Week 1 Summary

Dear RHINOs,
I want to first thank all the participants who contributed to the Forum discussion this week. As a reminder, to submit a comment, Login to RHINOnet, then click Technical/RHINO Forums/Interoperability:Linking RHIS and Other Data Sources. Then, choose the discussion thread you wish to read and/or write a comment. We’d love to hear from all of you about your successes as well as the barriers you have encountered in the process of building Interoperable systems.

In summary, the first week we presented questions in 6 threads as sub-topics to the discussion of interoperability, and another thread on scaling up interoperability. The most popular thread (most posts) was “Focus on Interoperability: EMRs vs Aggregate Systems”. There was a general consensus that the focus should, for now, be on interoperability of the aggregate systems. Comments such as these express this sentiment:

“The pace of development of EMRs and their wide roll is far behind that of routine aggregate systems… Don’t wait for the EMRs! let us build what we can and when other elements become operational/available then let us add them in.”

“We are putting the cart before the horse when supporting wide-spread EMRs in places without the infrastructure to sustain them. And diverting precious resources that could be used to strengthen and integrate aggregate data systems!”

“The vision for an interconnected EMR for developing countries is still some distance away. Even the most advanced countries have not achieved this for various reasons. From my observation, those that conceive some of these ideas have little knowledge about what it takes to deliver them. Developing a system is not just the software, we need to talk about the people and the processes as well. ”

This thread also brought up some other points as well. One participant stressed the focus of developing “use cases”:

“Teams/countries thinking of interoperability should think of the USE CASES first i.e. what do we want to achieve. Use cases help in one, documenting the health systems vision and then breaking it down into bite size pieces or phases.”

Another participant thought we should not worry about completely documenting the processes involved before building systems, but grow the system over time:

“The vision should be about building in standards that will allow you to grow your system over time. There is no country that can at one time identify all the processes that need to be built into the system at once.”

One participant thought that the technical aspect of interoperability was easy:

“Once we have the phased approach, mapping data exchange between existing aggregate or client level is a cake.”

Other participants thought otherwise:

“Data exchange between existing aggregate systems is not a piece of cake …If it was, then why don’t we see that it has been done successfully in many of the countries that have implemented aggregate systems?”

“We first try to connect the aggregate systems before venturing to link EMRs and …it is no joke.”
Other issues raised were the need for standardization between paper-based forms, EMRs, indicators and aggregate systems, the importance of Master Facility Lists, importance of system design, strong leadership as factors that influence interoperability. Finally, this thread has some great links to interesting articles and resources, so be sure to check them out!

The second most popular thread was a tie between “Enterprise Architecture” and “Resolving Fragmentation of the Health System”.
These comments summarize the discussion on Enterprise Architecture:

“An enterprise architecture should be discussed and agreed upon by all stakeholders but under the leadership of government; This will help good data governance structure be build and exchange the information.”

“Enterprise Architecture as a blueprint for the health information system. You wouldn’t build your house without a blueprint, and you shouldn’t build your HIS without one either.”

“One of the challenges I’ve seen with the Enterprise Architecture approach is how to keep it a manageable process. The health sector is a large and complex enterprise, and trying to develop a comprehensive architecture for every business processes is a daunting prospect.”

“Learning on EA developed for subsystems has been beneficial in getting stakeholders on board to tackle the need for higher level EA definition to guide interoperability between existing and proposed subsystems.”

These comments summarize the discussion on Resolving Fragmentation of the Health System:

“Recommendations to address fragmentation.
1. We should have good leadership at the central level to steer the process of health information systems development and implementation.
2. There should be a National Steering /Technical Committee- meeting regularly to discuss and find ways to address this issue.
3. Information Systems Development efforts should be made through participatory development process- while seeking partnerships from all possible stakeholders and program managers.
4. Solution to fragmentation of HISs be found through standardization of technology use/common platforms
5.. Integration of data be considered starting from the peripheral facilities and District Health Office level. “

“Let us not ignore the role of development partners who continue to create and support fragmentation.”

“While development partners have played a roll in fragmentation by setting up program or disease specific information systems, there is increasing recognition of the problem internationally, and some notable development partners (e.g. Health Data Collaborative, WHO, the Global Fund, USAID, etc.) are taking pains to align with country systems.”

Finally, we had discussion in 2 other threads, “Scaling up Interoperability” and “Master Facility Lists and other needed health information registries”

In summary, Scaling up Interoperability gave an overview of the situation for nationwide interoperability in Asia and Africa, and gave Liberia as an example of a strategic planning exercise to achieve nationwide scale-up interoperable systems. Another example came from Tanzania.

The comments on Master Facility lists both stressed the need for the governorship, ownership and management of the Master Facility List.

Again, please keep up this most interesting and informative discussion!!