E-health, strategy

2. What is eHealth?
Examples of eHealth from the WHO Toolkit
 Electronic Medical Records
 Electronic Health Records
 Personal Health Records
 Telemedicine (telehealth)
 Mobile Health (mHealth)
 Decision support systems
 Chronic disease management services
 Practice, patient and clinical management systems
 Electronic medication services
 Health knowledge resources
 Distance learning for health professionals (eLearning)
 Health Management Information Systems

3. 1. Leadership and Governance
Direct, coordinate stakeholders at all levels toward the delivery of a national
digital health environment
2. Strategy
and
Investment
Develop,
operate and
sustain the
national
digital health
environment
3. Service and Application
Identify the digital health services
and application to address the
health system goals
4. Infrastructure
Identify the digital health
infrastructure to support sharing
and improve health services
5. Standards and
Interoperability
To enable consistency and
accuracy of information
6.
Legislation,
policy and
compliance
To support the
development,
operation of
the digital
health
environment
7.
Workforce
eHealth component

4. eHealth Strategy Development in
LAO PDR
 2013 Preparatory training in use of WHO/ITU eHealth
strategy toolkit
 September 2014 – agreement with UNICEF and WHO to
provide to support to an eHealth core team from the
Department of Planning and International Cooperation
 2015 – engaged and consulted with key stakeholders
 MOH: all departments
 Other sectors: MPI, Prime Minister Office, MPT, ICT
suppliers
 Field visits: Luang Namtha, Bolikhamxay
 Final draft of an eHealth Strategy
 2016- Finalization of the draft strategy
 2017- Translation and adaptation into Lao strategy format

5. Vision
 By 2020, eHealth enhances access to quality health
services that enable all the people of Lao PDR to have
healthy and productive lives.
Mission
 Within the context of implementing the Health Sector
Reform Strategic Plan, to develop the ICT environment
and solutions that impact the health sector of Lao PDR
to improve access and utilization of quality health
services, together with improving the information available
for citizens and supporting improvements in the health
administration.

6. The key component of eHealth Strategy
1. LEADERSHIP AND GOVERNANCE
2. STRATEGY AND INVESTMENT
3. eHEALTH SOLUTIONS
4. INFRASTRUCTURE
5. STANDARDS AND INTEROPERABILITY
6. LEGISLATION AND POLICY
7. HUMAN RESOURCES

7. 1. Leadership and Governance
Roles and Functions:
 National Health Information Division
 By end 2017 National DHIS2 core team established.
 eHealth Unit
 By mid 2019, establish a National eHealth Unit, associated
governance arrangements, begun developing the costed
business case for implementing the Strategy, suitably
prioritised, and an eHealth investment plan.

8. 2. Strategy and investment
Development Partners
 By end 2017, provide a focal point for coordination of the eHealth
programmes run by Development Partners.
Innovation
 By the end of 2018, have established the first stage of a capacity to nurture
needed innovations that can go to scale, and develop an ongoing
programme to the end of 2021.
 Clinical decision-support tools need to be developed for clinical staff in
hospitals and health centres to use at the point of care to help improve the
quality of decision-making.
Surveys and Big Data
 By end 2018, have tested in Lao PDR the use of cellphone-based electronic
data capture for health surveys and research.
 By end 2018, have commissioned a study of the potential for developing a
“Big Data” environment capable of supporting healthcare decision-makers
in Lao PDR.

9. 3. Infrastructure
Internet
Quality Internet access: By 2919, provide sufficient bandwidth (and stability)
to enable hospitals to make controlled use of the internet, e.g. for learning
and professional development; specific clinical applications in realtime; and
training in eHealth.
eGovernment
Throughout 2017-2021, take full advantage of the size and scope of the
health sector in leveraging maximum benefit from the eGovernment
infrastructure.
Technology Providers
By the end of 2019 have established the mechanisms to take full
advantage of the size and scope of the health sector in leveraging
maximum benefits with technology providers (ongoing to the end of
2021).

