Interoperability in Crisis Donna Medeiros and Carl Leitner

Interoperability in Crisis Donna Medeiros and Carl Leitner Hl 7 Policy Conference December 5, 2014

Today’s Discussion n Overview of HIS in developing countries, especially Africa n Goals, challenges, progress n Technologies in use: Open. HIE, i. HRIS, DHIS 2, m. Hero n Case Study – Liberia

Acknowledgements • • • Regenstrief Institute Intra. Health International WHO e. Health and Knowledge Management CDC USAID MSF/Doctors without Borders Futures Group RTI International OGAC

Ebola Crisis Unprecedented Emergency Crisis and Response Humanitarian Assistance The need for quickly adaptable, locally relevant, open systems

Emergency Response and Global Health Security e. Health / informatics focus • HIS reporting • Surveillance – tracking, case based, Syndromic

e. Health areas - to name a few Areas 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 (e. Learning) 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 Open. MRS Implementers community ‘Call to Action’ (Liberia and Sierra Leone) • Health Information Exchange (Open. HIE) getting utilized

HIS Goals 1. 2. 3. 4. Functioning HIS with simple components, reporting that is high quality and high coverage, collaborations/communities of practice, use of open source, standards based Policies, strategies, governance Country ownership and scale up of health information systems National level Enterprise Architecture

Health Information System Ecosystem Example Data Repository / Warehouse Regional/National Level Stakeholders Regional and Global Collaboration Facility and Field Level Small Clinics • Patient level records • unique client identifier Mobile surveillance / DHIS 2 Tracker, other Supporting Lab Pharmacy Supply & Logistics Emergency

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 e. Health 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 • e. Health Strategy (2009) • EMR guidelines (2011) • ICT Policies at National Level (2012 -2013) • Interoperability – at EMR to DHIS 2 EMR rollout of > 600 hospitals (2013 2014) • National Data Warehouse(s) 13

Health SDOs Defines base standards and data models for clinical messages Defines concepts, data and processes for health and ICTs Defines message ‘Profiles’ that integrate multiple base standards Defines standards for reporting of administrative data (i. e. claims) Defines standards for public health vocabularies/terminology Defines standards for bio-surveillance reporting (i. e. , syndromic surveillance) Defines clinical terminology standards Defines standard codes for tests, measurements and observations

Back to ER CDC 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. ”

Open. HIE The Open Health Information Exchange (Open. HIE) Community: A broad, multi-stakeholder community supporting interoperable health information structures

Open. HIE Community of Communities • • • Client Registry Facility Registry Provider Registry Terminology Service Shared Health Record Interoperability Layer

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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.

Open. HIE December calendar

DHIS 2 Overview • 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. dhis 2. org/

Quick info on District Health Information System (DHIS 2) 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

DHIS 2 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 DHIS 2) • Training material and Capacity Building, M&E -a must • Need toolkits

Progress • Point of Care/EMR to DHIS 2 detailed implementation guidance's • Open. HIE • Freely available standards • e. Learning More governance needed, earlier involvement of HIS and public health informatics, toolkits

Atlas Call to Action in East Africa

Interoperability Guides (POC to Indicator District)

ICT Reviews and Recommendations

Carl Leitner Intra. Health / Capacity. Plus

m. Hero Allows 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 – –

m. Hero • 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.

m. Hero Brings together several sources of heath information to facilitate health worker communication. Systems included: • DHIS 2 • i. HRIS Manage • Rapid. Pro an interactive SMS an IVR (interactive voice response) messaging engine

i. HRIS

m. Hero Open Architecture DHIS 2 CSD FHIR SVS Inter. Linked Registry i. HRIS CSD m. Sync Coordinator Rapid. PRO Open. HIE Interop. Layer Open. HIE m. Hero builds on exisiting Ministry technologies like DHIS 2 and i. HRIS to link them with the Rapid. Pro mobile platform using Open. HIE technologies. Using open source standards and approaches creates an extended national collaborative ecosystem that other solutions can link into. health worker mobile phones

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Example Client Apps Open Architecture Grows Ecosystems Facility Finder – find facilities and directions via MOH website, Voice and SMS Facility Planner – Build apps that look at geographic gaps in accessibility Facility Registry HMISSee the health statistics of your country, sliced in many ways M&EPerformance-Based Sensors & Alarms – Track projects, Financing – Get data about water their efforts, and Track key metrics quality, open doors, key metrics and financial cold chain and other information about sensor data facilities Health Worker Registry

Mobile Open Data Kit (ODK)

Way Forward: Open Standards, Open Technologies, Open Data • Open and freely available Standards (HL 7, ISO, IHE) • Open Architecture • Open Source Software • Guidance documents, Toolkits, Trainings, e. Learning, collaborative platforms

PLUG FOR MHEALTH SUMMIT Open. HIE session next Tuesday December 9 9: 00 am -12: 00 am

Thank you Donna Medeiros Donna_d_medeiros@yahoo. com and Carl Leitner cleitner@capacityplus. org