On 31 January 2017, the African Union (AU) established the African centers for disease control and prevention (Africa CDC) with a mission to “strengthen Africa’s public health institutions’ capacities, capabilities and partnerships to detect and respond quickly and effectively to disease threats and outbreaks based on science, policy, and data-driven interventions and programs. ” Africa CDC’s authorizing statute defines one of its functions as “harmonizing disease control and prevention policies and surveillance systems in member states.”
The AU Member States have increasingly been implementing e-Health systems to improve health outcomes. However, most of these systems use technologies that are functionally suboptimal, have limited capabilities to exchange and use data from other disparate systems, and some are unsustainable due to their proprietary nature. Among the mentioned challenges, lack of interoperability among heterogeneous systems has been a key challenge to realize the potential benefits of e-Health in the AU Member States in a cost-efficient manner.
To overcome this challenge, the Africa CDC established the Health Information Exchange (HIE) Task Force members from all corners of Africa and the global digital health community of experts. The Task Force members prepared the AU HIE Policy and Standards for Digital Health Systems Document. The document outlines HIE policy and standard recommendations that can be adopted and used by the AU Member States to leverage interoperable e-Health systems.
The documents are presented in three main sections:
Section one recommends a set of HIE policy directions, including:
● An HIE governance framework and oversight mechanisms that promote partnership and collaboration among AU Member States to address emerging and endemic diseases as well as public health emergencies.
● A legal framework that ensures each Member State complies with all the HIE policies and standards.
● The conceptual HIE architecture for e-Health defines the pattern for health data exchange between key architectural components of the continent.
● Data privacy and security policies that ensure security, confidentiality and controlled access to health information
● Data use agreements that conform to national and continental privacy provisions.
Section two recommends a set of common technical data exchange standards that further strengthen the integration and interoperability of e-Health systems in the AU Member States. The data exchange standards include:
● E-Health system standards and development principles to ensure the development of interoperable digital health technology applications and services.
● Communication protocols, such as IEEE 11073-10101, 11073-10201TM, 11073-20101TM, and IETF, to enable device-to-device communication.
● Messaging and vocabulary standards, such as HL7, HL7-CDA, HL7-FHIR, DICOM, ADX, JSON and XML, to facilitate electronic data collection, exchange and retrieval of relevant data, metadata, information, and knowledge.
● Security standards, such as ITU-T, ISO/TS 22600, NIST-SHA, and XUA, enable the secure exchange of health information.
The lists of stakeholders’ engagement for policy, standards, and operational implementations. Taking into account the immense benefits of cloud computing, the use of cloud and shared services for AU Member States e-Health systems are recommended. Human Immunodeficiency Virus (HIV) and COVID-19 use cases are also presented to show how recommended policies and standards can be applied to specific disease domains.
The recommended HIE policy and technical standards are intended to ensure that the HIE is used in an effective, efficient, ethical, and lawful manner in the future.
Purpose and Scope of the Document
1. A set of principles and guidelines on HIE policy for e-Health systems;
2. A set of principles and guidelines informing HIE standards for e-Health systems;
3. An HIE implementation framework for e-Health systems.