Medic is bridging the gap between digital healthcare systems to improve patient care. Technical Product Owner Phil Mwago explains how.
At the Global Digital Health Forum in December 2023, I spoke about how, as the number of digital healthcare solutions increases, so does the need to ensure that these solutions are all connected to one another.
By that point, Medic was already nearly a year into developing interoperability for the Community Health Toolkit (CHT), to make this critical interconnectedness between digital health systems a reality.
We made the CHT compliant with Fast Healthcare Interoperability Resources (FHIR) – a standard for exchanging healthcare data electronically.
We then used these standards to develop a reference application based on a Request for Follow Up workflow – when a patient misses an appointment and a community health worker (CHW) needs to follow up.
And, in an exciting step forward in standardizing the digital health ecosystem, these standards have enabled us to now make the CHT interoperable with OpenMRS, an electronic medical records system.
How did we get to this point?
Reaching interoperability with OpenMRS
To begin with, we leveraged and enhanced the reference application, which was based on the open-source OpenHIE framework for building interoperable, scalable and sustainable health information systems.
The reference application focused on Loss to Follow-Up workflow, which is when patients disappear, either due to data error or lack of interaction between tracing systems. This can have serious consequences for people with health risks. It is also a key reason why interoperability between patient records and healthcare delivery apps is so critical.
From there, we mapped the CHT data that needed to follow a standardized naming system. We aligned these with OpenMRS concepts, as set out in the CIEL (Columbia International eHealth Laboratory) concept dictionary. For example, patient demographics such as first and last names, or age, can now be exchanged as data that can be universally understood by various systems.
With the data standardized, it can be routed between the two systems by OpenHIM, which serves as the middleware, or a central point of control, between both.
Why adopt interoperability?
A significant part of the role of a community health worker is to follow up on patient needs, provide care, and make referrals to healthcare facilities.
Interoperability means that patients are able to move across different points of care without fear of their records being lost. Through the CHT a community health worker can record a person’s details during a household visit, and this information can be shared with OpenMRS if that same patient is then referred to a health facility like a hospital.
Another feature that reinforces the importance of this project is that it supports antenatal and postnatal care workflows, in contexts where these follow-ups are a vital vanguard against high rates of infant and maternal mortality.
But the merits of interoperability extend beyond the efficiency and unity of care.
An interoperable configuration is scalable, meaning that users can easily configure the system with minimal turnaround times – versus peer-to-peer integration, where systems only exchange data based on need and any other additional configuration requires an enormous level of effort as no open standards have been utilized.
This has been especially true in the Kenyan context. All digital health systems – including the national CHT-based electronic community health information system (eCHIS), conform to FHIR standards so as to contribute data to the country’s shared health record.
Using these standards also means more reliable data, which is easier for end-users across disparate systems to understand.
When modeling big data that is not standardized, it takes a significant amount of effort to write queries as the user has to understand what the various indicators mean across the disparate systems in order to ensure data quality. This can be a lengthy process, especially if it involves translating between languages.
In short, it’s tedious. And it doesn’t need to be.
Working with standardized data means we can re-use queries across different projects. This bidirectional data exchange is a feature that we will look to reuse as we expand to other workflows in the near future, based on the learnings and adapted to new requirements.
Getting the data right, and getting how people use the systems right, improves the efficiency of the data analyst, policy makers, and caregivers. This then trickles down to the patients, improving the quality of care.
The future of CHT interoperability
Despite the incredible strides we’ve made in interoperability, this is not the end of the road and more achievements await.
We are delighted that the CHT interoperability reference application has been selected for implementation by Nepal’s Ministry of Health and Population. This has been the result of remarkable collaboration between in-country technical partners, app developers, caregivers and community health workers who stand poised to launch this groundbreaking endeavor.
Get involved in our interoperability work
Do you have a comment, question or feedback?
Submit them via our Github repository or the CHT forum. You can help us build a future where healthcare interoperability transforms advancements in patient care.