DHIS2 Interoperability August 16, 2014 Jørn Braa Bob Jolliffe Carl Leitner

HMN architecture - National data warehouse: Enterprise architecture for management

Getting data in - Data warehousing Web Portal Data capture from paper forms -Data mart -Meta data -Visualising tools Dashboard Data from Mobile devises Data warehouse DHIS 2 Extract Transform Load LMIS Graphs EMR HR Maps Mobile Getting data in - Data warehousing Getting data out - Decision support systems – ‘Business intelligence (BI)

Integration and interoperability DHIS : Data warehouse Statistical data Data transfer from iHRIS to DHIS, e.g.: #midwifes @health centre X for month of May Data transfer from OpenMRS To DHIS, e.g.: #deliveries @health centre X for month of May DHIS is calculating the indicator: Deliveries per midwife Per facility per month Interoperability Interoperability iHRIS: Human Resource records OpenMRS : Medical records Integration

In many countries there’s a lack of health workforce data: **on training status **on the registration of workers in certification or licensure programs **on the distribution and deployment of workers especially in rural areas **on management to meet emerging or changing needs **finally, on planning to develop policies and programs to place the right person with right skills in the right place at the right time All of these features and factors inform sound decisions as to the skills and availability of the workforce

In many countries there’s a lack of health workforce data: **on training status **on the registration of workers in certification or licensure programs **on the distribution and deployment of workers especially in rural areas **on management to meet emerging or changing needs **finally, on planning to develop policies and programs to place the right person with right skills in the right place at the right time All of these features and factors inform sound decisions as to the skills and availability of the workforce

What is Interoperability? Main Use Case: iHRIS & DHIS2 Data Exchange There are 2 Nurses in Plebo Clinic this month Thank you very much! iHRIS DHIS2 Collects detailed information on health workers Wants to share number of health workers by facilities and cadre In many countries there’s a lack of health workforce data: **on training status **on the registration of workers in certification or licensure programs **on the distribution and deployment of workers especially in rural areas **on management to meet emerging or changing needs **finally, on planning to develop policies and programs to place the right person with right skills in the right place at the right time All of these features and factors inform sound decisions as to the skills and availability of the workforce Wants to know number of health workers by facility and cadre

iHRIS & DHIS2 Data Exchange: The Problem of Standardized Lists There are 2 Nurses in Plebo Clinic this month There are 2 Nurses in Plebo Clinic this month Do you mean “Plebo HC”? What’s a Nurse? iHRIS DHIS2 In many countries there’s a lack of health workforce data: **on training status **on the registration of workers in certification or licensure programs **on the distribution and deployment of workers especially in rural areas **on management to meet emerging or changing needs **finally, on planning to develop policies and programs to place the right person with right skills in the right place at the right time All of these features and factors inform sound decisions as to the skills and availability of the workforce Computers are stupid! We need to tell them that “Plebo Clinic” and “Plebo HC” are the same iHRIS needs to tell DHIS2 about the cadres it manages

Governance of Standardized Lists All lists should be coded “Plebo Clinic” and “Plebo HC” all share the same code “24” This code is available to all systems What is in this list? What is a health facility? A point of clinical care? What about pharmacies? Labs? The MoH headquarters? What is a health worker? WHO: All people engaged in the promotion, protection or improvement of the health of the population Who owns each of the standard data lists? What is the authoritative body? Ownership = Responsibility to maintain and share this list

iHRIS & DHIS2 Meta-Data Exchange: Sharing Meta-Data / Standardized Lists Was ist Ihre Liste von Gesundheits-einrichtunge? Вот мой список клиник What is your list of clinics? Here is my list of clinics Here is my list of cadres? What is your list of cadres? iHRIS DHIS2 Wants to know list of facilities Wants to share list of HW cadres In many countries there’s a lack of health workforce data: **on training status **on the registration of workers in certification or licensure programs **on the distribution and deployment of workers especially in rural areas **on management to meet emerging or changing needs **finally, on planning to develop policies and programs to place the right person with right skills in the right place at the right time All of these features and factors inform sound decisions as to the skills and availability of the workforce Wants to share list of facilities Wants to know list of HW cadres iHRIS and DHIS2 need a common language to talk with each other! (SVS = Sharing Value Sets)

iHRIS & DHIS2 Data Exchange: Main Use Case – Revisited Es sind 2 der Cadre #4 in der Einrichtung #24 diesen Monat что? There are 24 of Cadre #4 at Facility #24 on 05-01-2014 Thank you very much iHRIS DHIS2 In many countries there’s a lack of health workforce data: **on training status **on the registration of workers in certification or licensure programs **on the distribution and deployment of workers especially in rural areas **on management to meet emerging or changing needs **finally, on planning to develop policies and programs to place the right person with right skills in the right place at the right time All of these features and factors inform sound decisions as to the skills and availability of the workforce Shared Standardized Lists Are Not Enough Need language to communicate the numerical data (DXF): The value we are reporting (Cadre #4) The place the data comes from (Facility #24) The reporting period (05-01-2014)

