HIMSS 2013 Demo A short user story illustrating a compelling OpenHIE –supported m/eHealth interaction for demo at the HIMSS Showcase in March, 2013.

Overview A short user story that illustrates a compelling maternal care / HIV workflow Mapping the story to RHEA PoC interactions The RHEA technology stack and where modifications are recommended to support IHE The IHE profiles and interactions corresponding to our user story

The “story” Mosa is pregnant; she goes to the local clinic where she registers into the ANC programme. She already has a pre-existing record at the clinic and in the Client Registry. Mosa’s rapid HIV test (at the clinic) indicates she is HIV positive. As such, she is flagged as “deliver at hospital” so that PMTCT protocols can be followed. Mosa has had some minor bleeding or “spotting”. During a routine visit with a CHW she shares this and the CHW reports it. The CHW tells Mosa she must go for a check up at the clinic ASAP. At Mosa’s 2nd ANC visit, she is found to be anemic. She is referred to the hospital for follow-up (“urgent”). After 3 days, Mosa has not yet attended the hospital for her follow-up. An “alert” SMS message is sent to her CHW in the village. The CHW finds Mosa in her home in a fever. The CHW arranges for Mosa to go to the Hospital where she receives appropriate care. The hospital has full access to all of Mosa's history.

A simple play in 5 Acts… Act 1 – OpenMRS @ Clinic 1.1 Mosa registers at clinic, she already has a pre-existing record; resolve her NID 1.2 Mosa’s history is taken; rapid HIV test administered indicating that she is HIV+ve Act 2 – RapidSMS @ Mosa's home 2.1 Observation of bleeding; CHW sends RISK message to RapidSMS (and on into the SHR) 2.2 CHW tells Mosa to go the clinic as soon as she can Act 3 – OpenMRS @ Clinic 3.1 Mosa attends ANC visit; resolve her NID 3.2 It is seen that Mosa is pregnant, that her HIV test came back +ve and that she now has anemia 3.2 She is referred to the district hospital with an “urgent” flag Act 4 – RapidSMS-supported follow-up of care 4.1 Mosa has missed her referral; CHW gets an SMS reminder to follow-up with Mosa 4.2 CHW visits Mosa at her home and arranges for her to go to the Hospital Act 5 – OpenMRS @ Hospital 5.1 Resolve Mosa’s NID 5.2 Retrieve and display Mosa’s shared health information: pregnant, HIV+, fever 5.3 Provide appropriate, informed care!

RHEA Technology JSON PIX XDS Referral “aging” logic REST REST SMS Workflow (openMRS) JSON PIX XDS Referral “aging” logic REST REST SMS IHE Interfaces CHW Ambulance CHW Manager

The “Black Box” Approach OpenEMPI EMPI XDS Repository OpenXDS PIX XDS Entire RHEA Infrastructure except CR and SHR

Why this strategy? We minimize the number of changes needed to our existing RHEA infrastructure; this reduces risk We are able to leverage our client applications unmodified; this preserves our “user story”, including the mHealth portion which is very compelling The only infrastructure piece we unseat is the SHR Our CR is already IHE compliant and can participate with us. (NOTE: at the Connectathon, we must show we can interoperate with any PIX provider) We will need to modify the openHIM to be able to save to and query from an IHE-compliant XDS repository instead of our existing OpenMRS-based SHR.

Necessary modifications The openHIM would need to be able to issue a PIX query and process the returned result from an IHE-compliant EMPI The openHIM would need to be able to save our existing HL7v2 messages to an IHE-compliant XDS repository The openHIM would need to be able to query an IHE-compliant XDS repository for one or more of our HL7v2 messages and process the returned result set IHE foundational audit (ATNA) and consistent time (CT) profiles would need to be supported HL7v2 messages sent to the XDS repository would need to be “echoed” to OpenMRS to trigger the referral “aging” logic currently in that implementation of the SHR

IHE Interactions 1.1, 2.1, 3.1, 5.1 Retrieve EMPI record PIX lookup using Rwanda NID 1.2, 2.1, 3.2 Save: patient history; diagnosis of pregnancy; diagnosis of HIV+; PMTCT order; observation (temperature); referral to hospital XDS – save HL7v2 ORU message(s) 3.2, 5.2 Retrieve: patient information XDS – query for HL7v2 ORU message(s)

January 2013 Connectathon Our “Black Box” will need to participate in the Connectathon in Chicago in January and successfully achieve 3 interoperability certifications: Patient Identity Cross-reference (PIX) Consumer XDS Document Source XDS Document Consumer IMPORTANT NOTE: at the Connectathon, we don’t get to choose who we interoperate with

March 2013 HIMSS Showcase At the Showcase, we will provide the entire RHEA “stack” including OpenEMPI and OpenXDS in their IHE-compliant roles We will demonstrate our workflow, including the RapidSMS-based mHealth interactions We will need a configured RapidSMS Server We will require a “basic” mobile phone (old Nokia) To run multiple successive demo’s, we will need a one-click mechanism to “reset” the system to our initial, pre-demo, state