The Use of Open HIE for the Tanzania

The Use of Open. HIE for the Tanzania BID Project Interoperability Overview

BID Initiative - Tanzania Better data. Better decisions. Better health. 4 November 2016

BID Initiative at a Glance The Better Immunization Data (BID) Initiative, led by the Tanzania Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) in Partnership with PATH and funded by the Bill & Melinda Gates Foundation aims to support Tanzania to enhance immunization and overall service delivery through improved data quality and use. Objectives: • Improve immunization data quality and availability. • Increase data use and decision skills at all levels of health system. • Build motivation to use data to improve performance. • Increase capacity to monitor performance

Tanzania challenges In partnership with Tanzania Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) through the Immunization and Vaccines Development (IVD) Program, the BID Initiative identified a number of critical data-related challenges: § Incomplete or untimely data. § Inaccurate or uncertain target population for calculating immunization rates. § Difficulty identifying infants who do not start immunization or who drop out (defaulter tracing). § Lack of unique identifiers for infants. § Poor data visibility into supplies at the facility level to district-level data and stock. § Complex data collection forms and tools. § Insufficient supply chains and logistics management. § Inadequate data management and use capacity at all levels of the health system.

Tanzania interventions To solve the challenges, the BID Initiative, in consultation with MOHCDGEC and healthcare workers at all levels of the health system, identified the following interventions: § Electronic immunization registry with supply chain information. § Automated, simplified report generation. § Barcodes on child health cards and vaccine supplies. § Targeted supportive supervision for health workers. .

Utilizing an Interoperable Architecture for Data Exchange

Architecture Framework

A Story to Illustrate How Open. HIE Works Let’s walk through the story of Mosa…

But First! Many thanks to Carl F, Derek R, Ryan C, Wayne N, Pascal B, Daniel F and others that originally created this story!

Meet Mosa • Mosa is 19 years old and lives in a small village • She is pregnant • Like many in her village, she is HIV Positive

Meet Mosa • Mosa registered at a local clinic providing MOHsponsored antenatal care (ANC).

Using National ID for Info 1. The clinic uses a local instance of an electronic medical record (EMR) and syncs with the shared health record (SHR). 2. The clinic’s local EMR uses Mosa’s national ID to sync with the National HIE.

Logging Protocols • The local EMR notes to the national SHR, through the Interoperability Layer, that Mosa requires hospital delivery using PMTCT protocols.

CHW Grace • Weeks into her pregnancy, Mosa experiences minor bleeding. • Grace, a community health worker attending to Mosa, logs this information on a basic mobile application.

At the Clinic • Grace advises Mosa to go to the clinic for a checkup. • At the clinic, Mosa is found to be anemic and referred to the hospital. • The referral is flagged ‘urgent’ and updated to Mosa’s SHR.

Three Days Later • Mosa has not checked in to the hospital. • A mobile alert is sent to Grace, who finds Mosa at home with a fever.

At the Hospital • Grace arranges for Mosa’s transport to the hospital. • Health workers there retrieve Mosa’s medical history from her SHR.

Appropriate Care • With the information from Mosa’s SHR, health workers know to implement appropriate PMTCT protocols during Mosa’s delivery.

BID Architecture

The Health Facility Registry is contains information on all the health facilities in the country.

Medic Client Registry maintains a master list of patients in a jurisdiction.

Rapid. Pro is a platform for creating complex SMS workflows. The Village Elder Mobile App is one example of an application that uses Rapid. Pro workflows.

Tanzania Immunization Registry (TIm. R) TIm. R is a multi-application, scalable immunization registry platform.

Vaccine Immunization Management System (VIMS) VIMS receives aggregate immunization coverage and other data from TIm. R.

How does BID work? Let’s walk through the story of Neema

Meet Neema • Neema is Mosa’s sister. • She lives in Saba Village and has just had a baby, whom she named Ally. • Neema is not HIV+ and her baby has been born healthy.

Meet Moses, Village Elder • Moses lives in Saba Village. • A Village Elder, he is dedicated to supporting the health of his people. • Moses has been registered with the BID birth registration system and tied to Saba Village. This allows him to play an important role in keeping his village healthy.

Meet Lucy, District Immunization & Vaccine Officer • Lucy is a DIVO who works in Arusha District. • Part of Lucy’s role is to ensure that there are no stock outs of essential drugs or commodities.

Registering Baby Ally • When baby Ally was born, Moses sent a SMS through Rapid. Pro that included important data elements: • Baby’s Name, Date of Birth, Gender and Mother’s Name

Populating the Client Registry • The information about baby Ally went from Rapid. Pro through the Interoperability Layer (Open. HIM) to populate the Client Registry (Medic CR).

Notifying TIm. R • The Medic CR pushes the information about baby Ally through Open. HIM into TIm. R.

Neema Takes Ally to the Clinic • • Neema takes Ally to get vaccinated. A nurse administers a vaccine then searches TIm. R to find Ally’s record. After locating it, she enters the names of vaccinations received and saves them to his record.

Neema Gets a Reminder Neema is busy with her new baby and misses his next vaccination appointment. • Three days later, she gets a SMS on her phone, reminding her to take Ally to get vaccinated. •

Managing Vaccine Stock Levels • Lucy, the DIVO, is working in VIMS and notices that BCG stock is low in Saba Health Center. • She enters a distribution in VIMS so that more BCG can be delivered to the facility.

Recording Vaccine Distribution Each week, Open. HIM pulls counts of vaccines given and stock levels from TIm. R and pushes them into VIMS. It also pushes aggregate data into VIMS on a monthly basis. • Thresholds for ‘below safety stock levels’ are kept in both VIMS & TIm. R. •

Managing Vaccine Stock Levels • The IL pulls this request from VIMS and sends a notification to TIm. R that more BCG stock is on its way.

Overview of Tanzania Immunization Registry TIm. R /tēmər/

What is TIm. R? • The Tanzania Immunization Registry (TIm. R) is a multiapplication, scalable immunization registry platform. • TIm. R consists of many components: – IMS – Immunization Management System • Cloud based, user’s don’t see this – Mobile Application – TIm. R Mobile • Android based disconnected client for TIm. R data – DIVO Web Portal • Web based portal for completing orders, running complex reports, etc. – Administration Portal • Web based portal for administering the TIm. R system – Interoperability Layer • Used to integrate TIm. R with other systems such as VIMS and DHIS 2 – Data Warehouse • Used to provide in-application reporting from TIm. R source data

Solutions Architecture Open. HIE Admin UI Mobile UI Mini IMS TIm. R Web UI Jasper Reports Jasper ETL

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