Carl Fourie - Jembi Health Systems, NPC Open Health Information Exchange (OpenHIE)

What is OpenHIE Global, open-source collaboration initiative emerging to assist in the strengthening of national health information exchanges for the underserved. Supported by a range of organizations through investment of time, resources and funding. Also a pattern of thinking An architectural approach and set of principles towards addressing health information systems challenges. The Problem: Health systems depend on many types of information to operate effectively, vital information is usually held in disparate systems and locations in varying formats with little harmonization between them making it hard to know what information is most complete, accurate or up-to-date. As a result health systems, especially those in resource- constrained countries, may not contain the quality or quantity of information necessary to provide appropriate or timely care of citizens.

“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.”

Overview, communities & architecture

Components and Communities A Client Registry or enterprise master patient index (EMPI) manages the unique identity of citizens receiving health services with the country – “For whom” A Provider Registry is the central authority for maintaining the unique identities of health providers within the country – “By whom” A Health Facility Registry serves as a central authority to uniquely identify all places where health services are administered within the country – “Where?” A Terminology Service serves as a central authority to uniquely identify the clinical activities that occur within the care delivery process by maintaining a terminology set mapped to international standards such as ICD10, LOINC, SNOMED, and others – “What?”

Components and Communities A Shared Health Record (SHR) is a repository containing the normalized version of content created within the community, after being validated against each of the previous registries. It is a collection of person-centric records for patients with information in the exchange. The Health Management Information System (HMIS) stores routinely- collected aggregate health care data, and facilitates their analysis with the goal of improving the quality of health services. The Interoperability Layer receives all communications from point of service applications and orchestrates message processing between the point of service application and the hosted infrastructure elements.

Point of Service: Fantastic 4 In support of this the POC / POS would be required to adopt the following processes: Set up a client in the CR (PAM) Find a client in the CR (PIX… PDQ as a last resort) Save information about a client (XDS, put CDA): –XDS-MS Medical Summaries (referral, discharge summary) –CCD – antenatal summary, immunizations, summary health record –XD-LAB (lab orders, lab results) –PRE (prescriptions), DIS (dispense) Retrieve information about a client (XDS, get CDA): –All of the above (as documents) –Ad hoc CDA “built” from discrete data

Creating Pre-defined Profiles

Find Client

Save and store Patient Health Information

Great job….good idea….but does it work? OpenHIE in Practice

Existing Projects There are a range of OpenHIE based projects underway and active Some of the projects we will touch on: – Rwanda: RHIE Maternal Use Case – South Africa: MomConnect – South Africa: Aggregate data exchange There are a range more that are emerging from within the community and different contributing partners. For more information

Rwanda Health Information Exchange (RHIE) Goals of RHEA and the developed RHIE –Increase the number of pregnant women accessing ante- natal care services –Increase the number of HIV-positive pregnant women accessing PMTCT services –Improve progress in implementing MDGs 4, 5 and 6 (lower incidences of maternal and child mortality and HIV/AIDS) Work alongside the Ministry of Health in supporting and strengthening an existing roll-out of EMR tools into a sub district of Rwanda

Rwanda Health Information Exchange Architecture

MomConnect Initiated and led by the South African National Department of Health Initially conceptualized as just sms’ing to pregnant mothers Primary objectives – Register pregnant women in antenatal care facilities – Subscribe women to health promotion messaging Expanded to include: – ANC data, – birth and delivery data, – (later) post-natal care and childhood immunizations;

MomConnect Component Architecture

Aggregate data exchange in South Africa Working with HISP South Africa Jembi has implemented a local interoperability layer to support data exchange between key partners. Core focus of the project has been to facilitate the electronic submission of data into the DHIS 2.x tools that HISP have deployed. Currently Jembi and HISP have defined and implemented an initial set of channels that are being adopted by the selected partners. These channels are: – Western Cape Aggregate Data Exchange (PREHMIS) – Virtual Purple Aggregate Data Exchange (VP) – WBOT mobile research data submission (Cell-Life)

Ward-Based Outreach Teams and Community Health Worker Integration

Thank you Mozambique Avenida Julius Nyerere no 3326 Condominio Diplomatic Village Casa numero um Maputo Rwanda Kacyiru Road Plot Number 1760 Kigali South Africa