10. 4. Legislation and policy
By end of 2019, ensure appropriate legal and guidance
frameworks are in place to enable eHealth
5. HUMAN RESOURCES
By 2021, have established the acquisition of appropriate
eHealth skills as part of the continuing professional
development of all members of the health workforce.

11. 6. Standard and interoperability
 Enterprise Architecture
 By end 2017 have established an Enterprise Architecture,
building on the work done for CRVS and DHIS2.
 Health Data Dictionary
 By the end of 2018, establish a National Health Data
Dictionary, and maintain and develop it to 2021.

12. 7. eHealth solution
2.1. National level Service Delivery System
 DHIS2
 Throughout 2017-2021, support development of the interface standards
(including data management requirements) for systems providing input to the
national DHIS2.
 Throughout 2017-2021, continue the Province-led programme for training and
support in implementing DHIS2, and plan for its continuing extension to
handle data from disease-specific, early warning, Expanded Programme for
Immunization, human resource and budgeting systems.
 OPD, IPD, MCH Services
 During 2018-19, explore the use of a digital Hospital Medical Record system,
such as OpenMRS2, in a typical Provincial and a typical District hospital.
 HIV/AIDS; Malaria; TB; Early Warning, and EPI.
 Throughout 2017-2021, migration of output from existing information systems
for MCH, malaria, TB, and HIV/AIDS, early warning and surveillance systems,
and EPI to provide input to DHIS2 should continue as planned, with Health
Centre staff provided with management information that they find useful and
timely.

13. eHealth solution
2.2.Promotion
 By end 2021, ensure all Village Chiefs and Village Health Volunteers have the
training and support they need to use eHealth for reporting and promoting
healthy behaviours.
 By end 2018, MoH to have engaged with consumers to test how best to
coordinate its provision of health information about services, healthy
behaviours, current health problems etc., are best delivered, in particular via a
single user-friendly website.
2.3.Other supporting systems
 Implementations of all current Service Delivery and Supporting Systems for
Local and National Health Services should proceed as planned, but evolve to
conform to those National eHealth Strategy architecture and standards agreed
for implementation by end of 2021.
.

14. eHealth solution
2.4 Local level eHealth System
 Forms rationalisation: By 2018, have begun to rationalise the existing plethora
of paper-based records and reports required of Health Centre staff; then provide
training (e.g. as part of the knowledge support programme) on their use and to
improve data quality; and align this with the roll-out of DHIS2.
 Knowledge support: By end 2019, ensure all Health Centre staff have eHealth
tools (e.g. apps for mobiles) that provide them with access to citizen health
information (relevant to the ethnic groups in their catchment), as well as the
clinical evidence and decision support tools they need at the point of care.
 Improve stock control: By end of 2018 have developed realtime reporting
systems that provide alerts to indicate if fridge controls are not keeping
vaccines safe.
 By end 2021, stock control systems for drugs, dressings and other commodities
should be managed via an agreed Logistics Management Information System

15. eHealth solution
2.5. Cross Sector Requirements
 Identity, Civil Registration and Vital Statistics
 From 2017, support the development of the architecture
and plans for a digitised CRVS, ensuring alignment with
the eHealth Strategy.
 By 2021, have supported the development of unique
identifiers and their use (within confidentiality
requirements) in supporting healthcare.
2.6. Universal Health Coverage (UHC)
 Throughout 2017-2021 Support improvements health facility
reports to improve data quality for monitoring UHC.

17. Five key areas of achievement
and Challenges of DHIS2
implementation
1. Legislation, Policy and Compliance
2. Standards and Interoperability
3. Human resources development and infrastructure to support
DHIS2 implementation
4. Budgeting to support system development and sustainability
5. Improving quality of data, use of information and
dissemination of health information

18. 1. Legislation, Policy and Compliance to
support DHIS2 implementation
Achievement
 Ministerial Decree No. 3213, date
December 5, 2017 on adopting
DHIS2 as a National platform for
health information system to collect,
consolidate and report health data.
 Approved Health Information
Strategy 2018 to 2025
 The roles and functions of the HIS
division has been approved by MOH
as part of DPC roles and function
Challenges
 Application of Ministerial Decree
need to be step by step (some of
existing programs are still
implement parallel system in data
collection and reporting)
 In the process of HIS strategy
implementation are need:
 Extensive budget support
 Allocated and mobilize current
existing budget from different
parties (DPs and Gov) to avoid
duplication and use of fund in
more efficient ways
 Strategy need to translated into
Lao and disseminate all parties

