iHRIS Blog: Dispatches from the Global Team

mHero and the Principles for Digital Development: Development Done Right

By Amanda Puckett BenDor

IntraHealth International and UNICEF launched the mHero platform in late 2014 in the midst of the Ebola outbreak in West Africa. Originally designed to help Ministries of Health connect with frontline health workers via SMS messages to collect and share information helpful for a rapid response to Ebola, mHero is now a tool embraced by Ministries of Health to support two-way communication for a wide-range of health services.

mHero is different than may other mHealth applications–it is not an application designed to address a single programmatic purpose. Rather, mHero provides infrastructure which is adaptable to a Ministry’s needs and which leverages information the Ministry is already managing on health workers. Deploying mHero is not about deploying a software technology, it is about people and processes–the organizational development needed to govern and manage such a powerful tool.

mHero is not a wholly new technology. Rather it is a system that embraces various open source health information systems such as iHRIS–IntraHealth’s human resources information system–and RapidPro–UNICEF’s two-way interactive messaging system–and DHIS2 to facilitate communication to health workers. Behind those communications, mHero’s technology allows system integration and information sharing leveraging components of OpenHIE, a set of technologies that allows data systems to speak to each other using open international standards for data exchange.

princplesfordigitaldevFrom its inception, the organizations supporting mHero have aligned the development and deployment alongside each of the nine Principles for Digital Development, a living set of guidelines intended to help development practitioners integrate established best practices into digital health programs. Here are the nine ways that illustrate how mHero was created and continues to evolve to ensure that digital development is done right.

Design with the User
With support from UNICEF and USAID, mHero’s small-scale pilot project took place in Liberia in November 2014, but before a single SMS message was sent, IntraHealth and UNICEF worked closely with Ministry of Health (MOH) officials to ensure every aspect of the system was designed to meet their needs. This included using the technologies the Ministry was already implementing (iHRIS, DHIS 2, and RapidPro) and creating a series of questions developed into SMS texts that sought information the MOH identified as a priority early in the response. Today, mHero is used in a variety of ways (such as the MOH’s mental health unit using mHero to speak directly with clinicians treating depression), and IntraHealth continues to collaborate with the Ministry of Health to adapt, pivot and adjust its implementation to meet the needs of the different users.

Understand the Ecosystem
There are a several ways that IntraHealth ensures that mHero is aligned with like-minded technologists in the health information system (HIS) ecosystem to communicate technology enhancements and build consensus for data exchange standards. Communication is key, especially in a rapidly evolving technology environment, and we are committed to sharing with our global colleagues how they may embrace the mHero platform. For example, a recent call of the OpenHIE Architecture Group highlighted how mHero could carry out the Mobile Alert Communication Management  (mACM) standard: communication for crisis response and providing care reminders for patients with cell phones. These types of discussions–virtual or in person–are important to understanding the needs that mHero can meet in the HIS ecosystem.

By adopting the OpenHIE architecture we allow for the various components of mHero to be swapped out. If the MOH does not use iHRIS to manage their health workforce, they can simply adopt the data exchange standards in the mHero Workflow and enjoy the benefits.  Currently, connections with communications platforms such as CommCare and ODKCollect are in the work which gives a Ministry the choice to use the tools they are comfortable as part of their mHero implementations.

Understanding the ecosystem requires appropriate avenues for sharing and engaging with stakeholders. We use many of these communication tools including Google Groups, GitHub, Wikis, Skype channels, Slack and participate in Hackathons.

Design for Scale
Interoperability–the ability of programs to communicate, exchange data and use that data with one another–is the backbone of mHero. This approach ensures that no matter which health worker information system or SMS tool is used in a country, as long as it meets the technology standards, the interoperability layer of OpenHIE can be harnessed to link these components together to instantiate mHero. This systemic approach does not limit a MOH to use any one health information or communication system such as iHRIS or RapidPro; rather mHero provides a roadmap for the MOH to bring these things together.

At the heart of mHero is an Interlinked Health Worker Registry, which brings together facility data and health worker data from all the various sources within in a country–from the MOH itself, from the professional councils, from a Master Facility List.  As mHero leverages these existing national scale data systems, mHero lets the MOH connect with the entire health workforce.

