GHANA HEALTH SERVICE HEALTH INFORMATION EXCHANGE IMPLEMENTED BY THE CENTRE FOR HEALTH INFORMATION MANAGEMENT-POLICY PLANING MONITORING AND EVALUATION DIVISION DOMINIC K ATWEAM HEALTH INFORMATION SYSTEMS ANALYST GHANA HEALTH SERVICE POLICY PLANING MONITORING AND EVALUATION DIVISION

OUTLINE - Overview of the Ghana Health Service Health Information Exchange The nationwide District Health Information Management Systems – DHIMS2 (DEMO) EPI data sets and reports EPI group sets of indicators in DHIMS2 DVD-MT like dasboard on DHIMS2 based on agreed minimum outputs EPI agreed minimum outputs agreed on with WHO-Afro,WHO HQ , GHS, MOH , WHO -GH New EPI Vaccine districts regional and national ONLY Store report ( not facilities) Revised monthly EPI faclity report DVD-MT and RIM like excel template from DHIMS2 to allow data exchange from DHIMS2 to DVD MT and RIM Performance Feedback to Regions and Districts Capacity Building Kintampo Case Study Over view of the GHS eTRACKER for matarnal and child health services (DEMO)

GHANA HEALTH SERVICE HEALTH INFORMATION EXCHANGE –GHS/HIE Overview GHS HIE The Ghana HIE is composed of existing functional components The HIE reflects current concrete reality (from the ground up) of data flows and systems delivering current use value It is also forward looking There is scope for it to be further elaborated

(Hams, iHost, OpenMRS etc.) HEALTH SECTOR REPORTING PORTAL DISTRICT HEALTH INFORMATION SYSTEM. DATA WAREHOUSE DHIMS2 INDIVIDUAL CLIENT RECORDS MCH, TB, HIV/AIDS IDENTITY MONITORING MANAGEMENT BACKUP OF DHIMS2 AND INDIVIDUAL DATA WAREHOUSE TRAINING INSTANCE OF DHIMS2 DATA WAREHOUSE FACILITY REGISTRY/ DATA DICTIONARY INTEROPERABILITY LAYER Orchestrate Data flows Alerting Gateway security Co-ordinate backups LOGISTICS MANAGEMENT (open LMIS) HEALTH WORKER REGISTRY (iHRIS) PATIENT LEVEL SYSTEMS (Hams, iHost, OpenMRS etc.) LAB SYSTEM (BLIS) MOBILE GATEWAY (USSID, SMS, short codes

Facility Registry Expansion Development (FRED) The Ghana HIE is composed of existing functional components. The HIE reflects current concrete reality (from the ground up) of data flows and systems delivering current use value. It is also forward looking. There is scope for it to be further elaborated. Routing and TLS encryption (nginx reverse proxy) Orchestration of data flows Implemented through a set of PHP scripts controlled by a central configuration file Individual Data Warehouse E-Tracker and Line Listing data Live Identity Management Single sign-on/user management on across applications Monitoring System and application level monitoring Planned DHIMS The national aggregate routine reporting system Live Training Temporary system for user training Live Back Up Archiving for disaster recovery Live Facility Registry Public facing master facility service Live Data Dictionary Structural metadata and vocabulary service Pending Data in Individual data warehouse is aggregated and posted as routine report into DHIMS. DHIMS database is replicated to Training Database. Backups are scheduled, moved off-site and tested. DHIMS is then moved to backup in data warehouse. DHIMS to facility registry. DHIMS is facility data source. Facility registry is driven by changes in DHIMSAlerting intercept to monitor/log changes being made at district level. DHIMS to data dictionary. Data element, disaggregation and dataset definitions Published annually. Individual data compiled and transported to backup. Hospital data (HAMS) is aggregated and posted to DHIMS. Potentially other EMR systems eg. OpenMRS, iHOST) Routine data posted from Lab System (BLIS) Health worker system (iHRIS) Aggregate reports of HR data CSD integration with infoman? OpenLMIS Mobile gateways GHS HIE STANDARD Facility Registry Expansion Development (FRED) The GHS HIE aligns to established standards such as DICOM and HL7 which support our specific system needs API specifications v1.0 for the FRED facility registry service. This provides information for analysts, architects and systems integrators to understand the behavioral and structural characteristics of compliant FRED facilities registries and consumers. It describes the FRED interfaces at a wire level, covering both the host and client services. This is based on the March 22, 2013 version of the API developed collaboratively by the facility registry community. Facility registry public API . IHE.net Care Service Discovery (CSD) http://www.ihe.net OpenHIE FRED api https://ohie.hingx.org Data Dictionary public API - DHIS2 native api to data dictionary components