19. 2. Standards and Interoperability
Achievement
 Technical discussion has been made to integrate
m-Supply into DHIS2 system so that data entry
into m-supply system is automatic push into
DHIS2 system
 Moving data collection from aggregated
monthly report to event or case based reporting
is in progress with, ANC, delivery, EPI, Malaria,
HIV/STIs and IPD in provincial and district
hospitals and some HCs (complete training to 5
provinces on event capture)
 Completion of pilot data entry into DHIS2 by
health center in Luangprabang and Saravan
 Completion development and testing off line
App data entry for HC level in Luangprabang
Challenges
 Limitation of ownership of programs in
managing quality of data reported through
DHIS2 (data entry, reporting, checking,
verifying )
 Integration of NHI M&E system into DHIS2
are still far behind the schedule
 Some programs are not trust the system yet
particularly the sustainability quantity and
quality of staff who managing the system,
infrastructure to support implementation
(servers, internet) of system,
 Training on the new event capture data entry
for provincial and district hospital staff need
more guidance from leader and financial
resources
 After training on event capture staff are not
entry data into system because of no computer,
busy with routine services, no internet at
provincial and district hospital

20. DHIS2
INTEGRATED
DATABASE
HMIS
(MNCH,
OPD/IPD)
TB
HIV/
Multi
Softwares
MALARI
A/ DHIS2
DPIC/ HIS TEAM
PROGRAMME
TEAMS
Data analysis
Information Products
- National Core Indicators
- HSDP M&E
- UHC, MDG/SDGs Report
- Health Service Situation updates
- GF reports etc…
- Programme Reports and Actions
DHIS2
Integratio
n
DHIS setup
Summary Report
CURRENT INTEGRATION MECHANISM in
dhis2
HRH
OTHERS:
DLIs,
Finance,
SARA; pop..
Exchang
e
DHIS2
setup

21. 3. Human resources development and infrastructure to
support DHIS2 implementation
Achievement
 There are at least 3 central staff has been trained in IT
specific for DHIS2, 5 staff for managing and support
the system.
 12 staff in total from MOH has been trained in DHIS2
Academy
 13 staff from HISP-VN ready to support DHIS2
implementation from 2015 to 2020
 Core team for DHIS2 at central, provincial established
 WIFI internet are now available for all 148 districts
 3 cloud production servers and 2 ground servers for
back up data and training Demo at National Internet
center and 3 local server for training.
 Servers-secure, routine backup and maintenance
(secure and encrypted person information to maintain
privacy and confidentiality based on health program-
meeting global standards)
Challenges
 Limit capacity of staff to use the system for data
analysis and report to the next level especially
at district level
 Turned overstaff who has been trained in
DHIS2 at provincial and district level
 Lacking of coordination meeting between
statistic staff and program staff at provincial and
district level to verify on accuracy, consistency
of data reported in DHIS2 before approved
 Equipment and internet connection are still need
for provincial and district hospital for event
capture data entry and use of system
 Training on how to fill the registration book for
program (MCH, FP and Nutrition) are still need

22. 4. Financing to support
DHIS2 implementation
Achievement
 The MOH has provided government annual
funding to support implementation of DHIS2 in
some activities since 2015
 MOH has harmonised the requirement for
financial contribution as part of the HIS strategy
of which available resources and gaps are
presented by geographical areas as well as by
programmatic areas.
 MOH has conducted assessment of gaps in term
of infrastructure: computer and internet: 30% of
health centres have been provided with computer
Challenges
 Despite the expansion of the system, there
has been limited commitment from donors in
supporting the system. So far, GF, WB and
WHO have been the key agencies that invest
and support this initiative at central; KOFHI
and UN support MNCH at in some
provinces.
 Extension of data entry into DHIS2 by
health center and implementation of village
health information need extensive budget
support

