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

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

3. VISION FORMATION

4. 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

5. 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

6. 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’ , 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)

7. 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

8. 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)

9. TECH STACK

10. 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.

11. THANK YOU