By: Amanda BenDor, Paul Biondich, Carl Fourie, Eden Tarimo, and Jamie Thomas
Organizing an international five-day meeting for a diverse digital health community is no easy task. There are venues to secure, agendas to develop, and invitation letters to draft. Yet the leaders and innovators of the OpenHIE community were driven to ensure that we all had a place where we could gather to get to know and learn from each other about health information exchange.
186 people from approximately 61 organizations around the world took part in the inaugural OpenHIE Community Meeting in Arusha, Tanzania for the five-day event. This meeting provided a unique opportunity for implementers to collaborate and improve their knowledge of OpenHIE, share user stories, and propose new priorities. Government leaders were able to learn from each other about approaches to designing interoperable solutions, as well as governance frameworks that have been applied for health system information exchange.
The organizing committee set out with several objectives for the inaugural meeting. Wanting to be sure to connect implementers and widen the network. Provide a space for community members to share their experiences, harmonize tools, contribute to OpenHIE global goods, and advance conversations and technologies to enable information exchange. As well as provide policy-makers (and those new to the community) a better understanding of OpenHIE and its role in promoting interoperability and systems thinking.
Opening sessions and remarks
The meeting was officially co-inaugurated by the Tanzanian Permanent Secretary for the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), Dr. Mpoki Ulisubisya; and PATH President and CEO, Mr. Steve Davis.
In his opening speech, Dr. Mpoki emphasized the following key notes:
- The OpenHIE community is an important platform for sharing technology from across the globe.
- OpenHIE is an opportunity to replicate and share solutions developed in other parts of the world.
- Data is crucial to decision-making. “If collected data is not being used for informed decision, it’s a waste of time.”
- It is critical to have an information system for tracking patients in a country.
Striking an agenda balance
Ahead of the meeting, the OpenHIE wiki was updated with sessions that covered four agenda tracks: Leadership and Governance, Facilitating Data Exchange, Standards and Interoperability, and Implementers’ Experiences. However, much of the agenda was intentionally left blank. Why?
OpenHIE wanted this to feel like a community event, creating a forum for people to interact, learn, and share outside of the traditional conference framework. One way of doing this was to facilitate an “unconference” agenda, whereby attendees propose sessions. On the first day of the conference, a board was filled with session topic ideas, ranging from eIDSR to OpenHIE training to the Interoperability Maturity Model. Participants then voted on the sessions they wanted to attend by placing stickers next to session topics on the board. By the first coffee break of the day, the community meeting agenda began to take shape.
“I really enjoyed the new ideas and variety of session organizers during the unconference sessions at the OpenHIE Community Meeting. The unconference sessions were a refreshing mix of new ideas and different approaches sourced directly from digital health leaders across the continent.”
– Wayan Vota, Director of Digital Health, IntraHealth
Session Highlights
Over the course of the event there was a great range of sessions covering a multitude of topics. Some strong highlights from the Interoperability and Standards track included the deep interest in how standards are applied to projects. Teams shared their experiences as they undertook the process of designing with standards and patterns in mind too. As well as a fishbowl and Q&A session with OpenHIE team members about how standards and profiles evolve and what it takes to go to a connectathon.
The host country, Tanzania, thoughtfully shared their experience around implementing an HIE and some of the challenges and outputs around that. This level of sharing gave great context to the event site visits too to see some of the HIE in action. There was also interesting input from other countries including South Africa with the African Health Information Exchange initiative and colleagues from Europe as they shared their experiences too.
The work that has been undertaken by Jembi and Intellisoft teams in addressing cross border data exchange was of great interest as well as the technologies and approaches to solving this problem. This level of knowledge sharing shed light on ideas of where HIE’s could be going in the future.
An exciting impromptu development during the event was, true to community and OpenHIE style, an unconference style software and solution showcase. This allowed teams with software and solutions to “grab a laptop”, setup at a table and demonstrate what they had to offer/show to interested members of the community. There was a great deal of interest and additional investment of time by the community for these showcases. This will most definitely be something considered for future events.
These are but a few of the highlights of the week!
Site Visits
Participants at the event, and the OpenHIE community as whole, support system interoperability and information exchange with the ultimate goal of improving health. The belief is that making data easier to access and understand will help health workers, clients, and others in the health ecosystem provide better, faster, and more informed services, from refilling a stock request at a warehouse to accessing a patient’s electronic medical record to consulting before providing care.
