interoperability in crisis donna medeiros and carl leitner hl7 policy conference december 5, 2014
TRANSCRIPT
Interoperability in Crisis
Donna Medeiros and Carl LeitnerHl7 Policy Conference December 5, 2014
Today’s Discussion
Overview of HIS in developing countries, especially Africa
Goals, challenges, progress
Technologies in use: OpenHIE, iHRIS, DHIS2, mHero
Case Study – Liberia
Acknowledgements
• Regenstrief Institute• IntraHealth International• WHO eHealth and Knowledge Management• CDC• USAID • MSF/Doctors without Borders• Futures Group• RTI International• OGAC
Ebola CrisisUnprecedented Emergency Crisis and Response
Humanitarian AssistanceThe need for quickly adaptable, locally
relevant, open systems
Emergency Response and Global Health Security
eHealth / informatics focus• HIS reporting • Surveillance – tracking, case based,
Syndromic
eHealth areas - to name a fewAreas of Innovation using ICT to achieve MDGs
o Electronic Medical Records
o Electronic Health Records
o Telemedicine (telehealth)
o Electronic Medication Services
o Health Knowledge Resources
o Mobile Health
o Decision Support Systems
o Chronic Disease Management Services
o Patient, and Clinical management Systems,
o Distance Learning for health Professionals (eLearning)
o Other Health Information Systems
Current State in Many Ebola Affected Areas
• Scant ICT infrastructure, strategies, policies, systems in those affected
• Complicated systems not doable • Mobile phone utilization
Voice, data, txt coverage quality diminishes considerably outside towns
• Surveillance systems need to leap frog• October 2014 OpenMRS Implementers community ‘Call to
Action’ (Liberia and Sierra Leone)
• Health Information Exchange (OpenHIE) getting utilized
HIS Goals1. Functioning HIS with simple components,
reporting that is high quality and high coverage, collaborations/communities of practice, use of open source, standards based
2. Policies, strategies, governance3. Country ownership and scale up of health
information systems 4. National level Enterprise Architecture
Health Information System Ecosystem Example
Small Clinics
LabEmergency Supply &
LogisticsPharmacy
Regional/National Level
Regional and Global Collaboration
Facility and Field Level
Supporting
• Patient level records• unique client identifier
Mobile surveillance /
DHIS2 Tracker, other
Data Repository / Warehouse
Stakeholders
Challenges for Public Health HIS• Level of maturity of public health information systems• Level of adoption and maturity of electronic health record systems• Access to electronic standards• Availability of trained resources within public health• Silo systems within public health information infrastructure (vertical,
fragmented, non-interoperable, varying levels maturity)• Lack of consistent definition of data content across programs• Lack of a defined national eHealth policy, program or initiative
towards adoption and implementation of standards• Limited participation of public health officials in standards
development• Not all data needed by public health comes from a single source or
resides in an EHR• Not all the data is in electronic format or in a structured/codified
state – data migration, reconstruction needed
Medical treatment area (MSF)
Clinic Line
Kenya’s Progression• eHealth Strategy (2009)
• EMR guidelines (2011)
• ICT Policies at National Level (2012-2013)
• Interoperability – at EMR to DHIS2
EMR rollout of > 600 hospitals (2013 - 2014)
• National Data Warehouse(s)
13
Health SDOs
Defines base standards and data models for clinical messages
Defines standards for reporting of administrative data (i.e. claims)
Defines standard codes for tests, measurements and observations
Defines message ‘Profiles’ that integrate multiple base standards
Defines concepts, data and processes for health and ICTs
Defines standards for public health vocabularies/terminology
Defines standards for bio-surveillance reporting (i.e., syndromic surveillance)
Defines clinical terminology standards
Back to ERCDC Incident Management System
“Mission is to improve the health of the underserved through the
open, collaborative development and support of country driven, large scale health information
sharing architectures.”
