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Achieving Universal Health Coverage - RHINO (HSR2018) pt.2

RHINO panhel presentation on "Achieving Universal Health Coverage: The Role of Routine Health Information Systems" (HSR2018)

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Achieving Universal Health Coverage - RHINO (HSR2018) pt.2

  1. 1. Routine Health Information Network Achieving UHC: Role of eHealth Architecture & Interoperability Vikas Dwivedi Data Use & Innovations Adviser John Snow Inc Liverpool, October 10, 2018 Health System Research Symposium
  2. 2. Universal health coverage
  3. 3. Facility deliveries by country (1990-2014)  Three-quarters of women globally now deliver with a skilled birth attendant Campbell OMR, Calvert C, Testa A, Strehlow M, Benova L, Keyes E, Donnay F, Macleod D, Gabrysch S, Rong L, Ronsmans C, Sadruddin S, Koblinsky M & Bailey P. The scale, scope, coverage & capability of childbirth care. Lancet 2016  This dramatic increase occurred mostly via facility deliveries
  4. 4. Women often left out of good quality care  Adolescents & unmarried women  Immigrants  Refugees & internally displaced women  Indigenous women & ethnic or religious minorities  Living in poverty  Living in informal urban settlements  Living in fragile states  Affected by humanitarian crises 53 million women not receiving childbirth care at all
  5. 5. Who is the Provider and what medicines were provided? Who is the client and what services are provided? What is the place of service? Who is paying and how much? Quality Equity Dignity Continuity of Care Multiple interacting system components
  6. 6. Service provision vs. continuity of care?Multiple points of contact for different services …and data about the same client may be collected in multiple systems… A common e-registry can be SHARED ACROSS MULTIPLE SYSTEMS and REDUCE DUPLICATE RECORDS Produ cts Laborat ory HR
  7. 7. THE QUESTION? How can Interoperable information systems support?
  8. 8. Dashboard to support district level management decision making % Treatment Provided % of days of Stock-out of Amoxicillin Training of health workers Treatment of U5 for suspected Pneumonia and Stock-out Status Treatment of U5 for suspected Pneumonia by Sex
  9. 9. Interoperability means the ability to communicate and exchange data accurately, effectively, securely and consistently with different information systems, software applications and networks in various settings. An architecture can facilitate communication between building blocks and promote interoperability across existing components
  10. 10. Mobile Applications Clinical Record Systems Hospital Information Systems Laboratory Information Systems M&E Applications The current situation
  11. 11. Institution-Based HIS & Data Sources National Health ICT Infrastructure eHealth Architecture Governance, Principles, Processes and Standards Point of Service HIS Surveillance IVR EMRNutrition eCHIS Patient PortaleLIS Facility Surveys (SPA+) eLMIS/HCMIS eHMIS / DHIS2 Health Insurance / eHNIIS IDSR / ePHEM HGIS Shared Services Master Facility Registry Health Data Dictionary eHIRIS Client Registry (EMPI) Shared Health Record Interoperability Service Authentication • Encryption • Routing • Transformation • Queuing • Validation • Translation Analytics & Business Intelligence Data Warehouse EHDAP Population-Based HIS & Data Sources Health Surveys Census CRVS eRIS External Systems Ethiopia: eHealth Architecture: Future State Education Agriculture Revision Date: 02-Jul-2018 11 Analytics and BI Meteorology
  12. 12. Who is the Provider and what test are conducted and medicines were provided? An under 5 who comes for the facility with signs of pneumonia? What is the place of service? Facility or Community Who is paying/insurance and how much? Coordinated care to support decision-making Health e-registry eRegistry Quality Equity Dignity Continuity of Care
  13. 13. What would this achieve and How? • Collect data once; use many times • Cooperation among stakeholders – Use consistent/standard rules – Sensitivity to legal, ethical, and social requirements – Commensurate levels of security, privacy, and confidentiality • Use a single set of foundational elements • There is more to interoperability than technology systems – Cooperation among people, systems, and organizations • Need everyone at the table – Policymakers, program managers, healthcare providers, technologists, donors, etc