Photo by Emily Nicholson of IntraHealth International

Photo by Emily Nicholson of IntraHealth International

Build for Sustainability
IntraHealth’s support for mHero during the Liberia pilot moved at the pace of the MOH. We committed to ensure that the MOH owned the system, determined the direction mHero would grow, and guided its use. Rather than establishing mHero as an IntraHealth project, we built the capacity of the MOH staff to own the entire process. This included providing tools such as templates for standard operating procedures and use case prioritization processes. But ultimately it has been the MOH to utilize these resources and iterate them based on their needs. This has been a success as the MOH has adapted mHero including it recently in the Liberia ICT Strategy and Plan. Building capacity for ownership has been a recipe for success that is being replicated in other mHero implementation countries.

Be Data Driven
mHero is about the communication between MOH and health workers, and that data collected from those communications is the crux of what makes mHero a useful tool. Through mHero implementation, IntraHealth assists the MOH to determine what data they need so that SMS seek to address those needs.  This data may be a one-time survey or a routine data collection; it can target a small cohort of health workers or all health workers in a cadre. A key part of this process is for the MOH determine the best way to use that data to respond to health workers’ needs. Building a culture of data demand and use is an ongoing and integral part of the mHero platform.

Use Open Data, Open Source, Open Innovation
As mentioned earlier, mHero embraces open innovation–sharing ideas, resources and knowledge with HIS experts. Open source programs are those whose source code is made available for use or modification as users or other developers see fit. This type of software is usually developed as a public collaboration and made freely available. Open source is a requirement for the technologies operating through mHero.  Systems like iHRIS ensure that MOH will avoid software and licensure fees. Our work ensures that we continuously engage with the HIS ecosystem such as OpenHIE to ensure that standards are understood and used through mHero. For example, a new standard mACM and a reference implementation of the standard emNUTT, was unveiled and tested to expand mHero’s reach to a variety of target lists including health providers, patients and health facilities by connecting with Facility Registries, Client Registries and Health Worker Registries.

Reuse and Improve
On the backend, mHero’s modular approach–integrating different systems, linking them with DHIS 2 and other HIS–allows for flexibility that is essential for the future of useful information systems. Sharing specific workflows and country implementation tools allows for users on the front end–those MOH stakeholders involved in the day-to-day running of mHero–to save time and focus on information needs from health workers. This also promotes shared learning experiences and lessons learned of implementation practices from country to country.

Address Privacy and Security
mHero’s data exchange ensures that privacy and security of health worker and MOH data is addressed. Leveraging the OpenHIE’s architectural model of an interoperability layer (in this case the OpenHIM), a component which adds a security later providing access control, and audit log as well as a data router and transformer to ensure systems communicate effectively. In building capacity at MOH to use mHero, we include this important discussion of privacy and security to help stakeholders understand not just that data is secure but how the system works to ensure data privacy and security is addressed.

Be Collaborative
mHero embraces the spirit of stakeholder collaboration, including national governments, experts in the ICT4D community and donors to plan how best to foster robust communications with health workers. The partnership for mHero extends far and wide to facilitate a meaningful conversation and collaboration to ensure successful operationalization and implementation in country, and continuously adapt the technology behind the platform to meet technology standards and changes.  To ensure dissemination, the mHero website shares a plethora of information about mHero including a robust toolkit for implementers.

mHero does not just embrace the 9 Principles for Digital Development–it only works because every day it adheres to these principles.  Implementation of mHero has the potential to impact health systems improvement and save lives.

Want to find out more?  Join us on Slack.

Cover photo by Ozzy Delaney.

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iHRIS Community begins using Slack

The Global iHRIS Community will begin using the cloud-based collaboration tool Slack to augment its community communications.  You can access Slack on your phone, from a web-browser as well as directly on your computer.

The Global iHRIS Google Group will remain the principal communication tool allowing community members to share news, pose questions and receive feedback.

“Sometimes email is too cumbersome when there needs to be a lot of back and forth discussion so Slack makes this easier, said Luke Duncan, an IntraHealth International Senior Systems Developer and member of the iHRIS Community. “Slack is nice because it keeps a history for others to benefit from.”

