1. Harvesting Architecture From Active eHealth Projects Paul Biondich, MD MS Shaun Grannis MD MS …and the entire OpenHIE community

2. What We’ll Cover Examples of information sharing Models of architectural development How architecture promotes reuse OpenHIE: a community of practice Discussion / questions

3. Overheard during WAHO meeting… Surveillance models are “front of mind” for most WAHO countries Concerns that surveillance might starve traditional health service delivery Are there ways to service surveillance & other aspects of health delivery simultaneously? How can we become informed consumers / directors of health IT implementation?

4. INTEROPERABILITY? ARCHITECTURE?

5. Surveillance System A Surveillance System B Surveillance System C

7. ?

9. Surveillance System A Surveillance System B Surveillance System C

10. Registry of Health Facilities National HMIS 230493 Ejisu Clinic 3544765-5 44908-2 Ejisu Clinic 3544765-5 927852 Juaben Hospital 4357245-2 Supports a consistent list of unique locations and care organizations that deliver health services within a country. Allows for rich descriptions of each of these places It answers the question “Where was care delivered?” Supports a consistent list of unique locations and care organizations that deliver health services within a country. Allows for rich descriptions of each of these places It answers the question “Where was care delivered?” Surveillance System A Surveillance System B Surveillance System C

11. Registry of Health Facilities National HMIS Registry of Health Terms 45Q72 # confirmed w/EVD 276-6 95425 # confirmed w/EVD 276-6 IND#452 # confirmed w/EVD 276-6 Uniquely identifies the clinical ideas that occur within an enterprise Defines codes for each idea, as well as how those ideas relate to each other Answers the question, “What health concepts do we need to communicate?” Uniquely identifies the clinical ideas that occur within an enterprise Defines codes for each idea, as well as how those ideas relate to each other Answers the question, “What health concepts do we need to communicate?” Surveillance System A Surveillance System B Surveillance System C

12. Registry of Health Facilities Inherently Reusable / Useful… Facility Finder: Person finds facility via name, phone number, etc. Facility Planner: Plan for future facilities by identifying geographic or other attributed gaps Facility-Based Performance Financing: track key metrics or financials for a given facility Whatever user-centric need emerges!

13. Building incrementally towards an architecture… MNCH Use Case

14. Dispensary / Antenatal Clinic Place where antenatalcare services are typicallydelivered Record system in place tomanage information foreach pregnant mother Often distinct electronicrecord system within eachclinic Place where antenatalcare services are typicallydelivered Record system in place tomanage information foreach pregnant mother Often distinct electronicrecord system within eachclinic Dispensary / Antenatal Clinic

15. Community Health Worker Community Health Worker Attends to mothers inbetween visits Identifies pregnancy, looksfor risk during pregnancy CHWs often communicatethis information via SMSmessage to a centralserver Attends to mothers inbetween visits Identifies pregnancy, looksfor risk during pregnancy CHWs often communicatethis information via SMSmessage to a centralserver

16. Dispensary / Antenatal Clinic District / Referral Hospital Community Health Worker Supports high riskproblems duringpregnancy Supports high riskdeliveries Each hospital often has adistinct hospitalinformation system thatsupport clinical andadministrative services Supports high riskproblems duringpregnancy Supports high riskdeliveries Each hospital often has adistinct hospitalinformation system thatsupport clinical andadministrative services District / Referral Hospital

17. Building towards an architecture?

18. Community Health Worker Dispensary / Antenatal Clinic District / Referral Hospital 230493 Ejisu Clinic 3544765-5 44908-2 Ejisu Clinic 3544765-5 927852 Juaben Hospital 4357245-2 Supports a consistent list of unique locations and care organizations that deliver health services within a country. Allows for rich descriptions of each of these places It answers the question “Where was care delivered?” Supports a consistent list of unique locations and care organizations that deliver health services within a country. Allows for rich descriptions of each of these places It answers the question “Where was care delivered?” Registry of Health Facilities National HMIS Registry of Health Terms

19. Community Health Worker Dispensary / Antenatal Clinic District / Referral Hospital 528465 Hemoglobin, Total 718-7 42798 Hgb Lvl 718-7 924356 Hemog Level 718-7 Uniquely identifies the clinical ideas that occur within an enterprise Defines codes for each idea, as well as how those ideas relate to each other Answers the question, “What health concepts do we need to communicate?” Uniquely identifies the clinical ideas that occur within an enterprise Defines codes for each idea, as well as how those ideas relate to each other Answers the question, “What health concepts do we need to communicate?” Registry of Health Facilities National HMIS Registry of Health Terms

20. Community Health Worker Dispensary / Antenatal Clinic District / Referral Hospital Registry of Health Facilities Registry of Clients National HMIS Registry of Health Terms 002867- 5 Dansua, Samia 463782 770301 Dansua, Samea 463782 1289495 Dans ue, Samia 463782 Maintains a unique and consistent identity for all clients receiving health care services. Answers the question, “For whom was care delivered? ” Maintains a unique and consistent identity for all clients receiving health care services. Answers the question, “For whom was care delivered? ”

21. Community Health Worker Dispensary / Antenatal Clinic District / Referral Hospital Registry of Health Facilities Registry of Clients National HMIS Registry of Health Terms 393719 Frances Marley 12563-3 429465-1 Nurse Idris Elba 14267-9 828364 Dr. Kwame Anyidoho 11935-4 Maintains consistent and unique identities for health workers within an enterprise. Allows for rich description of each health worker Answers the question, “by whom was care delivered? ” Maintains consistent and unique identities for health workers within an enterprise. Allows for rich description of each health worker Answers the question, “by whom was care delivered? ” Registry of Health Workers

22. Community Health Worker Dispensary / Antenatal Clinic District / Referral Hospital Registry of Health Facilities Registry of Clients National HMIS Registry of Health Terms Maintains a normalized collection of clients’ health data that is validated and standardized using each of the registries. Supports storing and querying patient centric data across the entire enterprise. Maintains a normalized collection of clients’ health data that is validated and standardized using each of the registries. Supports storing and querying patient centric data across the entire enterprise. Registry of Health Workers Shared Health Records Repository

23. Community Health Worker Dispensary / Antenatal Clinic District / Referral Hospital Registry of Health Facilities Registry of Clients National HMIS Registry of Health Terms Provides the infrastructure to process information coming from various point of care health applications Also processes queries coming from these same point of care systems Manages access to and security of the contents of the exchange Provides the infrastructure to process information coming from various point of care health applications Also processes queries coming from these same point of care systems Manages access to and security of the contents of the exchange Registry of Health Workers Shared Health Records Repository Interoperability Layer

26. Other real-world implementations Tanzania: BID (better immunization delivery) South Africa: momConnect Liberia: mHero Bangladesh: BHIE Philippines: PHIE Nigeria’s ICT Framework …many more being conceived

27. “Our 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.”

29. http://ohie.org

33. 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

34. The difficult stuff… Technology is the “easy part” Responsible technologies support: –Governance choices of the country/region –Requirements from the broadest set of stakeholders –Local development, evolution, and sustainability Who serves as “authority” within country for a given architectural component?

35. 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

36. http://ohie.org Questions? Want a copy of the slides? Scan ->..or go to: http://pgb.me/waho