1. Interoperability in Crisis Donna Medeiros and Carl Leitner Hl7 Policy Conference December 5, 2014

2. Today’s Discussion Overview of HIS in developing countries, especially Africa Goals, challenges, progress Technologies in use: OpenHIE, iHRIS, DHIS2, mHero Case Study – Liberia

3. Acknowledgements Regenstrief Institute IntraHealth International WHO eHealth and Knowledge Management CDC USAID MSF/Doctors without Borders Futures Group RTI International OGAC

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

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

6. eHealth 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 (eLearning) o Other Health Information Systems

7. 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 OpenMRS Implementers community ‘Call to Action’ (Liberia and Sierra Leone) Health Information Exchange (OpenHIE) getting utilized

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

9. Health Information System Ecosystem Example Small Clinics Lab Emergency Supply & Logistics Pharmacy Regional/National Level Regional and Global Collaboration Facility and Field Level Supporting Patient level records unique client identifier Mobile surveillance / DHIS2 Tracker, other Data Repository / Warehouse Stakeholders

10. 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 eHealth 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

11. Medical treatment area (MSF)

12. Clinic Line

13. Kenya’s Progression eHealth Strategy (2009) EMR guidelines (2011) ICT Policies at National Level (2012-2013) Interoperability – at EMR to DHIS2 EMR rollout of > 600 hospitals (2013 - 2014) National Data Warehouse(s) 13

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

15. Back to ER CDC Incident Management System

18. “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.”

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

20. OpenHIE Community of Communities Client Registry Facility Registry Provider Registry Terminology Service Shared Health Record Interoperability Layer

21. Architecture

22. 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. Health Interoperability Layer

23. OpenHIE December calendar

24. 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.dhis2.org/ DHIS2 Overview

25. 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 Quick info on District Health Information System (DHIS 2)

26. DHIS2 Architecture

27. 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 DHIS2) Training material and Capacity Building, M&E -a must Need toolkits

28. Point of Care/EMR to DHIS2 detailed implementation guidance's OpenHIE Freely available standards eLearning More governance needed, earlier involvement of HIS and public health informatics, toolkits Progress

29. Atlas Call to Action in East Africa

30. Interoperability Guides (POC to Indicator District)

31. ICT Reviews and Recommendations

32. Carl Leitner IntraHealth / CapacityPlus

33. mHero 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

34. 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. mHero

35. Brings together several sources of heath information to facilitate health worker communication. Systems included: DHIS2 iHRIS Manage RapidPro an interactive SMS an IVR (interactive voice response) messaging engine

36. iHRIS

37. mHero Open Architecture health worker mobile phones mHero builds on exisiting Ministry technologies like DHIS2 and iHRIS to link them with the RapidPro mobile platform using OpenHIE technologies. Using open source standards and approaches creates an extended national collaborative ecosystem that other solutions can link into. OpenHIE DHIS2 iHRIS RapidPRO Inter- Linked Registry CSD FHIR SVS OpenHIE Interop. Layer mSync Coordinator mHero

38. Architecture

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

40. Mobile Open Data Kit (ODK)

41. Way Forward: Open Standards, Open Technologies, Open Data Open and freely available Standards (HL7, ISO, IHE) Open Architecture Open Source Software Guidance documents, Toolkits, Trainings, eLearning, collaborative platforms

42. PLUG FOR MHEALTH SUMMIT OpenHIE session next Tuesday December 9 9:00am -12:00am

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