Duncan feels Slack could be utilized for implementation (or installation) assistance that often can’t be answered through a single email. This also includes development discussions about new iHRIS features.

To receive an invitation to the iHRIS Slack Community, please follow this link. You will be asked to enter your email and then receive an invitation to join the iHRIS Slack Community.

iHRIS Slack will use channels dedicated to discussions on specific topics. Presently, this list includes the following channels:

#general  – this is your starting place where you can ask general questions about iHRIS
#dev – this is for people interested asking questions about iHRIS and related software development
#mhero – for discussion about linking iHRIS in to the mHero communication platform
#francais – si vous pouvez lire ceci, vous savez ce qu’il est pour
#commits – this tracks all committed changes to iHRIS and related software.  this gives you a sense of what our team is working on

Countries with iHRIS or iHRIS-product installations (like mHero) will also have their own dedicated channels, such as #DRC, #dominicanrepublic and #kenya.

iHRIS Community managers also point out that compared to email groups, Slack is feature rich. Slack  allows users to search all content, including files, conversations and other users. Users can upload files like spreadsheets, images, PDFs and Word processing documents, into Slack conversations. Users can also share files directly with other users. Slack also allows users to send direct messages to others.

Photo, Auklet flock, Shumagins 1986, by D. Dibenski in Public Domain.

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More countries sign on to iHRIS: Global Community Still Growing and Adapting

Four new countries have recently adopted iHRIS and four more are in the planning stage to use the open-source health information system.

Presently, 23 countries utilize iHRIS to track and manage more than one million health workers. That is up from 18 countries in 2013.

The countries entering the planning stages to adopt iHRIS include:

  • Bhutan
  • Dominican Republic
  • Ethiopia
  • The Gambia

The possibility that 27 countries could utilize iHRIS illustrates the continued interest in the open-source solution for tracking and managing health care workers. Its growth underscores the fact that the iHRIS Community remains healthy and engaged.

At the same time, the global iHRIS Community is undergoing fundamental changes.

IntraHealth International continues to support the iHRIS Suite, and the US-based organization wants to broaden the community structure so all stakeholders have a greater say in iHRIS’s future direction. IntraHealth is currently working on ways to better engage stakeholders of all levels so everyone has a voice.

We will need everyone’s help to redefine the iHRIS community goals. More coming soon.

Photo of Globes by ricardo

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New Version of iHRIS Improves Health Workforce Data Presentation and Usability

IntraHealth International announces a major release of the iHRIS health workforce information software. Version 4.2 introduces changes to the core software that improve data presentation and usability.

iHRIS (pronounced “iris”) is a suite of free open source software specifically designed to supply low-resource countries with information to track, manage, deploy, and budget for their health workers. The iHRIS software has had 12 minor releases since version 4.1 was released in April 2012.

iHRIS helps capture data on health worker numbers, skills, qualifications, training, employment history, location, and more. With this information, health workforce managers and other decision-makers can address health workforce shortages and solve other challenges.

Over twenty countries around the world are using iHRIS to manage almost one million health worker records. These countries saved over $226 million in licensing fees alone, compared with similar proprietary systems.

IntraHealth International’s USAID-funded global project, CapacityPlus, supports the core development of iHRIS while several other IntraHealth projects customize the software for specific country needs.

Data Presentation and Analysis

New functionality in iHRIS Version 4.2 now makes it easier to present and analyze health workforce data for decision- and policy-making. 

iHRIS can produce a variety of standard or customized reports for analysis by decision-makers to answer a wide variety of policy and management questions. A new dashboard feature allows iHRIS administrators to easily merge, compare, and contrast several reports. Decision-makers then have an overall birds-eye view of the health workforce for more insightful analysis, and for monitoring or identifying health workforce issues. 

With new GIS reporting capabilities, users can now easily map geographic data associated with a country’s regions or districts, as well as facilities and training institutions. For example, a decision-maker can quickly see how many and what type of health workers are posted in a particular area or health center or how many health workers are undergoing specialized training in a certain district. 

