Health Worker Registry Community

The OHIE Health Worker Registry Community(OHIE-HWR) includes individuals, NGO’s and governments who share a commitment to aggregating and making accessible health workforce information using international standards and open source technologies. In most countries, health worker information is found across multiple and disparate systems making it very difficult to obtain a national picture of the entire health workforce. Moreover, maintaining accurate and up to date information on a mobile and sometimes isolated workforce can be challenging in a low resource setting. A health worker registry overcomes these challenges by first aggregating the key attributes for all health workers in the country from the multiple human resource information systems. Secondly, as a service to the health system, including smart devices and mHealth technologies, a health worker registry can securely share and validate health worker information using dependable and easy to adopt messaging standards.

The Health Worker Registry Community works primarily to develop, test and provide implementation support for open source health worker registry standards, applications and stakeholder guidance. This work includes contributing to the development of standards, crafting implementation tools and devising new methods for how health worker registries could integrate the health system and support health workers. The community is currently supporting the deployment of an OHIE Health Worker Registry in Tanzania, Nigeria, Zimbabwe and Rwanda. The OHIE-HWR technologies are also being used in the Ebola response in West Africa to link health workforce information systems with mobile platforms to support health worker communication and coordination. With each installation, the size of the community grows and the contextual experiences in each country contribute toward the improvement of the global OHIE Health Worker Registry application.

The Role of a Health Worker Registry

Unique ID

The health system depends on health workers but the health workforce is made up of thousands of individuals, some with the same names and each likely to have multiple identifiers. The HWR identifies duplicates and uniquely identifies each health worker across the entire health system.

Referrals

Supporting patient referrals requires the ability to cross reference health worker, facility and service delivery information. The OHIE-HWR use of of the Care Services Discovery (CSD) standard enables a health worker to refer a patient to another provider electronically.

Validation

With each service delivery there is an encounter with a health worker. As health systems progress to maintain longitudial health records for each patient, the HWR can validating that a documented care encounter was administered by a qualified health worker.

Interoperability

As health information technologies proliferate and support more care, they are currently tasked with maintaing their own separate lists of health workers. A health worker registry offers a common resource of information that all applications can access and contribute, supporting better information and interoperability.

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The OHIE Health Worker Registry Technology Stack

hwrinfographic In addition to defining an architecture and make recommendations on standards to use, OpenHIE provides a reference implementation of a HWR. The OpenHIE HWR is really comprised of several components:

  • The OpenInfoMan, a reference implementation of the CSD standard. The OpenInfoMan acts as the central data store for the HWR and provides the ability to query the HWR. A few key points on the OpenInfoMan engine:
    • The OpenInfoMan is the “engine” which drives the HWR
    • Acting as a service, the OpenInfoMan can also be used to drive other applications that want to make use of the data in the HWR.
    • The OpenInfoMan software allows for adapters to allow for access in the HWR through other APIs (e.g. OpenSearch, SOAP).
    • The OpenInfoMan acts a Value Set Repository according to the SVS standard which allows a simple way to publish terminologies related to the HWR.
  • The OpenInfoMan HWR Library: a library of stored functions which provides CRUD functionality for health workers to the OpenInfoMan
  • The OpenHIE HWR Management Interface: A web-based user interface built on iHRIS technologies to manage the HWR
  • The Interoperability Layer: Responsible for ensuring the security and data governance policy.

The CSD standard uses XML to describe the data model for:

  • health workers
  • healthcare organizations (for whom the health worker provides services)
  • healthcare facility (where the health worker provides services)
  • service (the services that a health worker provides)
  • calendaring support for service scheduling

The XML data model is defined using an XML Schema Definition (available here) and uses XPath to reference data elements in the data model. Different client systems may have the need for different slices of the MDS, and these data slices are made available through the use of “stored functions.” These stored functions are defined using the XQuery language. The OpenInfoMan software makes use of the BaseX version 8.0, an XML database. The OpenInfoMan HWR Library is simply a collection of stored (XQuery) functions that are made available on the OpenInfoMan. The OpenHIE HWR Management interface uses the OpenInfoMan HWR Library to perform CRUD operations on the HWR. More details and installation instructions are available.

Implementation Guide

The implementation process begins by first identifying the current stakeholders and motivations driving interest in a health worker registry. This step is intended answer questions like:

  • “Why do we want a master list of health workers?”
  • “What are the national priorities that a health worker registry will support?”
  • “What are the security and governance concerns surrounding health worker data?”
    Answers to questions like these will lay the essential policy and governance foundations for a national health worker registry.

A health worker registry should be responsive to users’ needs and the local context. User stories and data specifications are two ways to describe: “What will the health worker registry achieve and How should it operate?”. A primary objective of this guide is to promote and facilitate a country driven and user requirements based process. The ideal solution will be responsive to users’ needs and their context. To complete the activities in Step 2, an in-country meeting of stakeholders is highly recommended and can expedite the process.

Using the draft data specifications and user stories from Step 2 as the foundation to move forward, the next step is to initiate an agile and iterative development process of the health worker registry. The main outcome from this step is the implementation a tangible version of the new or updated registry, however it is common that all the previously documented requirements will not be completed.

Once an initial version of the health worker registry is implemented, a process of resolving the remaining the prioritized user stories will begin. The iterative development of the tool should be ongoing and also incorporate new stakeholders and/or user stories as they are identified. Close collaboration between technical and non-technical stakeholders is key to agile development to ensure technical solutions align with users needs. The core outcome from this step is a health worker registry with the user stories completed to create a minimally viable tool.

After completion of Step 4, the health worker registry will be at a point ready to be scaled more broadly among users and other systems that can provide or consume facility data. The goal of this step is to engage nationally with users and systems to ensure the management and institutional processes are in place for ongoing curation, governance, and data utilization.

After scaling the health worker registry and initiating the core integrations, it should be expected that requirements and requests for the registry will evolve over time. For this reason, ongoing support and continued agile/iterative strategies should remain in place. This can be organized by the roles of the technical support and implementation teams to triage requests for data, system enhancements, integrations, operations support or general troubleshooting among users. Common types of ongoing support are described below.

The purpose of this HWR implementation guide is to provide guidance for a team or individual responsible for the implementation of a central repository of health worker data at national level. This guide is broken into three sections:

  1. Getting Started with a Health Worker Registry
  2. Standards and Architecture
  3. Implementation of the OpenHIE Health Worker Registry

The target users for this guide are human resource information system advisors, developers and organizations with the capacity to work with in-country stakeholders. The individuals or organizations best suited to benefit from this guide are those with a mandate by government stakeholders to implement an HWR on their behalf and are members of the OpenHIE HWR community.

Community Resources

  

Participate in the discussion group and join our routine meetings to ask questions and get feedback.  Join Our Community Group 

Learn about best practices and access expertise, technologies and standards around health worker registries.  Visit Our Wiki Page

Meet other implementers and learn from their experiences.  Also use our Implementation Guide

 

Next Meeting


March 15, 2017
  • OHIE-Health Worker Registry Community Call
    Starts: 1:00 pm UTC
    Ends: March 15, 2017 - 2:00 pm UTC

    Location: Dial 800-220-9875(US) Code 34048002#