error icon will take you to the place on the form where the error has occurred.
Once the error has been rectified and save is pressed, the data will get saved and all the forms would be in a collapsed state on the left hand panel.

Note: The new UI does not have the ability to pin forms. The users must unpin any existing forms before they upgrade. Otherwise the pinned forms would continue to appear in the left panel for all the patients.

Patient Monitoring Tool:

This feature is being released with the feature turned off as it is still under beta testing by ThoughtWorks. This feature will help in monitoring if all the relevant data has been entered into the system for a patient. The schedule of what needs to recorded (Entities) and when (Milestones) will be defined at a local level by the implementers in a configuration.

For instance, Milestones can be months of the treatment elapsed since the treatment start date and entities could be the observations we would like to monitor for the patients. Entities could be clinical observations, drugs, or bacteriology results.

The flowsheet would then display for each patient a view of , data that is expected , data that is missing and data that is present according to the defined schedule.As a part of this feature we also highlight the the current month of treatment and the end of treatment in the flowsheet.

The details of configuring the flowsheet are available here.

Ability to hide Patient name and Image in the Patient summary Print:

This feature gives the users the capability to hide the patient name and the image o in the patient summary print, to keep these details confidential. This can be configured by the implementers. The details can be found here under ‘Hiding patient name and image’.

Alert Users to Network connectivity Issues:

The feature alerts the user in case of an network issue, to ensure that the data entered in the forms is not lost. When there is a loss in network, the user is prompted with an error message informing the same and it will be continue to be visible till the connection is back. Another message is displayed when the user is connected back to the network. Details about the configuration can be found here.

UNITAID Reports:

The remaining pieces on the UNITAID reports have now been completed. The following have been completed as a part of this release:

1. The enhancement to the UNITAID reports where only the initial start date of drugs is considered for counting the patient in a particular cohort is completed. Now the patient would only be counted in the cohort that overlaps with the initial start date of Bdq/ Dlm.
2. Count of culture results for month 6: For patients that do not have an outcome at the end of 6 months; we need to asses the culture status as on the sixth month. This report gives an aggregated view of different culture results for all the patients that are still on treatment.

Exports Enhancements:

There were several variables missing from the metadata code dictionary, this was because the metadata code dictionary had only the questions that have coded answers (a fixed set of options). Now all the other types of questions (variables/ Column names) have also been added to the metadata code dictionary. This includes numeric questions, text questions, and date questions too. Thus now we have also included a column for the datatype of the concepts.

Note: only the IDs from each file would not be there in the metadata code dictionary because this data is not generated from the system, The IDs are only used to link parent files to the child files in the export. E.g. id_baseline_template is used to connect one row in the baseline form to multiple rows in its child files like baseline_past_tb_treatment_table.csv.

Other Reports:

To generate a report from the system, the user must navigate to the reports application and select the date range for the report that needs to be run. After this the user must select the format in which the report must be generated.
(Note: This has been mentioned after the name of the report for the convenience of the user. Running the report in other formats might generate an erroneous file)
Following are the reports that are available in this release:

1. Adverse Events Report: This report generates a line list of all the adverse events that have been reported between the dates that the user selects. The information recorded for that adverse event is listed in the row for that adverse event.
2. Late Visit Report: This report lists all the patients that have not had a visit reported for the past thirty seven days. The date of the last visit is ascertained from the last follow up form that is filled for the patient. This report also gives the basic contact information of the patient so that he/she can be contacted for follow up.
3. Serious Adverse Events Report : This report generates a line list of all the SAEs that have been reported between the dates that the user selects. The information recorded for an SAE is listed in the row for that SAE
4. Adherence Monthly Overview Report : This report gives an overview of what the Adherence, completeness and DOT rate for different patients (treatments) have been over the months. It considers the month in which the patient’s treatment was started as the first month for that treatment. It also lists some of the basic parameters of the patient’s treatment like the TB profile and subclassification.
5. Daily/Weekly Visit Report : This report gives a list of patients that have their next scheduled visit falling in between the date range that is selected by the user. The next visit is determined from the last follow up form that was filled for the patient. It also gives information about some of the latest lab results for the patient.
6. Adherence Monthly Summary Report : This report gives the list of months between the date range selected by the user and gives the value of Adherence rate, DOT rate and completeness rate for all the patients for those months. (given that the form for that month has been filled for that treatment). It also lists the reasons for missing adherence for each of the patients for each month.

Note: now the reports have been organised so that all the reports that have to be run in the excel format appear together and all the ones that are to be run in the custom excel format will appear together.

User Feedbacks addressed in this release:

Following were some of the issues that were reported by the end users and have now been fixed as a part of this release.

