harvesting architecture from active ehealth projects paul biondich, md ms shaun grannis md ms …and...

Harvesting Architecture From Active eHealth Projects

Paul Biondich, MD MS

Shaun Grannis MD MS

…and the entire OpenHIE community

What We’ll Cover

• Examples of information sharing• Models of architectural development• How architecture promotes reuse• OpenHIE: a community of practice• Discussion / questions

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?

INTEROPERABILITY?

ARCHITECTURE?

Surveillance System A

Surveillance System B

Surveillance System C

?

Surveillance System A

Surveillance System B

Surveillance System C

Registry of Health

Facilities

NationalHMIS

230493   Ejisu Clinic

3544765-544908-2  

Ejisu Clinic

3544765-5927852

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?”

Surveillance System A

Surveillance System B

Surveillance System C

Registry of Health

Facilities

NationalHMIS

Registry of Health Terms

45Q72 # confirmed w/EVD

276-695425

# confirmed w/EVD

276-6IND#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?”

Surveillance System A

Surveillance System B

Surveillance System C

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!

Building incrementally towards an architecture…

MNCH Use Case

Dispensary / Antenatal

Clinic

• Place where antenatal care services are typically delivered

• Record system in place to manage information for each pregnant mother

• Often distinct electronic record system within each clinic

Dispensary / Antenatal

Clinic

Dispensary / Antenatal

Clinic

Community HealthWorker

Community HealthWorker

• Attends to mothers in between visits

• Identifies pregnancy, looks for risk during pregnancy

• CHWs often communicate this information via SMS message to a central server

Dispensary / Antenatal

Clinic

District / Referral Hospital

Community HealthWorker

• Supports high risk problems during pregnancy

• Supports high risk deliveries

• Each hospital often has a distinct hospital information system that support clinical and administrative services

District / Referral Hospital

Building towards an architecture?

Community HealthWorker

Dispensary / Antenatal

Clinic

District / Referral Hospital

230493   Ejisu Clinic

3544765-544908-2  

Ejisu Clinic

3544765-5927852

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?”

Registry of Health

Facilities

NationalHMIS

Registry of Health Terms

Community HealthWorker

Dispensary / Antenatal

Clinic

District / Referral Hospital

528465Hemoglobin, Total

718-742798

Hgb Lvl

718-7924356

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?”

Registry of Health

Facilities

NationalHMIS

Registry of Health Terms

Community HealthWorker

Dispensary / Antenatal

Clinic

District / Referral Hospital

Registry of Health

Facilities

Registry of Clients

NationalHMIS

Registry of Health Terms

002867-5  Dansua, Samia

463782770301

 Dansua, Samea

4637821289495  

Dansue, Samia

463782

• Maintains a unique and consistent identity for all clients receiving health care services.

• Answers the question, “For whom was care delivered?”

Community HealthWorker

Dispensary / Antenatal

Clinic

District / Referral Hospital

Registry of Health

Facilities

Registry of Clients

NationalHMIS

Registry of Health Terms

393719Frances Marley

12563-3429465-1 

Nurse Idris Elba

14267-9828364

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?”

Registry of Health

Workers

Community HealthWorker

Dispensary / Antenatal

Clinic

District / Referral Hospital

Registry of Health

Facilities

Registry of Clients

NationalHMIS

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.

Registry of Health

Workers

Shared Health Records

Repository

Community HealthWorker

Dispensary / Antenatal

Clinic

District / Referral Hospital

Registry of Health

Facilities

Registry of Clients

NationalHMIS

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

Registry of Health

Workers

Shared Health Records

Repository

Interoperability Layer

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

“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.”

http://ohie.org

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

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?

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

http://ohie.org

Questions?

Want a copy of the slides? Scan ->

..or go to: http://pgb.me/waho