Category: Syndicated

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6 days until the RHEA meeting in Kigali. The countdown continues. That noted we’ve had quite an eventful weekend. The JHS team pushed hard on Saturday to get the Ruhunda site to a working solution (this continues today – Tuesday).

We had some fun and games this weekend with heavy rain and no power for some stages, having the team working on the UPS for the server to get as much time as possible on the systems. We spent a good bit of Saturday working on patching together a network infrastructure in the interim (the MoH will rollout the updated network later on). There was an atmosphere of adventure with the guys working in the dark / by monitor light / by phone-torches, taping cables in place, checking network points, installing temp switches, pushing to get the internet connected and available through the Health Centre, not to mention the continued testing and tweaking (finding and fixing bugs) that come up when you lay down code in a real world setting.

“Without flash | with flash” – reality of field work. Jembi team
dedicated to work regardless of power (thankful
for UPS tho)
Wayne and Carl setting up interim network by phone-light
Yes its raining inside, luckily that isn’t a computer that its dripping
onto 😉
Results of the downpour
– on Road to Ruhunda

Nevertheless the weekend was quite an adventure. One of the key points that raised itself is that your field work is not uneventful and that just because it works in the lab it doesn’t mean it will work seamlessly in the field – expecte field bugs to crop up.

While the developers continued at Ruhunda to test against the lab HIE and now NDC HIE, I left for Rwamagana Hospital and Health Centre to check if there was any infrastructure challenges we needed to address this week. I was fortunate enough to be able to view the infrastructure of the Health Centre and Hospital (they are adjacent) [remembering that it was a Saturday – the Health Centre workers and MoH have pulled out the stops and have shown their dedication to the project though making sure people were available to meet us]. Our one challenge at Rwamagana was that there was no network point available at the ANC registration area (we had a 30m cable on hand to install as an interim solution). Beside this the Health Centre and hospital are technically ready for the system (bar the internet outage caused by the storm on Sunday).

Hospital Server and OpenMRS Server
@Rwamagana Hospital
&Health Centre

Monday saw the team back out to Ruhunda. We have focused on Ruhunda as it was the “most ready” in terms of users and projected infrastructure. We have worked closely (and continue to) with the MoH teams to define a checklist for the other sites to ensure they are system ready (i.e. all hardware and network is ready for us). In addition to the Jembi team we were joined by Gilbert (MoH), Liz (RHEA-MoH) and Dawn (MoH-Reginstrief) to review the work done and the “temp” additions the Jembi team had made to the network as well as to “see what we are working on” at the Health Centres. With the teams out at Rununda we finally had the internet up and “stable” with the MoH having an understanding of some of the challenges we have faced and how they have been mitigated. It really does make a difference walking someone through the challenges and fixes to make sure we are on a common understanding.

Our teams continued to test the system and code out bugs / add fixes from the field while Liz and Dawn looked at some of the ways of doing back data entry and Gilbert and the team looked at the infrastructure. While we had hoped to be live and running at Ruhunda by the end of the day we didn’t make that due to some challenges in the PoC module and our team is back out today to remedy this as best as possible in the time remaining.

Brainstorming fixes and solutions in the field

Walking through the data capture in the clinic
Testing internet connectivity and applying patches

As always follow us on http://twitter.com/jembi_hs (@jembi_hs) using #RHEA_HIE

Source:: RHIE

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Mission Control…that’s what the sense of the Jembi office and teams gave out. Walls covered with check lists and whiteboards our teams were planned and tracked thoroughly the day!

Our teams were back out to Ruhunda , Musha and started at Rwamangana. Ruhunda saw us bringing with us the networking team and satellite with us to work on the infrastructure while our teams continue to test the system. Today we hope to be able to complete the loop at Ruhunda and connect the system to the HIE.

Musha install is 90% complete and testing is underway. Had some challenges with a faulty switch and hoping to have this sorted out asap. Internet is in the process of being connected and while that is happening the Jembi team will test with our field kit to the HIE. ETA on Musha field test is slightly dependent on the Ubudebe data load.

Rwamangana has been loaded with our modules and initial testing to the Lab HIE has been done. The team is back out today to continue the Implementation and testing.

We are becoming frequent visitors and local IT companies as our field kit grows to meet our team’s needs. We’ve added 2 desktop switches, 3G enabled router, network cables and network tester.