Enter Numeric Value Error on the Lab Results forms: An error of “enter numeric value” would be shown even when all fields had numeric values entered and no fields would be highlighted in red to indicate the error. This was fixed as part of the release. The fields now accept only numeric values and only in case of an invalid entry the system would highlight the erroneous field and display an error message.
Open in a new tab button (green button on top right, that opens enter data on a new tab in the browser): This button helps the user to toggle between the dashboard and data entry, which is sometimes necessary for context and to aid in data entry. The defect that was pointed out was that this button opened the patient dashboard without the context of any treatment and thus allowed patient level data entry. Since this is invalid for the use case of endTB this defect has now been fixed and the button now opens the “Enter Data” screen for that treatment in a new tab.
Patients still in treatment even if treatment is ended: The issue was that the current month of treatment is displayed even after an end of treatment date is specified with an outcome. This was calculated as the difference between the start date and the date when the summary is being seen. As a part of this fix, we introduced Treatment Duration in the Patient summary , that is now displayed for those patients for whom end of treatment date is provided, instead of displaying the current month of treatment.
Date doesn’t Auto-tab : The issue reported was that the Date auto-tabs from day to month but does not to year, causing users to make data entry errors frequently in the month field. The issue was looked into and it was found that with the dd/mmm/yyyy format the mmm field does not auto tab to yyyy format but it does auto-tab to yyyy in case of dd/mm/yyyy formats. This is a browser limitation and the same has been communicated.
Inactive non TB drugs couldn’t be voided: The issue was that there was no void/delete option for the inactive Non TB drugs. Hence if a wrong order was stopped or auto-expired there was no way to remove this incorrect data. This issue has now been addressed by providing a void/delete option for the inactive Non Tb drugs.

Fixes to known Issues

Form conditions that have an “Add Section” do not work on the additional sections.
On the Bacteriology results form when you do an “add section” of the DST results the “other drugs” below it appears twice in the newly added section; once as a section and a tabular row below that. This has been fixed in this release.
Voided patients showed up on the patient information report. This has now been fixed.
Tab out from a date that is used for conditionally activating some fields does not take to the next field that is activated. This has now been fixed and can be seen on the baseline form on the date of past TB treatment table.

Known Issues:

On the TB drugs tab if a drug is stopped on today’s date and then started again, it is not reflected accurately on the Drugogram. This behaviour is only seen for today’s date. For all other dates, the feature works as expected. Also if this data has to be recorded
If the adverse events form has been voided for a treatment (by deleting each observations), we still see the line for that form in the adverse events form. This would be fixed in next release.
The “Late visit list report” currently shows all the inactive treatments too. This would be fixed in the next release by putting a check for the inactive treatments.

NOTE :

We have provided two scripts for users upgrading from 1.2/1.3 to 1.4. Please check the links below to access them:

UAT feedback:

This is the sheet where the users can add their feedback post testing. Please follow the conventions being followed so far in the sheet. A demarcation has been made in the sheet for denoting the feedback of this release.

Note: a separate sheet has been added to this titled ‘End User Feedback’. Kindly refer to that sheet for updates on issues related to end user feedback.

Following are the feedback from the UAT that are addressed as a part of this release:

Adding synonyms for Type of assessment: Now we have synonyms for the type of assessment that appear on the patient summary and the following would show up in the patient summary.
'Overall DOT rate (X)' in the Treatment Completeness Rate Section - The comma separated Individual Dot rates of the drugs has been replaced with the ‘Overall DOT rate (X)’ in the Treatment Completeness Rate section on the Patient summary.
‘Culture & Smear Results’ table has been moved below the Drug Regimen table on Patient summary.
SAE Upload privilege changed to Registration - Now a user with Registration privilege will also be able to SAE uploads. Earlier only a user with Admin Privileges was able to an SAE import.
Removing the Important dates section from Patient summary: The important dates section in the Patient Summary has been removed, as the information in this section was redundant.
Interim outcomes at 6 months: Spelling change: "selected" : The spelling of selected has been corrected in the Interim Outcomes at 6 months report.
Following tables have been added to the Patient Summary:

The audiometry tables for the left and the right ear
Baseline BPNS - Left & Right and Follow-up BPNS - Left & Right
Baseline Ishihara (Number of Correct plates) and Follow up Ishihara (Number of Correct plates)
Baseline Visual Acuity and Follow up Visual Acuity

Test Results for Automated tests

In this release, we ran automation scripts that we have written as a part of our test suite. They are divided into specifications (specs) and each spec contains test cases. We currently have 5 specs with 10 test cases. The test suite is work in progress, and we would be adding more test cases in the future.

These tests were run on the MSF, IRD and PIH environments. One sample of such a test result is shown below: