Posted Wed Mar 16, 2016 by John Liebhardt
Luke Duncan, from IntraHealth International’s Informatics team, successfully tested emNutt, an open-source component of mHero, to send messages from any eHealth or mHealth applications to a health worker or client.
emNutt, named after Emma Nutt, the world’s first female telephone switchboard operator, was tested at the IHE North American Connect-a-thon Week in Cleveland, Ohio, which ran from January 25 to 29. More than more than 500 software engineers and developers gather at The North American Connect-a-thon to collaboratively measure how much their healthcare applications are interoperable — the extent at which they communicate, exchange data and use that data with one another.
The successful tests will greatly expand the network potential of mHero, the mobile phone based communication communications system that connects ministry of health staff with frontline health workers via two-way SMS text messages.
From open source to proprietary healthcare applications
Duncan tested emNutt against two applications: Corepoint Health’s Integration Engine and Qvera Interface Engine. Health facilities like hospitals and medical providers in North America often utilize different systems to track such information as, say, electronic patient records, admission records and laboratory diagnostic reports. Many of these systems do not adhere to a set of standards that make interoperability essential.
“[These tests are] important because it allows any application to queue up alerts with one interface and they don’t have to worry about how it’s going to be delivered,” Duncan said. “They can focus on their application features and let the aggregator take care of any of the various ways to deliver the alert.”
These tests marked the first time an iHRIS-based product communicated directly with a propreity software system used in the North American healthcare context. Open-source iHRIS-based products have long adhered to health information system standards, but they generally only have communicated with other open-source software in the ICT4D context, like DHIS2 and those adhering to OpenHIE identified standards.
“This allows mHero to be used in context with other health information systems throughout North America,” said Carl Leitner, IntraHealth’s Associate Director of Health Workforce Informatics. “It also reduces the startup costs for new and innovative mHealth and eHealth applications. Instead of worrying about how to communicate with health workers and clients, they can focus on the their programmatic objectives.”
Working with mHero
mHero presently works by gathering phone numbers from IntraHealth’s health worker database iHRIS and broadcasting messages with UNICEF’s RapidPro platform. emNutt’s new functionality would allow mHero to use any mobile platform, such as Vodacom or CommCare, to distribute those messages to health workers. Using international standards to utilize any mobile platform will expand the mHero’s system reach. mHero allows countries to integrate existing communications systems that they are already comfortable using with the iHRIS database or other health workforce information systems.
Now with emNutt, mHero’s messaging reach is expanded to a variety of target lists including providers, patients and health facilities by connecting with Facility Registries, Client Registries and Health Worker Registries.
Testing against international standards
To test emNutt’s interoperability, Duncan ran the tests against the Mobile Alert Communication Management (mACM) international standard which highlights two use cases: Crisis Response and Care reminders standards. mACM provides a modern programming interface to messaging in the healthcare context. IntraHealth authored mACM with IHE, basing it on HL7 FHIR standards that deal with sharing and integrating of electronic health information. By developing and adopting open international standards and developing open-source products, IntraHealth continues to show its commitment to the Principles for Digital Development.
During crisis or emergency situations, such as the 2014 and 2015 Ebola outbreak in West Africa, health leaders find it is critical to communicate directly with health workers across organizational and national boundaries. emNutt was tested to be able to transmit messages through mHero by an authority — such as a ministry of information — to a number of health workers or security personnel.
For Care Reminders, patients or their dependents may receive care from a variety of providers across different health networks. Coordinating this care can be difficult. emNutt can be coupled with an Electronic Health Record, such as OpenMRS, to trigger care reminders, such as a vaccination reminder for a child who reaches a certain age that can be sent either to the mother or the health provider. It can also be used by systems such as DHIS2 to send alerts to the health workers in in a district based on triggers such as a unusually high level of reports of disease incidence.
mHero was born during the 2014-2015 Ebola crisis in West Africa to meet the needs of health ministries to communicate directly with health workers. emNutt’s success in January greatly expands the potential for the two-way communication tool. mHero users are now able to utilize many different distribution channels — without relying on specific mobile network operators — to broadcast messages to health workers. emNutt also allows mHero to send reminders and alerts directly to patients, a new piece of functionality.
This not only increases the audience for mHero, but also increases the areas in the world where mHero could be used.