Health IT - the African Approach Chris Seebregts, PhD Executive Director, Jembi Health Systems SOUTH...
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Health IT - the African Approach
Chris Seebregts, PhDExecutive Director, Jembi Health SystemsSOUTH AFRICA
HIMSS Asia-Pacific, Sep 2012
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Outline
• Challenges and opportunities associated with low resource environments
• Approaches to Interoperability in low resource settings
• Implementation experiences from Rwanda
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Current Implementation Blog
Carl Fourie, Jembi Health Systems, 18 September 2012, http://rwandahie.blogspot.sg/
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Open Community-Driven Technologies
• Open Architecture
• Open Standards
• Open Source Software
• “Ubuntu” – Southern African philosophy that we are who/where we are because of the community.
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Public Private Academic Innovation Models
Public Private AcademicMore Academic
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Funding for RHEA
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Health Enterprise Architecture Framework for National Health Information Systems Integration
• -> Capacity Building
• -> Methodology• -> Methodological
Tools
• -> Repository of Assets
• -> Registry Application• -> Reference Models
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Key Requirements (3) STANDARDS OF INTEREST (first list of 33) (1-18)
Note: Need to further rationalize the 50 standards needed into 4-5 buckets / business requirements – using enterprise view (the house picture) (use SKMT)
Deployment of a Clinical Data Warehouse TS 29585Provider Identification TS 27527Health Indicators for Conceptual Framework IS 21667Health Informatics -Service Architecture -Enterprise Viewpoint IS 12967-1 Health Informatics -Service Architecture -Information Viewpoint IS 12967-2Health Informatics -Service Architecture -Computational Viewpoint IS 12967-3Identification of Subjects of Health Care TS 22220EHR Definition, Scope and Context TR 20514Good Principles and practices for a clinical data warehouse TR 22221Health Indicators for Conceptual Framework TS 21667Harmonized Data Types for Information Interchange (name change 2007) IS 21090Guidelines for terminology development organizations TR 12309Common Glossary for ISO/TC 215 TS 28379Directory services for security, communications and identification of professionals and patientsTS 21091Secure Archiving of electronic health records Part1 Principles and RequirementsTS 21547Privilege Mgmt and AC-1 Overview & Policy Mgmt TS 22600-1HC Info Privilege Mgmt & Access Control P-2 Priv Mgmt TS 22600-2HC Info Privilege Mgmt & Access Control P-3 AC Mgmt TS 22600-3
Slide courtesy of Bron Kisler, Elizabeth Keller, Don Newsham, Joint Initiative Council
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Key Requirements (3) STANDARDS OF INTEREST (first list of 33) (19-33)
Functional and Structural Roles TS 21298 Pseudonymisation TS 25237 Information Security Mgmt in Health using ISO/IEC 27002 (name change 2007 Montreal and Brisbane)IS 27799 Capacity-based eHealth architecture roadmap -Part 1 - International Initiatives on eHealth SystemsTR 14639-1Capacity-based eHealth architecture roadmap - Part 2: Business Requirements TR 14639-2 Personal Health Records: Definition, Scope and Context TR 14292 Knowledge Management of Health Information Standards TR 13054Requirements for an electronic health record architecture TS 18308EHR System functional model ISO/HL7 10781Business Requirements for Health Summary Records - Part 1: Requirements TR 12773-1Business Requirements for Health Summary Records - Part 2: Environmental ScanTR 12773-2WHO ICD-10Logical Observation Identifiers Names and Codes (LOINC) SNOMED-CT (for LIC)SDMX-HD
Slide courtesy of Bron Kisler, Elizabeth Keller, Don Newsham, Joint Initiative Council
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SDMX-HD
The Statistical Data and Metadata Exchange – Health Domain (SDMX-HD), a data exchange format for the Monitoring and Evaluation community. See www.sdmx-hd.org
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Atlas of known OpenMRS Implementations
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Architecture and Solutionsslide courtesy of David Lubinski, PATH
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Improving Interoperability for Maternal and Child Health in Rwanda
slide courtesy of Derek Ritz, ecGroup
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Rwanda
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VISION - Rwanda eHealth Strategy(Dr Richard Gakuba, National eHealth Coordinator, Ministry of Health, Rwanda)
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GENERALIZING THE VISION - ISO 14639
• -> Vision and goals
• -> Domains• -> Governance
• -> Infostructure
• -> Infrastructure• -> Standards
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Goals
• 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)
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Business Architecture – MODELED (ArchiMate)
Slide courtesy of Mead Walker, Northrup Gruman
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Rwanda Health Enterprise Architecture Framework
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Canada Health InfoWay EHR Architecture
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Health Information Exchange Training in Canada
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Technology components
TS
HIAL
LRS
CR
PR
SHR
VCT Clinic
Mosa’s Village
Community Clinic
HL7
HL7
SMSCore Architectural Services:• Client Registry and Patient Identification (CR)• Provider and Facility Registry (PR)• Terminology Standards and Service (TS)• Shared Health Record (SHR)• Logical Record Service (LRS• Health Information Access Layer)
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Connectathon at Medinfo 2010
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Architecture of the Rwandan Open Health Information Exchange
1. Crichton R, Moodley D, Pillay A, Gakuba R, Seebregts CJ. An Interoperability Architecture for the Health Information Exchange in Rwanda. In: International Symposium on Foundations of Health Information Engineering and Systems. 2012.
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OpenHIM Interoperability Layer Design(developed by Ryan Crichton, Jembi Health Systems)
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OpenHIM Mediation and Orchestration Design(developed by Ryan Crichton, Jembi Health Systems)
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OpenHIM Component Scalability Design(developed by Ryan Crichton, Jembi Health Systems)
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Implementation of the Rwanda Open Health Information Exchange
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HL7 IP available free-of-charge
www.healthcareitnews.com/news/hl7-makes-ip-freely-available-ehrs
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Rwanda Terminology Service
developed by Hannes Venter, Jembi Health Systems - http://ts/jembi.org
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Maternal Concept LabDeveloped by Jon Payne, Partners in Health - www.maternalconceptlab.com
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Health Architecture Registry and Repositorywww.HingX.org
developed by Open Health Tools (www.openhealthtools.org)
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Applying the Framework in Mozambique
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Modeling eHealth Regulations
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Summary
• Low resource settings provide opportunities for advanced health information systems development and implementation
• Constraints on capacity and other resources promote the development of good practices
• Open technologies will play an increasingly important role in low resource environments
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Partners and Funders
PARTNERS• Ministry of Health of Rwanda• Jembi Health Systems• Regenstrief Institute• InSTEDD• Sysnet• Intrahealth• Apelon• Partners in Health• OpenMRS Foundation• RapidSMS (UNICEF)• University of KwaZulu-Natal• Pivot Access
FUNDERS• Canadian International
Development Research Centre (IDRC)
• Rockefeller Foundation (RockFound)
• United States President’s Emergency Plan for AIDS Relief (PEPFAR)
• United States Centres for Disease Control and Prevention (CDC)
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Thank you MozambiqueAvenida Julius Nyerere no 3326Condominio Diplomatic VillageCasa numero umMaputo
RwandaKacyiru RoadPlot Number 1760Kigali
South Africa