Category: Syndicated

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June 05, 2018

These are the paths that will lead us beyond lofty goals and onto practical action.


We know that interoperability is key to improving the effectiveness and resilience of health information systems.

As we’ve said before, it’s crucial to overcoming the fragmented and proprietary global health information systems we have today, and can allow governments and their stakeholders to make the most of their data, including extending, upgrading, and preserving it.

Yet how do we move from that lofty goal to practical action? For us at IntraHealth International, there are three clear pathways to greater health systems interoperability: standards, tools, and advocacy.

Interoperability Standards

Health information systems need clear standards to communicate with each other and with the wider health ecosystem. So we’re developing those standards.

For instance, through the OpenHIE effort, IntraHealth is a core contributor to the Care Services Discovery (CSD) profile, which supports queries across related directories that contain data about organizations, facilities, services, and providers.

We also contribute to the Mobile Case Services Discovery (mCSD) profile. This is based on HL7’s Fast Healthcare Interoperability Resources (FHIR) standard and supports transactions and actors similar to CSD, including pulling data on organizations, locations, health care services, and practitioners from multiple data sources and responding to queries on those resources.

Interoperability Tools

Standards are important, but without the software tools to make them useful, users won’t adopt them.

So we developed OpenInfoMan, an implementation of the CSD profile to find matching services and query for updated services transactions as part of OpenHIE. OpenInfoMan is the engine behind the CSD-compliant Health Worker Registry.

And now we’re working on an implementation of the mCSD profile to add FHIR support to the Health Worker Registry. This tool is extended from Jembi Health System’s Hearth FHIR server and gives implementers an extended set of operations beyond what is required by mCSD.

We are also developing Global Open Facility Registry (GOFR) tools, in partnership with DATIM and Digital Square, to support ministries of health as they develop and maintain master facility lists and link them with existing public sources of health facility data.

Interoperability Advocacy

Standards and tools need one last component to help communities adopt them: constant advocacy to engage decision-makers and shift from ideas to reality.

We are tireless advocates of interoperability in the US and around the world. At the Integrating the Health Enterprise (IHE) Connectathon—the health care industry’s largest, most rigorous interoperability testing event—we connected our tools with those of other vendors to ensure that just by following the mCSD profile, any two systems can exchange data, despite being built entirely separately.

And within the Global Digital Health Network (GDHN), we promote interoperability across the international development industry. You can RSVP now to join us at the June GDHN meeting, where we will focus on interoperability across the health systems ecosystem.

Later this summer, we’re looking forward to joining many of our digital health colleagues at the OpenHIE Community Meeting in Arusha, Tanzania, to support country-owned, country-driven, large-scale health information-sharing architectures. We are particularly excited to give policy-makers an opportunity to better understand interoperability and systems thinking.

After all, learning more about the problems they face in sharing and using data drives our investment in standards.

digital health Leadership and Governance policy & advocacy

Source:: Intrahealth Blog

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It threw the kitchen sink at us and made us work for it, but we made it!” – Wayne Naidoo (Technical Project Manager, Jembi)
Wayne and Desire upgrading the Health Center Implementation

On Wednesday this week, the team took on the challenge of attempting to setup and configure the Rwamagana Health Center Server on site with a new version of OpenMRS as well as installing the updated RHIE modules and connecting the Health Center OpenMRS implementation to the Rwandan Health Information Exchange (RHIE); all this in a single day. Challenging indeed but not impossible.

A particular aspect that made this deployment interesting was that the server also housed the Rwamagana District hospital OpenMRS implementation (one machine and two instances of OpenMRS running) hence we needed to minimise server downtime.

Dentist chairs make for great motivators when
sitting in a chilly server room as
Daniel proves
Throughout this particular site implementation, we experienced a number of technical challenges (the kitchen sink), these included nuances in how the particular servers disks were setup (different to our general deploy from other clinics), needing new ways to ensure we had a failover to revert the server back to its previous state (living by the “do no harm” mentality of not impacting negatively on systems) and a few others. All of these proved to be “fun” as we needed to get this Health Centre and Hospital server technically consistent with the other servers in the district.
Hard-Long-Day but smiles all round!
Florentin (MoH Administrator), Wayne (Project Manager),
Desire (JHS-Rw Developer), Daniel (Senior Developer)
At the end of a long day, we upgraded the Health Center Implementation and connected it to the Health Information Exchange, looking forward to another week of site installations and the interesting challenges that await us.
— Wayne Naidoo, Jembi Health Systems

Source:: RHIE

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Monday 5, Aug 2013

I’m sitting here writing this to the sound of drums beating and imagining the dance classes happening down the road from the Jembi office in Rwanda. Symbolic too, as the team are working to a steady fast beat!

Today (Monday) our team had a big push, we took on the task of getting 2 new sites installed. I must make the distinction between ‘installed‘ and ‘implemented‘. We have defined them as follows:

Wayne (Left) and Hannes (Right) after getting our test
environment setup pre go-live.

  • installed: the RHIE software and components are installed on server, validated and tested in connecting to the HIE. In a ready state for use.
  • implemented: the clinic staff trained on the system use and system being used in clinical care submitting and consuming data from HIE.

With that said we are excited to do a quick update from the field: Our Implementation Training team have successfully completed the first day of training at Karenge (the first new site to get installed last week) and are looking forward to the next few days of training and getting the users at Karenge up and running with the new system.

Desire (left) working with Gishari’s IT manager,
training on system use and administration

As for our Installation and Technical Implementation team I am excited to announce that we now have 2 more sites ready for our team to train users on! Gishari and Avega are now technically installed, tested and validated as being able to send and receive data from the Rwanda HIE!

Wayne setting up
Avega

We look forward to our team recouping tomorrow and reviewing the lessons learned from this hard day and using these to sharpen our edge of installation and implementation. Credit goes out to the Jembi Rwanda office for ensuring that things are running smoothly!

Looking forward to another great day in Africa tomorrow!

– Carl | Jembi Health Systems NPC (South Africa)

Some photos from the field:
Daniel reviewing the Rwamagana servers ahead of Wednesdays
installation
Desire, Wayne and Daniel: All smiles after a LONG day and having
Gishari and Avega installed!

Source:: RHIE

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Yesterday we successfully installed and setup the Karenge Server at site which is now officially connected with the HIE in Rwanda. We also parallelized a number of activities in the field and picked-up and prepared the Avega and Gishali Health Center Servers for the RHEA installation.
Wayne and Daniel | Jembi South Africa Team
Looking ahead, we plan on finalising the Avega and Gishali Server configurations today and plan to go out to Site on Monday to re-install these and potentially upgrade, install and test the Rwamagana Health Center Server at site on Monday as well.
Getting the system setup and local IT managers familiar with new fields.
A very exciting time as we are looking to increase our sites to the expected 4 new sites with the RHEA installation and server setup ahead of schedule originally due to be completed by the 20th of August. Exciting times as we are seeing more Jembi team flying to Rwanda next week few weeks! Why is that exciting….well.. that would put us in a really strong position to do some exciting work in the remaining time we have here in-country 😉 what that looks like we are hoping to announce SOON!
– Wayne Naidoo | Jembi Health Systems, South Africa
The Team! Happy after Karenge site is installed awaiting training team!

Source:: RHIE

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Cough…splutter…ahem.

Well dusting off the blog and firing it up again to get things moving on the updates front. We are still here and working hard! Since our last post the RHEA team have been hard at work and quite a few exciting things have happened.

Some of them include the launching of a new global initiative drawing a lot of its core from the work in Rwanda, the OpenHIE (www.ohie.org) an open source community focused around tool and technologies that strengthen national health information systems through facilitating data exchange.

We have been working at our live sites and monitoring and refining the features and functionality we have implemented. We have been refining our search mechanisms to make it easier for our users to find patients and reduce duplicate registrations, we have been gathering data on reports that are needed and we have been spending time ensuring that our tools and the OpenMRS components are all upgraded to 1.9.x (we have been working very closely with the MoH and their technical team to achieve this).

We have been hardening and updating the in country Rwanda HIE implementation and investigating new channels in the OpenHIM (www.openhim.org) and user/implementation driven needs and requirements for new connections and features in the hosted HIE. We have also moved into a more sustainable model for the HIE with the applications being hosted on MoH supplied server space in the National Data Centre in Kigali.

Wow so much! Watch this space as we now enter into another implementation phase!

Source:: RHIE

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International delegates and representatives from partnering organisations and various entities, excitedly made their way to Kigali – Rwanda, for the much anticipated Rwanda Health Information Exchange (HIE) workshop. The four-day workshop, 24th – 27th September 2012, hosted by the Rwanda Ministry of Health (MoH) and Jembi Health Systems focused on the outstanding RHEA work done-to-date, getting a preview of the Live Demo walk-through, and lastly to workshop and map the road ahead – towards achieving the ultimate “dream” – Better Health care for Rwanda through technology!

RHEA HIE workshop in a “nutshell” – daily highlights and pics!!!

Day 1

“Live and Connected”


Day 1 – An atmosphere of anticipation and expectation filtered through the main conference meeting room at Hotel Chez Lando, as delegates started to arrive and register at the main table for the four-day workshop. One could sense an eerie mix-feeling of excitement as the various delegates greeted and interacted with each other, before being seated awaiting the start of the four day-RHEA HIE workshop.

Dr Richard Gakuba welcomes delegates.

The Rwanda Health Enterprise Architecture project has grown in strength and finally – “moved from the conference rooms to health centers in rural Rwanda, touching the lives and promising better health care” – stated Dr Richard Gakuba (MoH – Director and e-Health coordinator) as he welcomed all delegates and officially declared the opening of the four-day workshop.
Live Demo Walk Through showcased on Day 1

“All smiles – we are finally Live and Connected”
Dr Chris Seebregts (Jembi) & Dr Richard Gakuba (MoH)

Day 2

“Lets’ get real”

Day 2 – A day which had been scheduled and marked for the RHEA working team to unpack some of the challenges faced thus far, and further deliberate on how to solidify the HIE architecture and the various components which make “it tick”. Delegates had the opportunity to “get real” and workshop the various challenges in a small group setting.
M&E plan focus group
Focus groups were formed around the topics:
  • Security & having a restorative backup plan
  • Monitoring and Evaluation plan
  • Transactions in the HIE
  • Ensuring most up-to-date clinical work flow for maternal health care.
An additional group focusing on the National Identification process and how this could be integrated into the RHEA HIE, was led Dr Richard Gakuba and Mr Nyamurinda Pascal – Director General of Rwanda National Identification agency (NID).
Dr Richard Gakuba and Mr Nyamurinda Pascal leads “NID” focus group discussion
Ryan Crichton (Jembi Senior Developer)
Facilitates “transactions in the HIE” focus group

Day 3

“Mapping the road ahead”

Day 3 – Mapping the road ahead for the completion and successful implementation of the HIE was set out according to Three tracks;
  • Track 1 – Completing implementation of the RHEA HIE in the Rwamagana district
  • Track 2 – Develop and implement new use cases
  • Track 3 – Continue building OpenHIE communities
Track 1 and 2 breakout focus group
The three groups continued discussions through most of the morning and had to reconvene later during the day, as Dr Richard Gakuba notified all that the Minister of ICT, Mr Jean-Philbert Nsengima, is on his way to Hotel Chez Lando for a surprise visit and sit-in to the RHEA HIE workshop. The Minister was grateful for the opportunity to address the delegates, and requested to have a sneak preview of the Live Demo and walk through.

Track 3 breakout group

Mr Jean-Philbert Nsengima – Minister of ICT
The Minister thanked and praised all contributors and the RHEA working team for their hard work and efforts. He vowed that the Ministry of ICT will support the RHEA HIE initiative going forward and believed that technology has the power to connect and improve health care in Rwanda.

Day 4

“Delegation pics”

Michael Gehron – HIS Coordinator – PEPFAR
Group photo taken on final day!
Representatives from Tanzania MoH
Lorrine Banister (Regenstrief), Jonnea Smith (Jembi) Ophelia McMuarray (Cardno), Wendy Schultz (InSTEDD)
“Improving Global Health by developing partnerships”
Dr Dennis Israelski (InSTEDD) and Dr Chris Seebregts (Jembi)
takes time out to visit kLABS in Kigali
http://klab.rw/