Our team are out again today (Saturday) and will feedback again tonight! Fun times! (pictures to follow)

Source:: RHIE

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A dramatic title but captures the core of today for the team. Following on from yesterdays efforts and actions in beginning the installation of the RHEA modules into the OpenMRS system at Ruhunda, the team has been working to overcome some of the challenges faced. One in particular that was causing some headaches was the fact that once we had loaded the Ubudehe data set (yes try say that name – I’ve been botching it all day), in short a large data set containing the patients for the region ±250’000 patients, the OpenMRS dashboard failed to load – well just hung. Making the system unusable for data entry (Critical issue).

After some investigation and brainstorming into last night and our team dividing roles to tackle this we discovered the challenge lay with a particular module which once disabled gave the system its functionality again. Took some digging and great work with the MoH teams to rapidly look through this and come to a decent solution, but a great example of collaborative work under time pressures. (For those worrying the pre-exiting module attempted to crunch through the entire patient data set to give info on the dashboard and was only needed in odd occasions by system administrators, do believe the MoH will be looking at reworking their module in the future with the growing data sets).

Team brainstorming how to solve “go-slow” problem on OpenMRS

Mean while the team was back out at Ruhunda completing the install with the modules and disabling the “go slow” culprit module. We are excited to report that all modules are installed and system is functioning without glitch (so far), what remains is loading of the NIDs agains the providers in the system and testing the link to the HIE (both were not able to happen due to power failure).

Tomorrow the team will head out back to Ruhunda to complet the setup and walk through the entering of the data (as it is a clinic day) with the data capturers and clinicians in the systems first data capture session. All going according to plan and the hardware we identified as still needing to be in its final resting place happens as expected. While this is occurring half of the team will be beginning the implementation at the Musha Health Centre learning from the lessons of Ruhunda and working to take it to an online and live state.

Many lines of code to get
things moving forward!

A quick update on our local HIE at the NDC here in Kigali. So far we have:

  • Shared Health Record (SHR): is up in the NDC, not connected or tested to other components yet.
  • Client Registry (CR): is up in the NDC, not connected or tested to other components yet, some patient matching still being tuned.
  • Provider Registry (PR): is up in the NDC, not connected or tested to other components yet.
  • Shared Health Record: is up in the NDC, not connected or tested to other components yet.
  • Terminology Service (TS): is up in the NDC, not connected or tested to other components yet.
  • OpenHIM: is up in the NDC, not connected or tested to other components yet.
  • Facility Registry (FR): is still being setup in the NDC.
On a side note the OpenHIM was presented in Paris recently as well as today at the ICT4Health conference in Cape Town (http://www.ict4health.org).
All in all a solid day with much more expected to happen tomorrow! As always watch our twitter handle @jembi_hs and hashtag #RHEA_HIE for updates.

Source:: RHIE

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Ruhunda HC –
First Testing Site

