Interoperability and eHealth Architecture
In Ethiopia, several digital health initiatives have been implemented including District Health Information System Version2 (DHIS2), Electronic Medical Record (EMR) Systems, Electronic Community Based Health Insurance (eCBHI), Electronic Community Health Information System (eCHIS), Logistic Management Information System (LMIS), Human Resource Information System (HRIS), and Master Facility Registries. However, these initiatives were characterized as fragmented, with identified duplicated efforts, inadequate ICT infrastructure or planning, insufficient enabling environments to support eHealth standards, and limited e-health coordination at multiple layers of the health sector. These result in disparate information stored in different locations and formats and make it seemingly impossible for data to be collated, synced, and shared.
In addition to the mentioned initiatives, many more digital health systems will be implemented in the country in the coming years. As a result, the Ministry of Health (MoH) prepared an eHealth Architecture intending to ensure equitable and affordable access to healthcare services in Ethiopia. The eHealth Architecture depicts a conceptual framework on how different digital health systems interact, and it also defines how interaction among these systems can be made possible through interoperability service.
To support the implementation of the interoperability among digital health systems in Ethiopia, the University of Gondar (UoG) in collaboration with the Ministry of Health of Ethiopian and Digital Health Activities (DHA) establishes a national interoperability academy. This initiative aims to overcome interoperability skill gaps by providing technical support for the MoH and other stakeholders. The academy will also work to establish local capacities to improve skillsets and knowledge on interoperability solutions sustainably as per the national eHealth Architecture. The MoH will lead the overall direction of the academy.
The objectives of this academy are to:
- Provide sustainable technical support to the MoH for the implementation of eHA and Interoperability
- Establish a national community of practice on interoperability and provide continuous support to the community
- Develop and provide high-quality short-term and mid-term courses or training on Interoperability and interoperability solutions continuously
- Identify and develop interoperability use cases for key digital health initiatives
- Pilot interoperability standards in Ethiopia
- Document evidence on the implementation of interoperability among digital health systems in Ethiopia
To establish a national academy in interoperability, the following steps will be followed:
- The University of Gondar will arrange a physical space to set up an eHA and interoperability lab at the Department of Health Informatics, College of Medicine and Health Sciences, University of Gondar. The lab will be equipped with necessary computers, smartboards, internet connectivity, and other necessary facilities and services for the academy. The lab will serve as a center for development, testing, and capacity building in eHA and interoperability areas.
- A multidisciplinary technical working group constituted of Health Informatics and the College of Informatics at the University of GondarA be formed. The group members will be academic staff with Ph.D. and master’s degrees in the area of health informatics, computer science, information system, information technology, and public health. In addition, Ph.D. and master’s students at the University of Gondar will be involved as group members to contribute to the capacity-building activities related to eHA and interoperability. This group will be providing leadership, technical support, and training, and researching eHealth architecture and interoperability. To improve the technical skills of the group, virtual training sessions will be conducted in collaboration with the Open Health Information Exchange (OpenHIE) community. Additionally, the group will take online courses on architecture and interoperability.
- The technical working group will be developing a short-term training curriculum that includes basic and advanced courses on enterprise architecture, interoperability, health data exchange standards, and governance issues. The curriculum will be reviewed in a national workshop involving subject matter experts.
- The technical working group in collaboration with local experts, from public and private institutions, and stakeholders (MoH and partners) will prepare high-quality training modules on enterprise architecture, data sharing agreements, health data exchange standards, health data privacy, health data security, and governance issues. The modules will be designed in a free content management system called Moodle.
- Then, a set of paperless training using Moodle will be provided to developers and experts working on various digital health system development projects, including DHIS2, EMR, eCBHI, eCHIS, LMIS, HRIS, and others. Additionally, training will be given to Health Informatics and Informatics graduates of the University of Gondar to create local talents. Additionally, the technical working group will set up the Ethiopia OpenHIE community group wiki. In this platform, policies, strategies, directives, and guidelines regarding architecture and interoperability will be discussed and shared. Moreover, the community event calendar, quick links, and other relevant resources and documents on eHA and interoperability will be shared.
- The academy will conduct two hackathons on testing interoperability among digital health systems in Ethiopia. In these hackathons, selected young talents from public and private universities will participate. Young talent selection will be based on their academic performance and interest to join the Community of Practice in interoperability and architecture. We will assign mentors from the UoG, MOH, private companies, and partners who can provide mentorship for students for three consecutive months. Young talents will then meet for a couple of days to collaborate on projects and demonstrate interoperability among digital health systems. Such hackathons will help in capacitating young talents for sustainable implementation of interoperability in Ethiopia.