Overview of the Ghana Health Service Health Information Exchange The Nationwide District Health Information Management Systems –DHIMS2 (DEMO) EPI data sets and reports EPI group sets of indicators in DHIMS2 DVD-MT like dasboard on DHIMS2 based on agreed minimum outputs New EPI Vaccine districts regional and national ONLY Store report ( not facilities) Revised monthly EPI faclity report EPI agreed minimum out puts agreed on with WHO-Afro,WHO HQ , GHS, MOH , WHO -GH DVD-MT and RIM like excel template from DHIMS2 to allow data exchange from DHIMS2 to DVD MT and RIM Capacity Building Kintampo Case Study Performance Feedback to Regions and Districts Over view of the GHS eTRACKER for matarnal and child health services (DEMO)

AGREED EPI MINIMUM OUTPUTS

NEW EPI VACCINE DISTRICTS REGIONAL AND NATIONAL ONLY STORE REPORT ( NOT FACILITIES)

REVISED MONTHLY VACCINATION REPORT

STATUS & UTILISATION OF VACCINE STOCKS AND OTHER COMMODITIES –FACILITY LEVEL

CAPACITY BUILDING –KINTAMPO CASE STUDY

Overview of the Ghana Health Service Health Information Exchange The nationwide District Health Information Management Systems –DHIMS2 (DEMO) EPI data sets and reports EPI group sets of indicators in DHIMS2 DVD-MT like dasboard on DHIMS2 based on agreed minimum outputs New EPI Vaccine districts regional and national ONLY Store report ( not facilities) Revised monthly EPI faclity report EPI agreed minimum out puts agreed on with WHO-Afro,WHO HQ , GHS, MOH , WHO -GH DVD-MT and RIM like excel template from DHIMS2 to allow data exchange from DHIMS2 to DVD MT and RIM Capacity Building Kintampo Case Study- Performance Feedback to Regions and Districts Over view of the GHS eTRACKER for matarnal and child health services (DEMO)

WHAT eTRACKER MEANS FOR DATA ENTRY IN DHIMS2 eTRACKER WILL POPULATE DHIMS2 DATA SETS WITHOUT ANY DATA ENTRY BY FACILITIES FAMILY HEALTH FORMS(RCH ) Midwives returns (form A) Family Planning PMTCT Child Health Returns(from C) Nutrition EPI TB & HIV/AIDS FORMS

IMPACT ON CHOs WORK AT THE FACILITY BEFORE eTRACKER AFTER eTRACKER DEPLOYMENT Reports Every month, trained staff in all health facilities manually tally and summarize Child and Maternal Health registries (ANC, Deliveries , PNC ,FP & Child Health ) into the monthly reporting forms Form A (midwife returns ) EPI Form C ( child health returns ) Nutrition All facility Child and Maternal Health service reports automatically populate DHIMS2 in their respective data sets reports. Copies can be generated Number of days used to tally Averagely 3-5 days Number of days used to tally None

IMPACT ON CHOs WORK AT THE FACILITY BEFORE eTRACKER AFTER eTRACKER DEPLOYMENT Period of reporting 5th for entry into dhims2 at facility level or submit to district for entry to be done for facility 15th For all data to be validated and signed of by DDHS for the previous month data Period of reporting Service data is aggregated by system and populates respective datasets in eTracker instance eTracker datasets is automatically pushed into dhims2 on the 15th of a month for the previous month . Services All clients details need to be recorded in a register every year. Client from other facilities have to be registered again Hard to trace defaulter and reschedule Registration is done once . Clients from other facilities have to be relocated and services continued Filter reports by defaulters and can re schedule etc

Mobile Hand Device (MHD) POLICY GUIDE LINES TYPICAL TRAINING SESSION Mobile Hand Device (MHD) POLICY GUIDE LINES DEMONSTRATION OF THE e-TRACKER HANDS ON TRAINING REGISTERING MOTHERS & CHILDREN AND THEIR SERVICES WORK PLAN …. MCH eTracker System Business Requirement MCH work flow eTracker agreed requirement for child health records National rollout plan cPBF work plan MOST OF THE WORK IS BUILT AROUND WHAT WE AS A COUNTRY HAVE LEARNT FROM THE BID JOINT LEARNING NETWORK …

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