Data Sharing and Use

By adopting and adhering to new international data standards and terminology, iHRIS 4.2 better interoperates (or shares health workforce data) with other health information systems. Improved interoperability enables iHRIS health workforce data to be integrated with clinical service data, for instance, and decision-makers to compare health worker numbers and productivity with service delivery needs. As computer systems and languages evolve fast, using standards can also reduce long-term software development and maintenance costs.

The new version also mapped iHRIS data fields to match the WHO’s new Minimum Data Set for Health Worker Registries, which specifies crucial data needed for national health workforce planning and monitoring and for cross-country comparison of health workforce supply  and demand.

iHRIS 4.2 is now available for download. Developers and implementers can install iHRIS version 4.2 or upgrade an existing iHRIS.

To learn more about iHRIS visit www.ihris.org or contact Luke Duncan, Senior Systems Developer, Health Workforce Informatics for IntraHealth, at lduncan@intrahealth.org.

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Using Evidence for Human Resources for Health Decision-Making

iHRIS and human resource for health information systems(HRIS) like it play a critical role in managing health workforce data. However, curating and maintaining data for the sake of it is not the goal. Using data to inform decisions is one of the primary objectives of the system. The USAID led CapacityPlus project led by IntraHealth recently published a technical brief on the subject and the iHRIS Community believes it is worth sharing.

A strong and well-distributed health workforce is essential for achieving national and global health goals. Effective policies to address workforce challenges, such as retention, should be informed by relevant data; however, the availability of evidence does not guarantee that it will be used for decision-making. A new CapacityPlus technical brief shows national stakeholders how to transform evidence into policy decisions and subsequent action.

Technical Brief 15In Using Evidence for Human Resources for Health Decision-Making: An Example from Uganda on Health Workforce Recruitment and Retention, authors Rachel Deussom and Wanda Jaskiewicz of IntraHealth International explain how countries can build interest, momentum, and political will to make policy decisions for retention strategies to strengthen the health workforce. Based on a literature review and the authors’ experience in Uganda, they describe six recommendations to help stakeholders turn evidence into effective policy decisions and subsequent action:

Using an example from Uganda, the authors illustrate how the development and sharing of evidence can support decision-making for change in health workforce recruitment and retention policies.

To learn more, read the new publication, available as a PDF and an interactive online version. CapacityPlus would like to know what you think; send them your feedback.

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Countries Use iHRIS to Fight Ebola

IntraHealth International and UNICEF are joining forces to help Liberia’s Ministry of Health and Social Welfare communicate with health workers in real time as the country fights to contain the Ebola outbreak. We are combining two existing technologies—IntraHealth’s iHRIS software and UNICEF’s UNICEF’s mobile phone SMS platform—into a powerful communication tool called mHero (Mobile Health Worker Ebola Response and Outreach).

mHero will allow the ministry to instantly send critical information to health workers’ mobile phones during the outbreak and in the future. The tool allows for:

  • Broadcast messaging
  • Reporting emerging cases
  • Sharing reference and training materials
  • Testing and improving the knowledge of health workers
  • Better coordination among the Ministry of Health and Social Welfare and far-flung health facilities

Since March, the Ebola virus has infected more than 3,600 people and killed over 1,800 in West Africa, including more than 120 health workers. This outbreak is the largest ever recorded. The World Health Organization predicts more than 20,000 cases will emerge before the outbreak is over.

In Liberia, there have been more than 2,000 suspected cases, and 78 health workers have died.

Health workers on the front lines are struggling with a lack of supplies and training, in addition to fear and stress. Some nurses in Liberia are on strike demanding personal protective equipment and higher salaries due to the risk.

Getting information quickly into the hands of the health workers who must diagnose and treat clients who have Ebola-like symptoms can save lives and protect health workers. Regular updates on the latest developments issued directly from the Ministry of Health can also reassure wary health workers who may feel isolated from the coordinated response.

Mobile Numbers Are Key to Reaching Health Workers Fast

One tool Liberia did not have at the outset of the Ebola crisis was a method for reaching its more than 8,000 public service health workers with late-breaking information. But thanks to the way one if its national health information systems was designed, that’s about to change, and quickly.

