Local Health Information Mediator OpenLHIM Local Health Information Mediator

OpenLHIM Overview Standalone service to web-enable facility systems Configurable for multiple source and destination systems Originally developed to integrate Pharmacy data from iDART into a drug stock warehouse Low resource, robust system Meeting with CIDER tomorrow to discuss this - outputs of meeting will inform this slide deck

AHIE Bill and Melinda Gates Foundation grant : African Health Information Exchange Paper lab results are often not entered into TIER.Net, weakening the ability to manage patients and generate operational reports for facilities Give TIER.Net access to centralised NHLS TB and HIV lab results

Lab Architecture Meeting with CIDER tomorrow to discuss this - outputs of meeting will inform this slide deck

Installer

Components Laboratory Repository Holds data from NHLS and possibly other sources Standards-based API endpoint Could be from NHLS (CDW) or Trak, PDHC, or ‘Lab Scrubber’ (staging database for lab data) Accessed via OpenHIM interoperability layer OpenHIM Interoperability layer Provides routing, security, transaction logging and replay, audit logging

Components OpenLHIM (Local Health Information Mediator) Runs on TIER.Net computer in facility Allows for intermittent and low-bandwidth data exchange by ‘trickling’ data Is decoupled from laboratory HIS and TIER.Net Inserts data into FHIR-compliant holding database in TIER Can handle other types of FHIR documents e.g. Pharmacy for integration with RxSolutions/iDart TIER.net Facility-based HIV back office management system

OpenLHIM HIV & TB Results Workflow OpenLHIM runs as a service on TIER.net computer When there is connectivity polls lab API (NHLS or PHDC) Receives manifest file detailing available lab results Trickle download of patient details and lab results FHIR bundles Places FHIR documents into folder structure TIER.Net imports data into a holding database TIER.Net matches patients and imports matched results into main db Similar procedure can be used for importing batches of results downloaded via USB stick OpenLHIM maintains state - what has been downloaded

NHLS Manifest File { "resourceType": "Bundle", "type": "collection", "total": 2, "entry": [ { "fullUrl": "289518755", "resource": { "resourceType": "Patient", "text": { "div": "THANDEKA THEODORA MPHINDWE | 2 associated labs" } } }, { "fullUrl": "404567950", "resource": { "resourceType": "Patient", "text": { "div": "MELPHOY SENAE | 1 associated labs" } } } ] }

Observation Observations are a central element in healthcare, used to support diagnosis, monitor progress, determine baselines and patterns and even capture demographic characteristics. Most observations are simple name/value pair assertions with some metadata, but some observations group other observations together logically, or even are multi-component observations. Note that the DiagnosticReport resource provides a clinical or workflow context for a set of observations and the Observation resource is referenced by DiagnosticReport to represent lab, imaging, and other clinical and diagnostic data to form a complete report.

FHIR CD4 Count Query

TIER.Net Robin.Burley@uct.ac.za

Background TIER.Net Paper registers widely used but unwieldy in large and/or mature cohorts Online electronic medical record (EMR) systems require infrastructure often not available everywhere A simple and robust offline electronic version of the paper register was needed Relatively inexpensive Rapid scale-up possible Easy to support National reporting requirements adhered to Facility management reports Interoperable

What is TIER.Net ? TIER.Net originally designed as an electronic replacement for the cumbersome ART registers. Over time the system has been expanded by the addition of HIV Testing, Pre-ART, TB testing, Drug sensitive and drug resistant TB modules. An MCH module is currently in development. These modules are interlinked providing longitudinal patient information between all modules / episodes. TIER.Net is scalable. It can be implemented in healthcare Facilities with low patient load all the way to consolidated country-level databases. Rich reports have been developed for each level of Healthcare. TIER.Net has been implemented in over 3500 healthcare facilities in South Africa as well as smaller implementations in the Democratic Republic of Congo, Guinea, Malawi, Mozambique and Zimbabwe. Although TIER.Net is an “offline” system, it can be linked to a single database on multiple computers on a local area network (LAN)

TIER.Net Interoperability IEDEA Data Exchange Standard (DES) import and export (XML) District Health Information System (DHIS) export ETR.Net export EDRweb export Microsoft Excel flat file export Import patient demographics from HPRS (HL7 PIX/PDQ) Coming soon: Import HIV-TB related laboratory results delivered as HL7 FHIR documents via OpenLHIM International epidemiologic databases to evaluate aids Patient Identifier Cross-Reference / Patient Demographic Query

AHIE Phase 1: Laboratory results import TIER.Net Facilities connected and using OpenLHIM will be able to import laboratory results provided by the OpenLHIM in HL7 FHIR format Results being imported to TIER.Net will be matched to TIER.Net patients on various strict conditions Those not matched are imported into an unmatched result repository where they can be managed manually Facilities not connected can make use of manual laboratory result import provided from district-level OpenLHIM/TIER.Net implementations Pilot November 2017

AHIE Future: Full Patient Records TIER.Net TIER.Net is an offline system so data is currently cascaded upwards to Sub District and District level manually via encrypted dispatch files (Quarterly) Phase 2 of AHIE will allow online sites or sites with intermittent connectivity and the OpenLHIM to automatically push data to central TIER.Net databases Q4 2018

TIER.Net Demo HPRS – TIER.Net interoperability AHIE Phase 1: TIER.Net laboratory result import via openLHIM