Shaun Grannis, MD, MS, FAAFP FACMI Biomedical Informatics Scientist Regenstrief Institute / Indiana University The Impact of Interoperability / HIE to a Health System’s Strategic Roadmap: Lessons from the OpenHIE Project

Today’s Agenda The Challenge OpenHIE Framework OpenHIE Community OpenHIE Implementations

Learning Objectives Review the goals objectives of the OpenHIE initiative Enumerate the core components of the OpenHIE framework Describe how the IHE profiles and IHE process supports the OpenHIE initiative

Learning Objectives Review the goals objectives of the OpenHIE initiative Enumerate the core components of the OpenHIE framework Describe how the IHE profiles and IHE process supports the OpenHIE initiative

CHW in the Village Local Clinic Community Hospital Clinical Record System Rapid SMS Hospital Record System Shared Record Coordinated service delivery Two-way information flow Continuity of person-centred care

OpenHIE Framework

Architecture Framework

Terminology Service A Terminology Service serves as a central authority to uniquely identify the clinical activities that occur within the care delivery process by maintaining a terminology set mapped to international standards such as ICD10, LOINC, SNOMED, and others – “What?”

Client Registry An enterprise master patient index (EMPI), or Client Registry manages the unique identity of citizens receiving health services with the country – “For whom”

Shared Health Record A Shared Health Record is a repository containing the normalized version of content created within the community, after being validated against each of the previous registries. It is a collection of person-centric records for patients with information in the exchange.

Health Management Information System A Health Management Information System is a repository containing the normalized version of aggregate-level content created within the community, after being validated against each of the previous registries. It is a collection of indicator-centric records for cohorts with information in the exchange.

Facility Registry A Health Facility Registry serves as a central authority to uniquely identify all places where health services are administered within the country – “Where?”

A Health Worker Registry is the central authority for maintaining the unique identities of health providers within the country – “By whom” Health Worker Registry

Health Interoperability Layer A Health Interoperability Layer receives all communications from point of service applications within a health geography, and orchestrates message processing among the point of service application and the hosted infrastructure elements.

Workflows OpenHIE workflows support common care processes by enabling data exchange using carefully orchestrated sequences of well-defined standards-based transactions. The Workflow Development Process: – Identify a Data Sharing Need – Define Actors who exchange data – Identify Standards & Profiles to support the workflow

OpenHIE’s Workflows … Save a new demographic record Query for a demographic record 1.Query by ID 2.Query by fuzzy match Update an existing demographic record Update inter-linked records Query for inter-linked records (Providers, Facilities, Organizations, Services) Save client encounter document Query for client encounter documents

OpenHIE’s Workflows … Save a new demographic record PIX ITI-8 Query for a demographic record 1.Query by ID PDQ ITI-21 2.Query by fuzzy match PDQ ITI-21 Update an existing demographic record PIX ITI-8 Update inter-linked records CSD ITI-74 Query for inter-linked records (Providers, Facilities, Organizations, Services) CSD ITI-73 Save client encounter document XDS.b ITI-41 Query for client encounter documents XDS.b ITI XDS.b ITI-43

OpenHIE A community of communities

Who we are OpenHIE is a diverse mission-driven community of communities including countries, organizations, individuals and donors working to promote sharing of health data across many different software products. We make and improve interoperability specifications and workflows, international standards, implementation guidance, and reference software to improve the exchange of health information.

MISSION Our mission is to improve the health of the under-served through the open collaborative development and support of country driven, large scale health information sharing architectures. VISION We envision a world where all countries are empowered to pragmatically implement sustainable health information sharing architectures that measurably improve health outcomes.

Community of Communities

Interoperability Layer Mobile Applications Clinical Record Systems Hospital Information Systems Registry of Health Facilities Registry of Clients Health Management IS (HMIS) Shared Health Records Repository Registry of Health Terms Registry of Health Workers Laboratory Information Systems M&E Applications Kenya’s FR

Community roles Develop and refine OpenHIE mission, vision, values and collaborative leadership Cultivate domain-specific communities of practice Define interoperability specifications and workflows Maintain forum for technology developers and implementers Identify and refine appropriate interoperability standards (working within Integrating the Healthcare Enterprise (IHE) process) Develop implementation guidance Develop and support reference technologies. Test technologies against standards to ensure compliance

Community tools Routine community calls – both domain-specific and OpenHIE overall Continued conversations between calls via mailing lists Open wiki archive of – notes and recordings of all conversations – Community plans – Interoperability specifications – Implementation guidance Open source repository of reference software and documentation.

Country Leadership & eHealth Capacities eHealth Strategy and Policy Framework eHealth Stakeholder Leadership ICT Infrastructure Health Information Technologists eHealth Literacy for Health Workers Global, Regional & National eHealth Partnering

OpenHIE Implementations

Implementations 1.Rwanda Health Information Exchange – Jembi, Regenstrief Institute, ecGroup 2.South Africa MomConnect – Jembi, Praekelt Foundation, HISP-SA 3.Other South Africa Implementations – Jembi, HISP-SA and Partners 4.Philippines Health Information Exchange – Ministry of Health and Partners 1.Tanzania Better Immunization Data Exchange – PATH, IntraHealth, ecGroup, Airis, Mohawk College 2.Health Worker Response and Outreach (mHero) – Intrahealth, UNICEF, USAID, Jembi, ThoughtWorks

To Get Involved ohie.org/getinvolved