## 3 Findings
### Impacting Data Management Processes  
In the TB control program, the routine data management process begins with the collection of data from all enrolled general practitioners (GPs). Once the consolidated paper-based report is prepared it is transferred to the next level of management (sub-recipient office), which then passes through multiple desk reviews and is finally entered into an Excel spreadsheet. The digitization of paper-based records takes a significant amount of time before it is shared with the next level of management (principle recipient office) for finalization and progress review meetings (Figure 5). Time spent in form-filling, data collection, transfer, aggregation and verification was measured by the direct observation. At baseline, these measures were recorded by observing the routine data management process. However, at the endline, the same measures were recorded by observing the ODK Scan workflow. Filling in the ODK scan-compatible TB form took longer than the old form. Extra attention was required for filling in bubbles and writing structured numbers on the guiding dots correctly. Each field worker (\(n=4\)) was observed while filling in three Scan-compatible forms. The average time taken to fill 12 Scan-compatible forms was 02 min 57 s (max, 03:04 s; min, 01:48 s). However, on average it took 1 min and 27 s to fill in one patient record using the existing TB03 register. The next aspect of data management, data collection, was not affected by the ODK Scan workflow because the process remained the same: visit all of the enrolled GPs of a district. Finally, with the routine data management process, once data collection was completed, it took 1-2 days to transfer data via local courier service, in the form of hard-copies. However, with the ODK Scan process the same transfer of data only lasted  
Figure 5: Routine data management process in the TB (Tuberculosis) control program of Pakistan. a few min. It only required the user to get to an area of internet connectivity and send the data to the ODK Aggregate Server. In the routine data management process, aggregation of records required manual data entry into a spreadsheet, and digitization of one record took 2 min. This digitization process was reduced to 10 s in the ODK Scan workflow. Moreover, the data verification process was greatly altered, as in the ODK Scan process the field worker took the sole responsibility of viewing and verifying data, while in the routine data management process this responsibility was shared between field worker and DMO. In terms of time, verification of paper based records took 20 s per record for the DMO, while in the ODK Scan process it took 3 min per record for the field worker. The increased consumption of time in the verification step of the ODK Scan is because of the app workflow involving identification and rectification of the misrecognized machine-readable data fields by moving point-by-point. The ODK Scan process provided a significant time reduction for the data transfer and aggregation steps; however, time required for the verification and form filling were increased as compared to corresponding processes of the routine data management (Table 2, Figure 6). The redesigned data management process saved resources by eliminating tasks that demanded time and money. In the routine data management process, paper-based records were sent to the office for digitization via local courier service. However in the redesigned process, manual entry of the \begin{table}
\begin{tabular}{c c c c} \hline \hline
**Data Management Processes** & \
\begin{tabular}{c} **Routine Data** \\ **Management Process** \\ \end{tabular} & **ODK Scan Process** &
\begin{tabular}{c} **Time Consumed in** \\ **Redesigned Process** \\ \end{tabular} \\ \hline Form Filling (per form) & 1 min 27 s & 2 min 57 s & \\ Data Collection (complete) & 3–4 days & 3–4 days & \\ Transfer (complete) & 1–2 days & 3 min & \\ Aggregation (per record) & 2 min & 10 s & \\ Verification (per record) & 20 s & 3 min & \\ \hline \hline \end{tabular}
\end{table}