Angshuman Sarkar. @angshus Bangladesh National Health Information Exchange Angshuman Sarkar. @angshus 2.5 years of work

Present Day: Bangladesh National Health Information Exchange (HIE) http://sharedhealth.github.io Provider Registry Patient Index Shared Health Record Terminology Registry Facility Registry Geocode Registry Identify Provider National Reporting System

VISION FORMATION

IN COLLABORATION WITH Direction & Guidance - Directorate General of Health Services (DGHS), Ministry of Health & Family Welfare (MoHFW) Development Partners - ThoughtWorks, DevNet, Activation, RightBrain Support - UKAID, Directorate General of Health Services (DGHS) Other programs & initiatives - DHIS2, Routine health Information System (RHIS), Unicef, International Centre for Diarrhoeal Disease Research, Bangladesh(ICDDRB), MSH

ARCHITECTURE TECHNOLOGIES Design for scale and extensibility Standard Compliant, Interoperable & easy to integrate Reliability, Availability, Serviceability (RAS) Cost effective, simple FOSS & maintainable, support Easy to adopt/develop/deploy

Admin Applications (HRM) THE HIE ECOSYSTEM Central HIE System Admin Applications (HRM) Patient Journal Client Management Application Datasense Identity Provider Facility Registry DHIS2 Master Client Index Provider Registry Location Registry Terminology Registry Shared Health Record Health Information Exchange Gateway … Clinic Hospital 1 OpenMRS TR: Manages Medical Terminologies, mappings, codings Tooling: OpenMRS Concept Management Module Managed by ‘Terminology Working Group’ Standards identified: ICD 10, LOINC, WHO ATC MCI:Manages clients/patients information, Identifier management (primary, secondary), Demographic queries, Duplication detection, Merging of patients, Other workflows - approval, death etc Standard: Bangladesh CCDS SHR:Repository for Patient Medical records, Longitudinal health records, Maintains indexes, No reporting of data Standard: HL7 FHIR, Encounter Document - Loinc ‘Details Document’ 51899-3, very much like a CCR FR: Manages Facility Information, Existing DGHS HRM system Standard: Facility Registry API (FRED) PR: Manages Care provider Information, Existing DGHS HRM system Standard: FHIR Practitioner resource LR: Geo-coding system for all regions of Bangladesh in hierarchical manner Standard: BBS Geo codes OpenSRP Community Health Worker Applications Client System (e.g. Hospital EMRs, CHW Systems)

MICROSERVICES ARCHITECTURE Choreography not orchestration Independent systems Event Driven Architecture (EDA) Integration by subscription to event streams (e.g. Catchment Stream) Event Streams - Simple Atom based protocol Multi node cluster (SHR, MCI), asynchronous processing All systems speaking one language (same standard) Independent simple systems Integration by reacting to events originating from other systems Allows for systems to be stay decoupled, have their independent build and release cycles Scalability by division Divide by catchment wise processing Explain catchment concept No heavy middleware (MoM) Microservices Multinode

TOWARDS A DIGITAL HEALTH PLATFORM Life-time electronic health record Keeping in mind future Universal Health Coverage Measure progress of different health targets proposed in 2030 SDGs Linking to Civil Registration & Vital Statistics (CRVS)

TECH STACK

Why this architecture? Build loosely coupled systems with reference/time/platform autonomy Maintain domain system integrity (bounded context) ‘Continuous Delivery’ Think Platform Unbundle common layers To build and stack over core services To build local capability and context To build ecosystem Evolve-ability is not an afterthought. This is one of the foundational first principles.

THANK YOU