In part one of our interoperability series, we explored how interoperability is crucial not only in exponentially digital societies, but specifically within healthcare to ensure better care coordination and service delivery.
Medic’s journey to create an interoperability layer in the Community Health Toolkit (CHT) – leveraging Open Health Information Mediator (OpenHIM), Open Health Information Exchange (OpenHIE), and Fast Healthcare Interoperability Resources (FHIR) – includes steadfast support and collaboration from fellow digital health ecosystem partners, focused research, and multiple technical working groups. In this blog, we’re excited to share what our consortium has achieved over the past few years.
Pioneering a New Era of Collaboration
Supported by Digital Square at PATH, Medic led an inaugural consortium of ecosystem partners that included Dimagi, Ona, Possible Health, the University of Washington, and the Community Health Impact Coalition (CHIC) from August 2020 through June 2022. Our collective efforts focused on establishing community-driven consensus and defining key digital standards and interoperability frameworks for Community Health Information Systems (CHIS). This groundbreaking work was the start of shaping the future of healthcare coordination worldwide.
Technical Working Group 1.0: Bridging the divide
In this period, we embarked on an important development journey, convening a digital health community of practice on the OpenHIE wiki. Together, we developed a reference architecture and a prototype that accounted for the diverse CHISs deployed globally.
This group also initiated a Delphi study to solicit insights and build consensus around common features, workflows, and interoperability use cases for CHISs among a systematically selected pool of global experts. Complete findings are presented in a draft manuscript, which will be submitted for peer review in 2023.
Technical Working Group 2.0: Accelerating progress
Following the Delphi study conclusion, the technical working group, including Medic, Ona, Living Goods, and Dimagi reconvened, tasked with revisiting the reference architecture and prototype and applying recommendations identified by the study. This included building community health information systems to Electronic Management Records (EMR) systems as a high-priority use case.
The group began the work on a proof of concept based on the Request Community Based Follow-Up. The idea is to use a mediator based on the OpenHIE architecture and FHIR standard.
In the context of a proof of concept, the intended users of the interoperable systems are community health workers (CHWs), and caregivers on the requesting systems, including EMRs and Electronic Health Records (EHRs) on the requesting system side.
Technical Working Group Results
In the first quarter of 2023, in the context of TWG 2.0, Medic started building an interoperability framework for the CHT. The Ecosystem Focused Working Group implemented a mediator facilitating data exchange between the CHT and a requesting health system.
The outcome of this project is an interoperable layer based on the OpenHIE architecture and FHIR standards. OpenHIM is the main component of the interoperability layer, and a custom mediator was built to deal with the workflow.
Paving the way for innovation
Leveraging on the power of FHIR compliant systems and the CHT, we formatted data in a way that could be readily understood. Building upon our value of openness, we established a publicly available repository, providing a valuable resource to the larger community.
The CHT and the Requesting system communicate through the OpenHIM Mediator based on the FHIR standards (represented by the FHIR Resource). The interoperability layer allows disparate systems to interact with the CHT; the proof of concept serves to show that interoperability standards can be successfully used.
MoH Kenya: eCHIS Validation and Implementation
This proof of concept was validated by the Ministry of Health as they were looking to integrate their EMR with their CHISbrand new eCHIS built with the CHT. MoH Kenya conducted a series of workshops to integrate various systems within the digital health platform in Kenya and Medic was part of the workshops organized by the ministry to build a solution for information exchange.
Medic supported MoH in building mediators from their EMR into the middleware to allow seamless integration with eCHIS for an end-to-end referral workflow. We anticipate building more workflows with MoH through collaborative efforts.
Conclusion
As the steward of the CHT, Medic is committed to addressing the opportunities for impact at scale; we have built mediators into OpenHIM that allow any system to exchange data with the CHT.
There are ongoing conversations with MoH-Uganda to incorporate the interoperability layer we have built in a real-world scenario workflow and expand the work with the Ministry to other workflows supported by the EMR. By envisioning a future where all users can effortlessly interoperate their systems with the CHT, we are poised to revolutionize healthcare coordination. This will improve the efficiency of healthcare givers and support data-driven decision-making.
We would like to extend our gratitude to Digital Square for supporting Technical Working Group 1.0, and Patrick J McGovern Foundation, Panorama Global, and CHIC for their engagement and support for Technical Working Group 2.0.
Stay tuned for our third and final blog post of this series where we will delve on how we use FHIR standards to achieve CHT interoperability.
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