In 2013, Liberia’s Ministry of Health and Social Welfare began implementing iHRIS (pronounced “iris”), IntraHealth’s free, open source health workforce information system. iHRIS helps countries track and manage data on their health workers. Nineteen countries are currently using the system.

As of today, the ministry in Liberia has added records for 3,000 health workers to the system, has collected paper records for data entry for an additional 5,000, and is entering records at a rate of 450 per week. Ninety percent of these records include health workers’ mobile phone numbers.

Because iHRIS conforms to the international Care Services Discovery (CSD) and other interoperability standards and is open source, it can quickly be integrated with UNICEF’s SMS platform. During a code-a-thon last week, developers and public health officials from IntraHealth, UNICEF, and ThoughtWorks laid the groundwork for connecting data from iHRIS to UNICEF’s platform to create the mHero application.

mHero is engineered using OpenHIE interoperability technologies.  Using open architecture, standards, and approaches means that mHero can access health worker data from any CSD-compliant data source, such as a community health worker registry, and offers a consistent source of health worker information to other mobile platforms that work with OpenHIE.

“I’ve spent a good part of my career advocating for the power of interoperable, open source health information systems,” says Dykki Settle, director of health workforce informatics at IntraHealth. “It’s easy for policymakers to postpone investments in their health sector information systems and focus on more tangible health sector initiatives. The Ebola outbreak is certainly not the type of proving ground I ever wanted for the power of good data and strong information systems, but I am grateful Liberia made the initial investment and hopeful that mHero will not only make it easier for health officials to get the right information to the right people to help control this outbreak, but will also support more resilient health systems once the outbreak is over.”

Liberia’s Ministry of Health and Social Welfare implemented iHRIS with support from the United States Agency for International Development (USAID)-funded Liberia Rebuilding Basic Health Services Project, led by JSI. IntraHealth’s iHRIS software was developed under the Capacity Project and continues to be supported through theCapacityPlus project, which is led by IntraHealth and supported by USAID

This press release was originally posted at IntraHealth International

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Countries Save $177 Million with iHRIS

We know that iHRIS helps save lives by allowing countries to place health workers where and when they are most needed. But it also saves money. A lot of money.

Annually iHRIS gives the 19 nations that use its open source software the opportunity to save $177 million. Without iHRIS, that money would be spent on licensing fees alone.

That’s money that iHRIS nations can reinvest in their people, systems, and infrastructure to improve the health and lives of their citizens.

iHRIS Country Map

The Real Value of iHRIS

That $177 million figure, impressive as it is, is not the whole story. The real-dollar value of iHRIS extends beyond licensing fees.

Consider the other benefits that accrue to nations that implement iHRIS systems:

  • Free customization, support, and ongoing updates of the software
  • Optional modules and systems to expand iHRIS functionality
  • A global community of developers constantly working to improve and expand the software

 

All these benefits spell additional savings. The updates and support volunteered by the iHRIS community would cost nations more than US $30 million or more each year if they were using proprietary software.

Now consider the benefits that are hard to put a price tag on, but that have clear value in human terms:

  • Local empowerment: countries take control of the development and direction of their health information management.
  • Global partnership: a community of developers, implementers, and users support one another to make iHRIS better.
  • Development of local skills: iHRIS implementers encourage local solutions to national needs.

 

These additional benefits put the real value of iHRIS far beyond the $177 million figure. Ultimately, the value of iHRIS does not rest on the fact that iHRIS is free of charge, but on the fact that iHRIS results in a better product with plenty of support. To do what iHRIS can do “right out of the box,” proprietary systems often need costly customizations. iHRIS’s adaptability to local needs alongside its zero-dollar price tag is why more and more nations are coming on board.

Every Voice Adds Value

Because iHRIS is built on the principles of sharing and learning from one another, everyone in the community is valued, and everyone adds value. While saving money is a great reason to choose iHRIS, open source offers much more than dollar value.

Ricardo Lopez, iHRIS technical advisor, spoke to us recently about what iHRIS means to him and to his nation of Guatemala. Here is an excerpt from that interview:

What is the value of iHRIS and its open source software to you and to your country?

Guatemala doesn’t have that much money to buy expensive proprietary software. So iHRIS is a big opportunity to have a great product without having to pay an outside group expensive licenses.