iHRIS & DHIS2 Data Exchange: System Complexity I CAN HAZ INTEROPERABILITY? mHealth Medical Records Supply Chain mHealth mHealth Yes! Doctor Council iHRIS DHIS2 Crisis Alerts Nursing Council In many countries there’s a lack of health workforce data: **on training status **on the registration of workers in certification or licensure programs **on the distribution and deployment of workers especially in rural areas **on management to meet emerging or changing needs **finally, on planning to develop policies and programs to place the right person with right skills in the right place at the right time All of these features and factors inform sound decisions as to the skills and availability of the workforce Labs Share cadre lists Share facility lists Share number of health workers Share facility list Share stock lists Share current stock levels In-Service Training

iHRIS + DHIS2 Interoperability Variations of the above implemented in: What if there is more than one iHRIS system? What if you don’t have iHRIS?

Health Information System Health Information Exchange Interlinked Health Services Health Worker Registry Facility Registry Terminology Service Client Registry Health Management Information System Shared Health Record DHIS2 OrgUnits DHIS2 Aggregate Data Warehouse Interoperability Layer Messaging / Alerts DHIS2 Tracker Citizen Access Training Information Systems Point Of Care Applications mHealth Apps

Care Services Discovery Care Services Discovery (CSD) International Standard from IHE (Integrating the Health Enterprise) Federated XML data model Extensible API for Health Service Discovery OpenInfoMan (Reference Implementation) XQuery Implementation using BaseX Adapters (e.g. FHIR, OpenSearch) Interlinked Health Services Health Worker Registry Facility Registry Interlinked Health Services Health Workers Organizations Facilities Services

Care Services Discovery - Actors Services Finder Services Directory Brokers queries on health services Services Finder Services Directory Services Finder Info Manager Services Directory Services Finder Services Directory Services Finder Services Directory Wants to know about health services Knows about health services

Organizational Affiliation Service Delivery Organizations National (MOH, FBO) Regional, District Collections (e.g. Org Units at level < 4) Professional Councils and Organizations Insurance Funds What service delivery organization employees a health worker? What service delivery organization manages a facility? Health Workers Organizations Facilities Services

Facility Affiliation What is the physical location of a health worker? What services are available at a facility from a health service delivery organization? What services does a health worker provide at a facility? Health Workers Organizations Facilities Services

Provider Affiliation Who is the contact health worker for a facility? Who is the contact health worker for an organization? Health Workers Organizations Facilities Services

Federated Facility Information Faith Based Organization Faith Based Organization Ministry of Health Private Sector Private Sector Facility Registry Organizations Facilities

Federated Health Worker Information HR Management System iHRIS Manage HR Management System iHRIS Manage License + Registration iHRIS Qualify HR Management System iHRIS Manage License + Registration iHRIS Qualify License + Registration iHRIS Qualify In-Service Training iHRIS Train In-Service Training iHRIS Train In-Service Training iHRIS Train Health Worker Registry Health Workers Organizations Pre-Service Training iHRIS Grad Tracker

Data Governance Of Federated Directories

Current Health Worker Registry Implementations

HWR & DHIS2 Data Exchange: Main Use Case – Revisited (Again) There are 24 of Cadre #4 at Facility #24 on 05-01-2014 Thank you very much Interlinked Health Services Health Management Information System Health Worker Registry Facility Registry DHIS2 can act as Source Directory for FR DHIS2 as HMIS can synchronize the list of facilities from FR HWR pulls list of facilities from FR HWR publishes list of health cadres on a Terminology Service (TS) DHIS2 as HMIS pulls list of health cadres from TS and creates data set DHIS2 as HMIS pulls aggregate HW data from HWR

Facility Registry Scenarios Native Support DHIS2 (direct support for CSD in core) Facility Registry Facade DHIS2 (metadata export) OpenInfoMan (Services Directory) Facility Registry DHIS2 (pulls org unit data) External Synchronization Rwanda, Kenya*, Tanzania

Terminology Service Scenarios Native Support iHRIS 4.2 Terminology Service Facade DHIS2 (metadata export) OpenInfoMan (SVS Repository) Terminology Service DHIS2 External Synchronization SVS, CTS2, FHIR, etc.

Getting Connected OpenHIE http://ohie.net Health Worker Registry Community https://groups.google.com/forum/#!forum/provider-registry Facility Registry Community https://wiki.ohie.org/display/SUB/Facility+Registry+Community BaseX https://basex.org OpenInfoMan DHIS Adapter https://github.com/openhie/openinfoman-dhis HWR Implementation Guide http://bit.ly/1oUkJTF OpenInfoMan https://github.com/openhie/openinfoman IHE ITI Committee http://wiki.ihe.net/index.php?title=ITI_Technical_Committee HMIS Community https://groups.google.com/forum/#!forum/open-hmis Care Services Discovery http://bit.ly/1mPKbot