1. NHID/mRegistry Workshop | 16 September 2014 1 |1 | Overview of Mobile Registry (OpenSRP) and National Health ID (NHID) Registry and Index Projects Mark Landry, WHO (landrym@wpro.who.int)

2. NHID/mRegistry Workshop | 16 September 2014 2 |2 | Outline Use of Information and Communications Technology (ICT) to enhance integrated active case management Feasibility of implementing a mobile Registery (mRegistry) platform to address HIV lost to follow up Importance of investing in a National Health ID (NHID) registry and index for immediate benefits and to address future purposes

3. NHID/mRegistry Workshop | 16 September 2014 3 |3 | SETTING THE SCENE

4. a Started ART scale-up Started VCCT scale-up Finger prick testing HIV Epidemic in Cambodia

5. Confirm & enroll in Pre-ART ART PreART TB PW KPs STI Finger Prick    Case Management Coordinator (CMC ) PMTCT, TB/HIV Treatment as Prevention Partner Tracing and Testing CMP Civil Society Organizations (Community-based Prevention, Care and Support) Integrated Active Case Management to Maximize Retention linking prevention and care for KPs CMP: Case Management Provider

6. NHID/mRegistry Workshop | 16 September 2014 6 |6 | JUNE/JULY MISSION HIGHLIGHTS

7. NHID/mRegistry Workshop | 16 September 2014 7 |7 | Key Considerations Need for innovative, cost-efficient use of ICT in increasing resource constrained environment Disparent NCHADS databases with duplicative patient records plus loss-to-follow-up issues Multiple unique ID schemes for health services and patient monitoring systems (PMRS, MARPS, Fingerprint ID, CRVS, medical records/folders, etc.) Significant health ICT investments made and more planned with urgent need for better coordination across all Avoid one-off projects and plan for scale and sustainability

8. NHID/mRegistry Workshop | 16 September 2014 8 |8 | Potential Use of Mobile Registry Platform Linked HIV active case management patient data into Web-based real-time data synchronized integrated mobile platform Unified IDs – Adoption of PMRS 9-digit NHID (w/ check digit) Target: CMCs/CMAs, HCs, Outreach HTC, VCCT, Pre-ART, ART, TB/HIV, STI Tech Exchange (PMRS, OpenSRP, Fingerprint ID, HC/Hospital tablets, other)

9. mehlg@who.int

11. NHID/mRegistry Workshop | 16 September 2014 11 | Linking Individuals through Unique IDs ID Poor/PMRS Card and 10-digit ID emerging as NHID 9 alpha-numeric ID for MARPS (KP) linked to NHID 17 alpha-numeric ID for RMNCH and CRVS also linked to NHID Phased approach, incorporate patient data one- database-at-a-time into NHID Registry and Index Use HIV continuum of care, integrated active case management approach to initiate development

12. NHID/mRegistry Workshop | 16 September 2014 12 | Next Steps Taken Developed concept note (ToRs and budget) for integrated active case management mRegistry Feasibility Analysis and prototype to be completed by the end of December 2014 Initiated NHID Registry and Index development using a Web- based solution for unifying and implementing a NHID scheme that can expand and adapt as needed Support recommendations for short- and long-term NCHADS data management strengthening Support national eHealth action planning and prioritization and capacity building

13. NHID/mRegistry Workshop | 16 September 2014 13 | M-REGISTRY TO ADDRESS HIV LOST-TO-FOLLOW-UP

14. NHID/mRegistry Workshop | 16 September 2014 14 | Task 1: mRegistry (OpenSRP) Feasibility Analysis Build upon recommendations to NCHADS (Hutton, US CDC) see reference slides Review/clarify existing patient flow/data flow analysis (HIV patient monitoring cascade) Conduct user needs assessment and gather requirements –Focus group discussions, including patients, CMPs, CMC/CMAs, system owners, managers, partners, etc. –Develop use cases using a ‘user story’ approach for integrated active case management

15. NHID/mRegistry Workshop | 16 September 2014 15 | Task 1: mRegistry (OpenSRP) Feasibility Analysis (continued) Prioritize 1-2 lost to follow-up scenarios –VCCT  Pre-ART  OI/ART –PMTCT  OI/ART Capture and document technical requirements Propose, design, discuss, re-design mobile registry forms and user interface with stakeholder input Review array of existing infrastructure, technologies, platforms, tools, components in use (analysis of alternatives) Develop prototype and capture user feedback

16. NHID/mRegistry Workshop | 16 September 2014 16 | NHID REGISTRY AND INDEX

17. NHID/mRegistry Workshop | 16 September 2014 17 | Task 2: NHID Registry and Index Development Build upon previous recommendations to NCHADS (Hutton, US CDC) see reference slides Design NHID web-services and database model –Map all existing ID schemes from current registries, applications, databases (NCHADS, DPHI, partner-supported systems, etc) –As the core or ‘proxy’ national health ID for starters, will need to develop Internet access point to PMRS (Health Equity Fund/ID Poor database) – DPHI Map, analyze, de-duplicate, develop automated quality checks and protocols, etc. for NHID indexing and consolidated database model