Source:: RHIE

Click. A sound often associated with something locking into place, a switch being flipped or a concept making sense (ok the last one isn’t really a sound). So CLICK!
So why am I stuck on CLICK today? There is an eerie feeling of anticipation for the day today. Yesterday evening we received an update that truly marked the start of something. Yesterday evening the RHEA project began the move from working in an “off-line mode” to a “live-connected mode”.
As of ±4pm CAT 20 September 2012 the RHEA project had its first connected Health Centre using the system as part of the clinical care! Quite an achievement and many many hours of work in the RHEA team to get it here.
First Health Centre connected!
The Jembi team moved onto Musha and setup the modules and ran as many tests as possible (internet still proving to be a problem – while at the Health Centre the server was not able to “see it”). Tired, dazed, hopeful and slightly frustrated not to have completed the entire test at Musha that day the retired for the evening eagerly anticipating today!
Today we demonstrated live to Richard and a few other delegates the system registering a patient and sending data to the Client Registry, sending and pulling encounter information down from the SHR at the Ruhunda site. What an achievement for the teams! Musha still struggling with connectivity (being intermittent was able to complete a full day of clinical use of the system in an offline mode (data being queued to be sent when connection is stable). It was an amazing time to see new users using the system and actively working through all the workflows!
The Rwanda HIE Architecture, the components that
allow the HIE to “tick” so to say.
http://rhea.jembi.org
Reeling a little to try and comprehend where we are today, the RHEA team have implemented an Open Source Health Information Exchange stemming from the original and ongoing Health Enterprise Architecture project in Rwanda. Each component built on the requirements of Rwanda, many of them coded in Africa itself; contributions and developments from great international teams; training courses run and capacity continued to be developed to support this initiative in RWANDA!
6 months ago we have a beta version of the Facility Registry and some requirements for the other components, today we have the software installed, configured and functioning within the clinical uses case! Yes we know its not perfect and there will be bugs and glitches, there always are, but we have moved from a lab use case to a live instantiation of the technologies and ongoing work to ensure the clinical use and advantage are realised to the maximum.

Congratulations to the teams for so much hard work and hours of after hours work and discussions to get us to this stage. We look forward to the RHEA meeting next week where we will be discussing this more and showing the use of the system in a demo on Monday morning!

Continue to follow us on Twitter (http://twitter.com/jembi_hs) and #RHEA_HIE.

Source:: RHIE

Well it’s all in the title, well most of it, and sums up the teams work for yesterday. Let me unpack. Our goal for yesterday were:

  • To have Musha installed, tested and connected to the HIE
  • Turn on Ruhunda (i.e. have working with the HIE)
  • Complete first day of clinical use of the PoC system

<!–

“IT LIVES – PoC Lives”

–>

Liz and Dawn with the clinical staff and Wayne and Ishimwe supported the use of the PoC in the clinic’s workflow and continued to tweak and test against the HIE respectively. We have been fighting some persistance issues in persisting patient information that comes from the SHR and the team is working through the code to find the “nasty critter” (read bug) that is causing this issue.
Hannes and Desire started out at Musha in the morning where they rapidly deployed the PoC modules and tested the in-clinic workflows, unfortunately due to some administration issues there was no internet at Musha yesterday (challenges with Satellite and work orders and scheduling) and hence they were not able to test the system against the HIE. For those wondering the 3G was proving to be a challenge to pull through the entire clinics network too. A decision was made to send the team to Rwamagana Health Centre / Hospital.
Hannes and Desire moved from Musha to Rwamagana where they complete the install of the RHEA PoC modules and continued to test the workflows against the HIE (Rwamagana shares its internet with the hospital – a fiber connection). This combined with the ongoing Ubudebe load at the sites proved to be a ‘full’ day for Hannes and Desire. The afternoon saw both teams working, in conjunction with the Remote teams in RSA, to resolve the persistance bug and a few others that had crept up – a task that continues today.
In summary of yesterday:
  • RHEA PoC modules are installed at Ruhunda, Musha and Rwamagana;
  • Ruhunda is using the PoC in its clinic for ANC (was supported by Liz and Dawn);
  • Both Ruhunda and Rwamagana’s internet is running and connection to the HIE is tested (internet connection)
  • Musha awaits internet connection for final site specific workflow testing
  • PoC module persistence bug to be resolved today, followed by module update at each site and final testing
That said today’s schedule see the team back out at Ruhunda to trouble shoot the issue and remedy. Following this to roll out the new module to Musha (internet expected by noon), test the workflows at Musha and connect (in a permanent status) the site to the HIE. The same will be done for Ruhunda and Rwamagana.
All things working according to plan (and we know that this isn’t always the case) we will have Ruhunda live and connected to the HIE with Musha and Rwamagana following shortly.
Our 2 first sites including the addition of Rwamagana.