23. 5. Quality of data by DHIS2
and dissemination of health
information
Achievement
 % of completeness of report 95%
 Definition of each data element could be direct obtain
while enter data in DHIS2, update validation rule and
Max-Min for MCH data entry form
 A lot of work has been done to promote the use of
available information in the integrated DHIS2 HIS:
management dashboards for MOH, programme
management dashboard, and provinces are encouraged
to create their dashboard
 All provincial PHO and programmes have used DHIS2
for reporting especially for monitoring progress of DLI
 Regular update standard report in DHIS2 for WB and
GF project to monitor progress of project
implementation
 DHIS2 system could be use to monitor progress of 10
NA indicators, UHC and SDGs
Challenges
 Only 65% of timeliness
 Staff are careless while recording and
compiling data from registration book before
enter data into DHIS2 , just know that they have
to report to the next level
 Staff at different level are not regular checking
data reported in DHIS2, not use feedback tools
which are available in the DHIS2 system
 The use of DHIS2 system to monitor progress
of health program implementation at central
level are lower than provincial and district level
 Use of health information for planning and
decision making is limited just only stack at
completeness of data entry
 Delay in development and dissemination of
Annual Health Statistic report

24. Percent completeness of data entry
in to DHIS2 system
25.3%
25.2%
23.9%
90.5%
96.8%
91.6%
61.4%
100.0%
96.3%
97.9%
98.8%
97.7%
98.4%
99.1%
98.6%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
MCH OPD IPD
2013 2014 2015 2016 2017

25. Key activities planned in
2018-2019
 Completion of integrated of HIV and TB in to DHIS2 system
 Improve integration of EPI data entry and reporting system into DHIS2 with involvement and
ownership of NIP
 Completion of interoperability of between DHIS2 and M-Supply so that information from M-supply
push into DHIS2 automatically.
 Expansion of data entry into DHIS2 by HC level at 2 provinces
 Begin to implement Village information (family folder) in DHIS2 to collect target population
information
 Provincial wide dashboard
 Diseases surveillance in VT
 Creation of Health Facilities Profile (HFP) in DHIS2 for Laos
 Introduce ICD 10 cause of death in DHIS2
 Pilot MCH tracking of ANC to PNC, Birth and Immunization in one district VT capital
 TB tracking in all provinces
 Malaria elimination in Lungprabang and Xeighkong (Person tracking)

26. HIS implementation Road-map 2013-2025
Phase I (2013- 2015) Phase II (2016 – 2019) Phase III (2020 -2025)
- Development of DHIS2
unit with health facilities,
data entry form for OPD, IPD and
into DHIS2)
- Purchase computers and Servers and
install at national Internet Center
(MOTCC)
- Train key staff on DHIS2 Academy
Vietnam
- Train on data entry and use of
to all provincial and district staff in
provinces
- Establish follow up system to
province and district
- Coordination and fund mobilization
- Development of HIS-strategy and
eHealth strategy
- Capacity building to provincial
and district staff in managing
DHIS2 system
- Improving quality of data
reported and promotion of
of information for planning
decision making
- Integrated information system
HIV, TB, Malaria, Health
Financing, Health Insurance,
WASH,; HRH, CRVS, ICD10
- Extension of direct data entry
HC to DHIS2
- Implementation of Community
Based health information
applying DHIS2
- Development of ICT enterprise
architecture
- Extension of DHIS2 to health
financing, health insurance, M-
and CRVS, NHIB (ATD)
- Government allocated budget to
continue support DHIS2 especially
ICT
- Health Information Center
established to manage and own
DHIS2 system
- Strengthen eHealth networking with
other countries in the region and
HISP

27. Demo on the use of DHIS2
1. To create Dashboard to
monitor programs health
indicators
2. To report on progress of
10 government indicators
3. To monitor malaria
outbreak
4. To track EPI data
https://hmis.gov.la/dhis-web-
dashboard/

34. Thank you!