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 B
Surveillance
System A
Surveillance
System C
Surveillance
System B
Surveillance
System A
Surveillance
System C
Registry of
Health
Facilities
National
HMIS
• Supports a consistent list of unique locations and care
organizations that deliver health services within a country.
3544765-5
• Allows
3544765-5
44908-2
230493
for
each
Ejisuof
Clinic
Ejisurich
Clinic descriptions
4357245-2
of
927852
these
places
Juaben
Hospital
• It answers the question “Where was care delivered?”
Surveillance
System B
Surveillance
System A
Surveillance
System C
Registry of
Health
Facilities
National
HMIS
Registry of
Health
Terms
• Uniquely identifies the clinical ideas that occur within an
enterprise
276-6
276-6 ideas
276-6 for each idea,
• Defines codes
as well as how those
95425
45Q72
IND#452
relate# confirmed
to eachw/EVD
other # confirmed w/EVD
# confirmed w/EVD
• Answers the question, “What health concepts do we need to
communicate?”
Surveillance
System B
Surveillance
System A
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
• 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
• 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
Community
Health
Worker
Dispensary /
Antenatal
Clinic
Community
Health
Worker
• Supports high risk
problems during
pregnancy
• Supports high risk
deliveries
District /
Referral
Hospital
• Each hospital often has a
distinct hospital
information system that
support clinical and
administrative services
Community
Health
Worker
Dispensary /
Antenatal
Clinic
District /
Referral
Hospital
Building towards an
architecture?
Registry of
Health
Facilities
National
HMIS
Registry of
Health
Terms
• Supports a consistent list of unique locations and care
organizations that deliver health services within a country.
3544765-5
• Allows
3544765-5
44908-2
230493
for
each
Ejisuof
Clinic
Ejisurich
Clinic descriptions
4357245-2
of
927852
these
places
Juaben
Hospital
• It answers the question “Where was care delivered?”
Community
Health
Worker
Dispensary /
Antenatal
Clinic
District /
Referral
Hospital
Registry of
Health
Facilities
National
HMIS
Registry of
Health
Terms
• Uniquely identifies the clinical ideas that occur within an
enterprise
718-7
718-7 ideas
718-7 for each idea,
• Defines codes
as well as how those
42798
528465
924356
relateHemoglobin,
to each Total
other
Hgb Lvl
Hemog Level
• Answers the question, “What health concepts do we need to
communicate?”
Community
Health
Worker
Dispensary /
Antenatal
Clinic
District /
Referral
Hospital
Registry of
Health
Facilities
Registry of
Clients
National
HMIS
Registry of
Health
Terms
• Maintains a unique and consistent identity for all clients
receiving health care services.
463782
•
002867Answers5 the
question,
Dansua,
Samia
Community
Health
Worker
463782
770301
“For
whom
Dansua,
Sameawas
Dispensary /
Antenatal
Clinic
463782
1289495 Dans
care delivered?
”
ue, Samia
District /
Referral
Hospital
Registry of
Health
Facilities
Registry of
Clients
National
HMIS
Registry of
Health
Terms
Registry of
Health
Workers
• Maintains consistent and unique identities for health workers
within an enterprise.
12563-3
•
14267-9
11935-4
429465-1
828364
393719
Nurse
ElbahealthDr.
Kwame Anyidoho
AllowsFrances
for rich
description
of Idris
each
worker
Marley
• Answers the question, “by whom was care delivered?”
Community
Health
Worker
Dispensary /
Antenatal
Clinic
District /
Referral
Hospital
Registry of
Health
Facilities
Registry of
Clients
National
HMIS
Shared Health
Records
Repository
Registry of
Health
Terms
Registry of
Health
Workers
• 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.
Community
Health
Worker
Dispensary /
Antenatal
Clinic
District /
Referral
Hospital
Registry of
Health
Facilities
Registry of
Clients
National
HMIS
Shared Health
Records
Repository
Registry of
Health
Terms
Registry of
Health
Workers
Interoperability Layer
• 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
Community
Dispensary /
District /
exchange
Health
Antenatal
Referral
Worker
Clinic
Hospital
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
Kenya’s
FR
Registry of
Health
Facilities
Registry of
Clients
Health
Management
IS (HMIS)
Shared Health
Records
Repository
Registry of
Health
Terms
Registry of
Health
Workers
Interoperability Layer
M&E
Applications
Mobile
Applications
Clinical
Record
Systems
Hospital
Information
Systems
Laboratory
Information
Systems
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 Literacy for Health Workers
Health Information Technologists
ICT Infrastructure
eHealth Strategy and Policy Framework
eHealth Stakeholder Leadership
Global, Regional & National eHealth Partnering
Questions?
http://ohie.org
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