1. Local Health Information Mediator
OpenLHIM
Local Health Information Mediator

2. 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

3. 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

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

5. Installer

6. 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

7. 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

8. 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

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

10. 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.

11. FHIR CD4 Count Query

12. TIER.Net

13. 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

14. 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)

15. 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

16. 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

17. 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

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