The Open Health Information Exchange (OpenHIE) Community:
A broad, multi-stakeholder community supporting interoperable health information structures
OpenHIE
OpenHIE Community of Communities
• Client Registry• Facility Registry• Provider Registry• Terminology Service• Shared Health Record• Interoperability Layer
Architecture
Health Interoperability Layer
• A Health Interoperability Layer receives communications from point of service applications and orchestrates message processing between the point of service application and the hosted infrastructure elements.
OpenHIE December calendar
• Global impact– Preferred health management information system in
over 30 countries – Helps governments and health organizations manage
operations, monitor processes and improve communication
– PEPFAR support, WHO adoption Maintained at http://www.dhis2.org/
DHIS2 Overview
Open Source software free for everyone to install and use
supported by
Infrastructure: Runs on devices on hand, mobile, PCs, and does not rely on connectivity
Integrated system -Typically used as national health information system for:•data management •analysis •health program monitoring and evaluation•facility registries and service availability mapping •logistics management and for mobile tracking in rural communities
Quick info on District Health Information System (DHIS 2)
DHIS2 Architecture
Lessons Learned in this brief history of time
Adoptable and Adaptable •Solutions have to be simple, quickly adaptable, work at country level on/offline•Go off existing resources and global open systems (such DHIS2)•Training material and Capacity Building, M&E -a must•Need toolkits
• Point of Care/EMR to DHIS2 detailed implementation guidance's
• OpenHIE • Freely available standards • eLearningMore governance needed, earlier involvement
of HIS and public health informatics, toolkits
Progress
AtlasCall to Action in East Africa
Interoperability Guides (POC to Indicator District)
ICT Reviews and Recommendations
Carl Leitner IntraHealth / CapacityPlus
mHeroAllows information to health workers’ mobile phones including:
– Broadcast messaging– Reporting emerging cases– Sharing reference and training materials– Testing and improving the knowledge of
health workers– Facilitates coordination among the Ministry
and far-flung health facilities
• Supporting frontline health workers is vital and we simply cannot wait. There is a critical need to establish a more robust communications and data collection system in light of the Ebola outbreak.
• Equipping them with the right kind of information about Ebola diagnosis, treatment, prevention as well as health worker safety, will enable them to support their communities to fight back against Ebola. Information is power and finding the fastest and most efficient ways to disseminate this information is key.
mHero
mHero
Brings together several sources of heath information to facilitate health worker communication. Systems included:•DHIS2 •iHRIS Manage •RapidPro an interactive SMS an IVR (interactive voice response) messaging engine
iHRIS
mHero Open Architecture
health worker mobile phones
mHero builds on exisiting Ministry technologies like DHIS2 and iHRIS to link them with the RapidPro mobile platform using OpenHIE technologies. Using open source standards and approaches creates an extended national collaborative ecosystem that other solutions can link into.
OpenHIE
DHIS2
iHRIS
RapidPROInter-Linked
Registry
CSD
CSD
FHIRSVS
OpenHIEInterop.
Layer
mSync Coordinator
mHero
Architecture
Open Architecture Grows Ecosystems
Facility Registry
Facility Finder – find facilities and
directions via MOH website, Voice and SMS
Health Worker Registry
Facility Planner –
Build apps that look at
geographic gaps in accessibility
HMIS- See the health
statistics of your country, sliced in many ways
M&E- Track projects,
their efforts, and key metrics
Performance-Based Financing –
Track key metrics and financial
information about facilities
Sensors & Alarms –Get data about water quality, open doors, cold chain and other
sensor data
Exa
mp
le
Cli
ent
Ap
ps
Mobile Open Data Kit (ODK)
Way Forward:Open Standards, Open Technologies,
Open Data• Open and freely available Standards (HL7, ISO,
IHE)• Open Architecture• Open Source Software• Guidance documents, Toolkits, Trainings,
eLearning, collaborative platforms
Plug for mHealth summit
OpenHIE session next Tuesday December 9 9:00am -12:00am