What a day! It is easy to get wrapped up in the rush of it all and look ahead at the “Rivers” still needing to be crossed and not take a minute to turn around and look at the “Mountains” summited and the efforts put in by the teams. 11 September is a day remembered for a great tragedy in the US – something not to be taken lightly. Today 11 September gains an additional memory for me; today marks the beginning of the Roll-out of the RHEA work to the Health Centres. We understand that the roll-out is a process and some may debate as to when it “started” or when it is “done”. But today marked the Jembi Health Systems Rwanda team setting out to Ruhunda with the goal of beginning the implementation process (setting up of the software). A step towards a system that will be used to treat and monitor patients! While it will not be tied into the HIE today (we did say it was a process and testing is key) today is the day we have gone out to make a difference and leave a system with a change! Near countless man-hours and calls and meetings, years of work, addition of team members, change of technologies – are just but a few obstacles that the team (entire RHEA team) have crossed to stand at the banks of our next “river” (implementation) and begin the “building of our bridge” to bring us closer to the summit of the next mountain!
± 6 months ago (March 2012) sitting in Kigali, Rwanda the technical direction of the RHEA project changed; away from a single stack enterprise solution to a service orientated and bus architecture designed to be built on open source technologies. At that stage we have 1 and I’d venture 2 halves of our 6 piece architecture (excluding the PoC) up and running. Today 6 months later we see ourselves beginning the installation process of the software | services at the national data centre (NDC) in Rwanda! Now we know that the tools aren’t without fault or limitations and we expect them to continue to evolve and grow as they start to come into daily use, but what a period! Credit goes to all teams who “put shoulder to the wheel” to move this forward and a listing of solutions and those involved can be found on our project site (http://rhea.jembi.org)
Installing, testing, configuring, tuning;
and repeat @ Ruhunda
JHS-RW team working hard
Coming back; today we have visited and worked at Ruhunda Health Centre, installing the Point of Care components the RHEA team have developed over the past 6 months. Quite a milestone and the first milestone of the Implementation and ongoing roll-out of the system. There is something eerie about being in a rural health centre and interacting with rack mounting servers and all-in-on PCs. They seem to be more at home / comfortable in a corporate setting rather than placed on a wooden table sharing a room with a hand basin. Yet there is a sense of “norm” or “right” that you get as one is privileged enough to see the solution unfold. Take a few minutes to remove yourself from the pre-assumptions around how this technology should be deployed and look the “heart” … it’s here to perform a service and that is what it will do. Yes there is good reason to have the machines correctly mounted in server cases in temperature controlled environments and to have the infrastructure tested and tuned before installing a new application, but honestly how were the early systems put online? “duct-tape and a garage” is the image that springs to mind. There is definitely something around being “rooted” in the early days of garage hackers that one gets sitting in a health centre with these machines. They are here to work and they will not be stopped because they aren’t mounted or air-conditioned – a real feel towards organic growth of the facility. I think the MoH teams are often overlooked and the efforts they have gone through to ensure that the centre has it’s network infrastructure in place and machines ready is not something to be waved off lightly!
Back to the deployment update; today’s goal was to have the RHEA PoC system deployed and the health centres ready to start capturing the Maternal Care data using the updated PoC tools. This included the installation of the RHEA Modules and new forms. With this we aimed to test the systems ability to connect to and correctly process test data from the RWANDA HIE (Lab version). Ambitious to say so our selves.
We have deployed our forms and spent some time with the IT staff navigating the OpenMRS system. There are some technical challenges with the system being extremely slow and we are investigating this tonight (hopefully – given that we obtain our required data sets). As expected there were a few configuration glitches which the teams are working on and will cycle back to the HC with the updated modules in the next day or so. While attempting to test the connection to the Laboratory HIE was an objective for the day, we were greeted with the lack of connectivity too; it is something we will be addressing as we move forward. There have been a few hiccups with the modules deployment (Personal Attribute in particular) but this is expected and is, surprisingly, working according to plan (the plan of testing the roll-out in the field and ensuring that we can mitigate against challenges as we go).

Some images from Ruhunda HC.

Aside from the Health Center visit the teams continue to deploy the services to the NDC and have, at this stage, completed the loading of the files to the NDC and now continue the configuration and integration testing.

We also see Wayne and Hannes arriving in Rwanda to work with the JHS-Rwanda (RW) team in the rollout of the HIE and to the designated clinics.

Follow us on twitter at: http://twitter.com/jembi_hs using the #RHEA_HIE hashtag.
More to follow tomorrow as we tackle this!

Source:: RHIE

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A welcome banner to our trainers
and trainees from previous
weeks’ trainings

This is poised to be an exciting week with the RHEA team pulling out all the stops as members push to move from our “cloud – laboratory” into our “field setting” (installed in Rwanda). Given a few hic-ups on the way and finding “creative” ways to come round them we are looking ahead at a week filled with implementation, testing and tuning.

Some of the tasks underway and planned include:

  • The Jembi Rwanda team is setting up the Rwanda HIE (http://rhea.jembi.org) in the National Data Centre. Our teams have worked tirelessly along with the MoH to move “near” mountains to source the required hardware and hosting space to start the process of migrating from the Amazon ec2 service to the in-country service.
  • Implementation teams are poised to start the process of rolling out the software to sites and begin the process of facilitating the back-entry of ANC data as well as testing the connectivity and accessibility of the RWANDA HIE from the Health Centres this week.
  • RWANDA HIE configuration and testing to be done alongside rollout and tuned through an iterative review of systems and interactions with Point of Care systems and HIE.
  • Jembi Rwanda Team working well towards finalising the meeting preparations and calling on delegate to confirm attendance.
  • MoH and Jembi (as part of RHEA team) are working at ensuring the support structures are in place to accomodate the new features and support users through the transition.

What a week a head of us. All this in the shadow of the successful trainings that have been happening over the past few weeks around the various registries and services!

Source:: RHIE

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Creating a blog for the Rwanda Health Information Exchange implementation project.

Source:: RHIE