What does it mean to you to do this kind of work?

Every day in the news I see that people don’t have good health because the area where they live doesn’t have medicine. They don’t have a doctor. They don’t have a nurse. They have big problems with nutrition. I want my country to have a good health service, to know where we need doctors, nurses, and other health-related resources. For me personally, it’s very important to help, to improve how information is managed. The rural areas especially need help to manage their data.

What is it about working with open source and the iHRIS community that you especially value?

Working in an open source community gives me the chance to work with people who make incredible contributions in programming. I do this kind of work because of the open source ideology. Everybody can use the code. The community can share all the knowledge.

With proprietary systems, it’s very difficult to access information, to access new developments. Everything costs a lot of money — the courses, the licenses, the tools. Everything has a cost. With open source, you obtain a good software at no cost. I prefer open source software because I think it’s the fairest approach.

Versatility Equals Ever-Expanding Value

To put the final decimal point in place, factor in the versatility of iHRIS. iHRIS open source software can easily be adapted to broaden its functionality, and its value, in response to a need.

Take Tanzania as an example. iHRIS implementer Juma Lungo is adapting iHRIS to track all the assets of his Computer Science Department at the University of Dar es Salaam, assets such as furniture, computers and supplies.

iHRIS implementer Bakari Bakari, also in Tanzania, is customizing iHRIS to track all public employees, extending use of the system beyond health workers. This expansion of iHRIS in Tanzania increases the value of iHRIS from $177 million to more than $200 million annually.

As iHRIS Community Manager Michael Drane puts it: “This is why iHRIS is such an asset for the nations that implement it. It’s always inherently of greater value, because at any given moment it can be adapted to suit additional needs.”

iHRIS isn’t just software that saves nations money. iHRIS helps train a workforce of empowered and creative individuals working together to improve lives, resulting in an end product tailored to each nation’s different needs.

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VSO, THET and Ministry of Health Push iHRIS Forward in Malawi

If you’re not convinced that open source is right for global health and development then talk with Herman Fung. Herman,  a VSO volunteer who spent nearly two years in Malawi working at the Ministry of Health on a health systems strengthening project funded by Tropical Health and Education Trust (THET) is a strong proponent of iHRIS and open source software. At the request of the Ministry of Health, Herman and five other volunteers implemented iHRIS Manage because it was free and open source. Herman was an active community member, taking advantage of the community’s collaboration tools to implement the software at a fraction of the cost proprietary systems require. We are particularly proud of the team in Malawi. Herman and his team demonstrate that it does not require direct financial or project management support by CapacityPlus to implement and use iHRIS for managing a country’s health workforce. The iHRIS Community and it’s free online resources are sufficient support to implement and maintain the software.

Herman describes the scope and success of iHRIS in Malawi in his blog post  A to Z: I is for iHRIS.  This is a must read for anyone who wants to understand the power of open source and the cascading impact it can have in global health. Thank you Herman and the iHRIS MoH Malawi team!

Below is just one example of  iHRIS in Malawi empowers its users to turn data into information.

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International Standards Adopted in Zimbabwe for National Health Worker Registry

These programmers see the light, embrace international standards for the Zimbabwe Ministry of Health and Child Care’s new national health worker registry.

HiTracZimbabwe

The registry is a database that will pull together a basic set of data on health workers from various information systems in the country.

Once the data are available, health leaders can use them to make all kinds of decisions that can improve the health of Zimbabweans—from influencing health workforce policy to improving the delivery of clinical services.

But first, the computer programmers in this photo had to figure out how to make the different systems “talk” to the registry, or share agreed-upon information.

That’s why IntraHealth joined Zimbabwe’s Health Informatics Training and Research Advancement Center (HITRAC) and Jembi Health Systems to hold a one-week “OpenHIE coding academy.” All three organizations are members of OpenHIE, an open source community that helps countries strengthen their health information and developed the model registry on which Zimbabwe’s is based.

Most of the programmers work for HITRAC, which is leading the work that’s funded by the Health Information Public-Private Partnership.