To realize sustainable technical support to the MOH for the successful implementation of eHA and interoperability, the following approaches will be followed:
- First, we will identify health information system stakeholders and experts in the area of eHA and interoperability and organize a workshop to identify and develop priority data exchange use cases. Then, the use cases will be shared with developers and experts working on system development projects so that interoperability will be considered and implemented in various digital health systems.
- We will provide legal, organizational, semantic, and technical support for the selection or design and development of a platform for the interoperability layer for the prioritized use cases. We will also ensure the feasibility, usability, security, and privacy of the platform for the interoperability layer. In this case, we will involve experts from stakeholders, universities, and the OpenHIE community through consultative workshops. In doing so, we will consider the existing terminology service (national health data dictionary (NHDD)) and the Master Facility Register (MFR), a single source of truth for facilities that exist nationally. In addition, the technical working group will work with the MOH to adopt the appropriate semantic and syntactic standards, globally known mapping standards.
To establish a national community of practice on interoperability, the following approaches will be followed
- To sustainably implement interoperability among digital health systems, a national Community of Practice on interoperability and eHealth Architecture will be established. The University of Gondar in collaboration with the MOH will work on mapping and selecting eHA and interoperability experts from academia, and public and private organizations that have experience and interest in enterprise architecture and data exchange standards. Members will be selected based on their experiences, interests, and level of commitment toward achieving the successful implementation of the eHealth Architecture. The University will provide the required support for the Community of Practice via virtual seminars, coaching, and training on interoperability and architecture. The technical working group in collaboration with the Community of Practice will organize and hold national and international conferences/workshops on contemporary issues of eHA and interoperability.
- The technical working group will create a platform called Ethiopia Digital Health Interoperability Network wiki in which the Community of Practice meet regularly to share ideas, experiences, and best practice for the successful implementation of interoperability. We will provide support to the Community of Practice until it reaches the level of self-sustainment.
To document evidence of the implementation of digital health system interoperability in Ethiopia, the following approaches will be followed:
- A research and best practice documentation team, multidisciplinary in its nature, will be established in the Academy. This team will comprise experts from Health Informatics, Informatics, Biostatistics, and Public Health. The team will publish articles and news on architecture and interoperability in blogs. The team will also actively facilitate and publish content related to eHealth architecture and interoperability in the Ethiopia OpenHIE community group wiki.
- The team will produce scientific publications on the processes of selecting an interoperability layer platform, interoperability design and implementation, and testing and quality assurance mechanisms of interoperability implementation.
- Lessons learned from the eHA and interoperability implementation will be documented, reported, and presented to the MOH and other stakeholders. In addition, experiences related to leadership, high-level technical assistance, training, and support, and evidence generation on eHealth architecture and interoperability will be shared with stakeholders through scientific publications and presentations in workshops.
The deliverables will be disseminated to beneficiaries through scientific publications, reports, presentations in virtual and physical meetings, workshops and conferences, Wiki forums, and blogs. Ways of dissemination are presented for the following specific deliverables:
- Training on enterprise architecture, data sharing agreements, health data exchange standards, health data privacy, health data security, and governance issues will be provided to stakeholders through face-to-face and virtual classes using Moodle and Zoom.
- Hackathons will be conducted on testing interoperability among digital health systems in Ethiopia virtually and physically. In addition, young talents selected based on their academic performance and interest will be mentored related to eHA and interoperability activities.
- Priority data exchange use cases will be disseminated to developers and experts working on system development projects, including DHIS2, electronic medical record systems, eCBHI, eCHIS, LMIS, HRIS, and others through workshops and reports.
- The technical working group in collaboration with the Community of Practice and the MoH will be organizing and holding national and international conferences or workshops on contemporary issues of eHA and interoperability.
- We will be publishing articles and news on architecture and interoperability in blogs.
- We will actively facilitate and publish content related to eHealth architecture and interoperability in the Ethiopia OpenHIE community group wiki.
- We will produce scientific publications on the processes of selecting an interoperability layer platform, interoperability design and implementation, and testing and quality assurance mechanisms of interoperability implementation.
- Lessons learned from the eHA and interoperability will be documented, reported, and presented to the MOH and other stakeholders
- Gained experiences related to leadership, high-level technical assistance, training, and support, and evidence generation on eHealth architecture and interoperability will be shared with stakeholders through scientific publications and presentations in workshops
- Digital Health Activity
- Ministry of Health
- University of Gondar
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