18. NHID/mRegistry Workshop | 16 September 2014 18 | Perform localized and manual cross-database ID matching analysis and development for individuals in demonstration area (Battambang) Explore cost-sharing services between NCHADS and DPHI on Internet access and Cloud-based hosting services across increasing array of Web-based applications and services Initiate NHID development program through MoU agreements and stepwise approach towards convergence of a NHID in the future (considering patient data security, confidentiality, and privacy protocols) Task 2: NHID Registry and Index Development (continued)

19. NHID/mRegistry Workshop | 16 September 2014 19 | Deliverables HIV mRegistry Feasibility Analysis (Implementation Plan) for all phases: –Planning (use cases, requirements, analysis of alternatives) –Design specifications (prototype and user feedback) –Development approach (scalable and flexible) –Deployment (training requirements) –Operation/maintenance (roadmap for sustainability) Cloud-based NHID Registry and Index requirements and database model ready for deployment

20. NHID/mRegistry Workshop | 16 September 2014 20 | Previous Recommendations Resource Number Type Minimum Experience Level Estimated Level of Effort (Months) 1Data Base Administrator;.NET programmer3+ years 24 (may be spread over 36 months) Plan all systems and generate all tools required to support all data input and output needs to provide a robust national patient registry infrastructure (with no single points of failure); Plan all infrastructure required with project manager; work as needed to support consensus with stakeholders; pilot test and implement patient registry. 2Project Manager3+ years36 Plan all requirements to support availability of an electronic and paper based patient registry service for all patient registration, data updates, printing of identification cards, estimate costing and HR requirements to provide ongoing national support, estimate data volume, generate recommended functional and technical requirements and get feedback from stakeholders, report to stakeholders to gain approval, develop functional and technical specifications, plan work packages and schedule, pilot test and manage a national scale up for a high quality outcome for this task. Build a National Health Identifier Registry and Index

21. NHID/mRegistry Workshop | 16 September 2014 21 | Previous Recommendations Integrate the National Health Identifier Registry with the ID Poor System Resource Number Type Minimum Experience Level Estimated Level of Effort (Months) 1Data Base Administrator;.NET programmer3+ years12 Plan all systems and generate all tools required to support all data input and output needs to provide the infrastructure required to support the merging of current ID Poor data with the National Patient Registry (with no single points of failure); Plan all infrastructure required with project manager; work as needed to support consensus with stakeholders; pilot test and implement patient registry. 2Project Manager3+ years12 Plan all requirements to support integration of an electronic and paper based patient registry service with the ID Poor data, receive nightly data updates, estimate costing and HR requirements to provide ongoing national support, estimate data volume, generate recommended functional and technical requirements and get feedback from stakeholders, report to stakeholders to gain approval, develop functional and technical specifications, plan work packages and schedule, pilot test and manage a national scale up for a high quality outcome for this task.

22. NHID/mRegistry Workshop | 16 September 2014 22 | Previous Recommendations Implement Infrastructure to Support Health Data Sharing Resource Number Type Minimum Experience Level Estimated Level of Effort (Months) 1Data Base Administrator;.NET programmer3+ years12 Plan all systems and generate all tools required to support all data input and output needs to provide the infrastructure required to support the merging of current ID Poor data with the National Patient Registry (with no single points of failure); Plan all infrastructure required with project manager; work as needed to support consensus with stakeholders; pilot test and implement patient registry. 2Project Manager3+ years12 Plan all requirements to support integration of an electronic and paper based patient registry service with the ID Poor data, receive nightly data updates, estimate costing and HR requirements to provide ongoing national support, estimate data volume, generate recommended functional and technical requirements and get feedback from stakeholders, report to stakeholders to gain approval, develop functional and technical specifications, plan work packages and schedule, pilot test and manage a national scale up for a high quality outcome for this task.

23. NHID/mRegistry Workshop | 16 September 2014 23 | Previous Recommendations Provide electronic tools for rapid patient enrollment Resource Number Type Minimum Experience Level Estimated Level of Effort (Months) 1Data Base Administrator;.NET programmer3+ years18 Organize additional data structures required to support persons reactive but not enrolled in Pre-ART; Generate electronic forms to support the planned functional requirements; 2Project Manager3+ years18 Plan input and output needs of data consumers to support early enrollment, form stakeholders group, generate recommended forms and get feedback, explore PC based and alternative cell data capable device based input (smart phone), report to stakeholders to gain approval, develop functional and technical specifications, plan work packages and schedule, pilot test and manage a high quality outcome for this task. 3PC and Network Administrator3+ years12 Work with project manager to plan and specify functional and technical requirements of all infrastructure to support early enrollment; implement the pilot test; provide pilot results and estimated time frame for national rollout, perform, document, and test all items related to national infrastructure for early enrollment.