During the week, the programmers created a plan for integrating information from the ministry’s health workforce information system and other information systems in the country, like those managed by the health professional councils, TrainSMART (which tracks in-service training for health workers), and DHIS2 (which tracks service delivery info and disease statistics).

The plan ensures that the registry is compatible with the international Care Services Discovery standard, a defined way to exchange data that makes it easier to access and merge health workforce data from various sources, and that data-sharing is secure.

IntraHealth’s Carl Leitner co-authored the Care Services Discovery standard and facilitated the academy (he’s sixth from the right in the photo above). He explains why all this matters:

“If countries follow international standards, they open themselves up to innovative health workforce information tools developed by other countries that follow the same standard,” Leitner says. “What is really exciting is we have opened up the possibilities for the ‘appification’ of health workforce and health services data. In other words, we are creating a market opportunity for country and regional software developers to make use of health service data in their own apps.

The model health worker registry is based on IntraHealth’s iHRIS and OpenInfoMan software platforms developed under the IntraHealth-led and USAID-funded CapacityPlus project. Other current implementations include Nigeria and Rwanda.

By Carol Bales and Dr. Carl Leitner

Read more about the coding academy.

Read more about why data standards are important.

Photo courtesy of Carl Leitner.

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OpenHIE- Bridging information systems and mobile applications with common standards

What is OpenHIE (Health Information Exchange)? And what does it mean to the iHRIS community?

OpenHIE is a framework that allows for sharing information across different health information systems. For iHRIS users, it’s an opportunity to contribute to and access a much bigger picture of their nation’s eHealth landscape.  One of the major components of OpenHIE is a national health workforce registry. A Health Worker Registry (HWR) serves as the central authority for maintaining the unique identities of health workers within a country. The registry not only provides a big-picture view of the country’s health workforce, but also enables numerous uses cases for analysis, validation, and interoperability within the larger health information system, eHealth architecture, or health information exchange. It harmonizes data gathered from various sources that categorize and store information differently from one another, resulting in higher-quality data. This improved data quality supports more refined analysis of the health system for quality measurement, reporting, and research, with the aim of improving health outcomes.

OpenHIE and the HWR represent a natural progression along  the continuum that iHRIS has followed since its inception. Ten years ago, iHRIS began helping countries move from paper to electronic record keeping. Now that the data are captured electronically, the iHRIS community has been focusing on learning how to use that data most effectively. Part of that process entailed classifying and categorizing the data, essentially creating electronic  lists to help analyze the information.

“We’ve created a set of technical tools for iHRIS users,” said Carl Leitner. “Now we need to build a culture of using those tools. Typically we’ve been working within one organization. But now the question is, ‘How do we work across multiple organizations?’”

Complex questions about governance and policies arise when you work across organizations, as well as fears about ownership of data. “How can we best mitigate some of the issues and fears that people have about sharing data?” said Leitner. “How do we open up people’s perception so that they see it’s beneficial to share this data? What solutions have people found to overcome some of these innate fears that people have?”

Nigeria provides a good precedent for how a nation can go about this. Nigeria spent two years developing a minimum data set of health worker information, agreed upon by the federal Ministry of Health, as well as by the other national stakeholders and states. “Everybody got together and developed this minimum data set. One we had that, all we had to do was adapt the health worker registry to make sure that those minimum data set fields were captured.” According to Leitner, the technical aspects of it are relatively small. The trick is getting the consensus; for example, getting everyone to agree on the definition of the term “facility.”

“OpenHIE is the meeting point for different health information system components to agree on standards so that all those systems can talk together.” It can substantially reduce the complexity of data exchange. By taking part in it, iHRIS stands to further realize its mission of national ownership of information. A great place of iHRIS community members to take part is by joining the OpenHIE HWR Community.

“I think we’ve gotten to the point where all of this work we’ve done — getting health worker data from paper into electronic form, cleaning it up, thinking about what  the data standardized lists are — we’re getting to a point where it’s going to start to have some really large impacts on the health system.”

As Nigeria continues its work with OpenHIE, other nations are coming online as well. Zimbabwe, Kenya,  Botswana, and Rwanda are preparing deployments, and other nations will likely come on board soon.

The sky is the limit when it comes to the opportunities that are presented to countries when common standards connect information systems together.

 

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