Source:: RHIE

Yesterday has been quite a day for the JHS-RW and RHEA team as we mustered our forces and had a full charge at our implementations; 2 vehicles loaded with teams went out to 3 sites (Ruhunda, Musha and Rwamagana). We sent out the technical team in one car; dropping Hannes Venter ( Teams ready to head out!

Our focus was to get teams to the 3 sites to ensure that we are all working as efficiently as possible. Focused on testing Ruhunda, installing at Musha and making sure that Rwamanagana is upgraded to the latest OpenMRS.
Implementation Kit and
Barcode Scanners &
Printers
Our second car was loaded with Michel, Liz and Myself (later picking up Eric from MoH). Our team was really the overview and gap filler today. Something that we picked up from yesterday was the need to follow the old South African saying “‘n boer maak ‘n plan” (translated: a farmer makes a plan) and in this we set out to stock ourselves with a few key things that formed part of our “implementation kit”. Given that the health centres were networked by an outside team we would need to be aware of what we may need to have on hand to meet our subtle changes. Thats said, it is surprisingly easy to find what you need in Kigali (I said easy not fast). We spent a large time of the morning getting spare network cables (fly leads; 5m and 10m combinations); extension power cords, duct-tape (or similar), spare modems; and working with MoH teams to take out bar-code readers, printers and labels. All this and a swiss army knife and we made our way out to follow behind the technical team.
Quite a day and a tough day on many sides with power failures at the sites forcing teams to drain the UPSs to keep the servers up and running and getting as much done as possible. To quote Wayne; “Everything is running on empty, UPSs, Laptops and Developers”. It was a long day and during it we’ve achieved a few key things:
Musha has been loaded with all PoC modules and all providers were loaded into the system. We are heading out today to complete the testing of the site and load the Ubudehe data set; in the testing we are aiming to test the site connection (internet connection) as well as the modules connection to the HIE.
Jembi and MoH working at Musha to ensure all is loaded
and functioning as expected.
Musha Health Centre (Part of it – it is a few separate
buildings)
Rwamagana has been upgraded to the correct version of OpenMRS and we have part of our team heading out to Rwamagana today to begin the installation of the modules and testing before loading the Ubedebe data sets.
Ruhunda is “bucking a bit” and giving us some physical infrastructure challenges but we are working closely with MoH and clinic teams to remedy this as soon as possible. The OpenMRS system is installed with our modules and as soon as we get connectivity (3G modems are not functioning well in the area) we are able to test with the HIE. The team has both internet consultants (Satellite company) and network staff out with them today to work on pulling it all together.
Ryan is working on knitting together all registries and services in the HIE which have been stood up in the National Data Centre (NDC) in Rwanda and we should have some great progress on this today. Once these are up and running we are able to start to pull data through the entire HIE system, from Clinic to Cloud (the HIE in the NDC).
We have had some challenges with loading the Ubudebe data as it is quite a data set to load (takes approximately 4 hrs) but the teams will be working over the weekend to ensure that the 3 sites are correctly loaded with the Ubudebe data ready for clinical work next week.
As always watch this space for the next update and follow us on twitter http://twitter.com/jembi_hs and use the hashtag #RHEA_HIE.

Source:: RHIE

There was an eerie sense of silence in the Jembi camp last nigh…well it didin’t last too long and was followed with quite some laughing and possible hugging (we are still awaiting photographic evidence of the latter). Why you may ask, why this change or reaction.

First Health Centre to start using the PoC functionality

Today marks the day that the RHEA Point of Care module will be actively used in the Clinic for the first time! 8 days ago we went out to begin our implementation process of installing software and testing at Ruhunda and today marks the mentored and supported use of the PoC system at the clinic on the ANC clinic day. It has been a long uphill run to get the system to this point, note: we are not connecting to HIE as of yet as there are a few more tests to run but that isn’t stopping us collecting clinical data;

Today the team has divided; one to move onto Musha to replicate the implementation done at Ruhunda and the other back out to Ruhunda to support Liz and Dawn and the clinical staff as they start to use the system at a clinic and medical level.

Tired but back into the car for the next day.

We are running into some heavy challenges with internet at the various sites, Ruhunda being fixed and moving forward well – Musha giving the team a headache but we are confident that this will be resolved in the not to distant future.

We are all excitedly anticipating the call/sms from Wayne saying that X clinic is now connected to the Rwandan HIE and is sending live data to the SHR! These are, as always, exciting times and will keep us all updated!

Source:: RHIE