As part of the OpenHIE Community Meeting, participants had the opportunity to visit health facilities (10 health facilities) in near Arusha city, Arusha district and Meru district to see the Tanzania Immunization Registry (TImR) implemented by the Better Immunization Data (BID) Initiative which used components of the OpenHIE architecture. Each site visit include no more than 10 people, and provided a demonstration of the immunization registry system in operation at the site. The site visit also highlighted how electronic stock management and the immunization registry make the daily lives of health workers easier. As well as allowing more health workers at multiple facilities access to a patient’s data, giving patients the freedom to travel to the facility most convenient to them for vaccinations.
For those who are unfamiliar with TImR it was introduced in 2016 and has been integrated with the countries Vaccine Information Management System (VIMS) to make up Tanzania’s Electronic Immunization System (EIS). TImR offers the following benefits:
- Electronic immunization registry with supply chain information
- Automated, simplified report generation
- Barcodes on child health cards and vaccine supplies
- Targeted supportive supervision for health workers
- Peer support networks
- Online and offline functionality
Barcodes used by TImR uniquely identify each client and can also be used to search the immunization registry for returning clients by using a simple handheld barcode scanner, synced with the TImR device. This feature helps healthcare providers to see a high number of clients in a short time. TImR is able to work offline in addition to online, which enables the immunization service to be functional in areas without reliable internet access. Information collected in the offline mode is later transferred to the central server to enable information exchange with other facilities.
If you would like to learn more watch the video below as Walter Michael Ndesanjo with Tanzania’s Ministry of Health, Community Development, Gender, Elderly and Children discusses the TImR system.
Connect-a-thon
The first OpenHIE Community Meeting was followed by a two day Connectathon/Hackathon. This event provided technical attendees a space to get their hands and minds into some of the deeper points of OpenHIE. The focus was around a set of “challenge groups” that emerged where participants were collaboratively looking at how to address the problems in support of OpenHIE. These groups included “Case Based Surveillance”, GOFFR, ADX on FHIR, OpenHIM (Installation and building mediators) and the “Global Goods on a Box” (which later transitioned to an academy trac).
Teams were encouraged to share experiences, challenge preset ideas, come up with ways to solve problems and very much encouraged to learn. To the last point there was a fantastic introduction session to the basics of FHIR, Docker and other tools that are cross cutting for HIE operations and development.
Aside from the “formal” groups we had many side conversations and projects, including OpenLMIS, some development of prototype mediators for data exchange and other technical conversations where members got to work collaboratively towards an outcome.
Some of the highlights included:
- A lot of interest in learning more about FHIR (Fast healthcare Interoperability Resources)
- A lot of new members engaging around Case Based Surveillance ideas
- Great working groups around ADX of FHIR (PoC developed)
- Many teams left with more hands on experience of tools.
- The coining of the name “HacKonnecALearnAThon” defined as a single event promoting the hacking of solutions, learning of ideas, connecting of systems and building of community
Closing sessions/remarks
During the transition between the unconference sessions and the connec-a-thon, we reviewed our progress as a community in an open session that allowed us to share lessons learned for future conferences. During these discussions, we committed to regular (yearly) events, each held in the environments we are directly trying to serve. A number of country representatives expressed interest in hosting future events. The comments strongly reinforced the power of coming together for peer learning and consensus building around health information exchange. Some participants expressed pleasant surprise as to how something so seemingly “unorganized” at first glance could be so valuable and educational. The unconference closed with most participants taking working meetings, social time, and meals that lasted long into the late hours of the night.
Where we go from here
While OpenHIE has been together virtually as a community for the last 3-5 years, for many of us, this was the first time we’ve ever been able to meet face-to-face as this growing collection of people, organizations, and partnerships. The show of support for this event exceeded all of our expectations. For all of us, it’s mind-blowing as to how much we’ve accomplished given the constraints we all face. OpenHIE, from our eyes, is broadly considered the “go-to” place for work around operationalizing data sharing strategies within constrained environments. This being said OpenHIE will have to continue to quickly transition our community processes from a focus on socializing what we as a community are all about into daily meaningful action for countries trying to practically implement health data sharing architectures. This event was a powerful reinforcement and injection of energy into what we’re trying to accomplish together as a community. All of us are moving forward the many actions we agreed to: establishing new working groups within OpenHIE, engaging the standards development communities in new ways, and making the proceeds of our work more “self service” for countries. Some of us are even planning now for next year’s event! Until then!