  14. 14. Rwanda Liberia Zambia Rwanda Health information Exchange South Africa’s: MomConnect South Africa eRegistry: Pregnant woman Bangladesh ‘Ananya’ for messaging to CHWs & ‘Kilkari’ for pregnant families India Achieving UHC at scale with linked insurance and clinical systems Thailand Tanzania Philippines Ethiopia
  15. 15. Designing Information Systems
  16. 16. Three key lessons 1. The need for Architectural approach with multiple sources: Service Delivery, Health Workforce, Medical products/commodities, Payments/Insurance, Place of service delivery 2. Harmonized design of systems elements in an interoperable manner 3. Use of open group models, data standards, and source software to enable customization, ease data exchange and implementation
  17. 17. THANK YOU FOR JOINING!!!
  18. 18. HOSPITAL INFORMATION SYSTEM FOR HEALTH FACILITIES IN LIMITED RESOURCES ENVIRONMENTS
  19. 19. Utilisateurs/décideur s nationaux DIS DRS CHR District CS et Hôpitaux points focauxR MA bulletins/ annuaires Site web points focaux Site web Site web ? R DHI S2 OpenIM IS OpenR BF
  20. 20. Information needs in health facilities INFORMATION HEALTHCARE FOR PATIENTS HOSPITAL MANAGEMENT HMIS (DHIS2) DISEASE SURVEILLANCE HEALTH INSURANCE (OPENIMIS) PBF (OPEN RBF) BILLING
  21. 21. Health facilities with limited resources present many challenges LIMITED FINANCIAL RESOURCES POOR INTERNET CONNECTIVITY UNSTABLE POWER SUPPLY, DIFFICULT ENVIRONMENT END USERS UNFAMILIAR WITH ICT, WINDOWS & LINUX LOW AVAILABILITY OF QUALIFIED TECHNICIANS LARGE AND DIVERSE QUANTITY OF DATA TO BE COLLECTED CONSTRA INTS 5
  22. 22. CERHIS • Android tablets for simplified EMR : they replace paper registers – Individual administrative data – Individual medical data • Follows the patient itinerary in the health facility • Information is shared between local users (local server with LAN, Wi-Fi) • Highly configurable depending on countries / health facility type / national programs… Pharmac y Maternit y Consulta tion Laborato ry Admissio n
  23. 23. CERHIS • Patient medical history, from successive visits (EMR) • Use information for billing • Dashboards and Excel exports for health facility management • Produces and sends aggregate data (DHIS2, RBF portal…)
  24. 24. hardware (Protection and charging cabinet) + support Server & network Android devices, storage, protection & charging Batteries
  25. 25. Architecture of the system USERS META DATA DATA USERS META DATA DATA USERS META DATA DATA • Server • Linux • Couchbase NoSQL database, document-oriented, JSON • DB stores data + metadata + users • Computes aggregate data every night • Sends data periodically if internet available • Clients • Android • CERHIS App • Couchbase Lite NoSQL database • DB is a replication of the server’s DB • Connected through Wi-Fi • Continuous background syncing • Horizontal scaling • Going Open Source (code review)
  26. 26. Addressing challenges • Easy to use and intuitive • Configurable (requirement of the NHMIS) • Works without internet • Robust • Tolerates power outages • Limited costs
  27. 27. Login Serge *********
  28. 28. Admission: administrative data, starting a visit Serge ********* Laboratory Maternity Consultation Pharmacy Admission
  29. 29. Consultation Serge ********* Laboratory Maternity Consultation Pharmacy Admission
  30. 30. Hospital Laboratory Emergency room X rays Pharmacy Admission Administratio n Operation room MaternityObstetrics Surgery Pediatrics Medicine Ophtalmo. Dentistry Preventive consultation Curative consultations ENT In patient department Out patient department
  31. 31. Outputs: medical history of the patient (EMR)
  32. 32. Outputs: sending information to DHIS2 Data is transferred on USB key or temporary internet connection
  33. 33. Pilot project in Kinshasa – 1 district hospital (38 tablets, 120 users) – 2 health centers (12 tablets, 12 users) – Replaces registers, based on NHIS models – Produces monthly reports sent to national DHIS2 – Configuration and training with local partners – Continuous training and support by local partners – Power supply with solar panels – No internet – SMS monitoring – Operating for 9 months
  34. 34. AEDES Loïc Vaes lvaes@aedes.be 2018
  35. 35. Questions? @RHISNetwork www.rhinonet.org The_rhino@jsi.com Routine Health Information Network

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RHINO panhel presentation on "Achieving Universal Health Coverage: The Role of Routine Health Information Systems" (HSR2018)

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