Brandon Bowersox-Johnson, Elias Muluneh and Craig Appl (Unlicensed) attended the OpenHIE Community Meeting and Connect-a-thon in Arusha Tanzania 31 July - 4 Aug 2018. This page documents the activities and outcomes of the meeting.

This event demonstrated that OpenHIE has significant momentum as the paradigm for interoperability in global health MIS. OpenHIE is not just a diagram shared in conference presentations; there is now clearly action on the ground in 10+ countries where a Health Information Mediator (HIM) is established and interoperability is a working fact of life. The primary uses of OpenHIE are for health records (EMR) interoperability, but many country representatives spoke to us demanding a pattern for supply chain interoperability and requesting an OpenLMIS-to-DHIS2 integration. Jembi Health Systems had a huge presence (~25 attendees) at this event, has a large staff in many countries (eg, 40 staff in Mozambique) and appears to be a market leader dominating the work in establishing a HIM, but there is no clear leader or voice for supply chain interoperability. There is a significant opportunity for the OpenLMIS community to play a stronger role setting the standard for OpenLMIS-DHIS2 integration and more broadly leading in the supply chain interoperability space.

In the notes below, you'll see the conference sessions brought lots of learning and helpful information. The site visits were incredibly eye-opening to see how health workers use the supply chain IT systems we work on. Finally, at the Connect-A-Thon, we cut new ground by making significant progress on new designs and a working prototype implementation of Health Facility Registry interoperability with OpenLMIS using HEARTH FHIR server. Details below including GitHub code.

See the bottom of this trip report for Value/Outcomes and Next Steps.

Day 1: Enabling System Interoperability

Opening Speakers

Steve Davis, CEO, PATH: Our focus must be on the front-line health workers who are the true heroes of global health.
Dr. Mpoki Ulisubisya, Permanent Secretary, Tanzania MoHCDGEC: We must make sure our systems speak the same language. We have to ensure our work truly addresses reducing the health worker data entry burden, such as moving off of paper record-keeping on a daily basis.
Dykki Settle, PATH: This is your community, and you each have a responsibility to steer it forward.
Jennifer Shivers, Regenstrief: We need to incorporate new ideas and new use cases into the OpenHIE workflows. The current workflows do not reflect the full picture of the work being down in this arena.
Shaun Grannis, OpenHIE Architect, Regenstrief: The OpenHIE architecture framework blueprint is intended to be changed, not just be be used as-is. We were surprised when we created it that it appeared in so many conference sessions and so many places! That is great, but it must change and evolve to move interoperability forward.
- "Also, this week, I want to learn what people get out of OpenHIE: is it software? is it guidance? is it documentation? or maybe the primary value of OpenHIE is the community to learn from."

BID Project in Tanzania / Implementers Experiences

Presenters: Oswald Luoga, PATH; Emily Nicholson, IntraHealth; Ally Shaban, IntraHealth
Challenges: uniquely identifying patients/children; incomplete or untimely data; and more
Interventions: Electronic Immunization Registry; automated report generation; barcodes on child health cards and on vaccine supplies; and targeted supportive supervision for health workers.
See live note-taking from the OpenHIE community here: https://notes.ohie.org/2018-07-31_Implementers_Experience_BID
See screenshots from TImR: https://drive.google.com/open?id=1PC02iDrIcm1mYQ17RZsWs5PPu8gxzKGh
See video demos of TImR: http://bidinitiative.org/photos-videos/timr-demo-full/ (full 19 minutes) and http://bidinitiative.org/photos-videos/timr-demo-overview-2/ (new overview)

Leadership and Governance

Presenters: Hermes Sotter, Director of ICT, Tanzania MoHCDGEC; Carol Kyozira, Uganda MoH HMIS Division
Big focus is on the pillars of governance
A few organization charts showing the different groups that govern and manage these MIS systems; key elements are technical working groups (TWG) along with clear ownership by the Ministry of Health
(Nobody filled out live note-taking at https://notes.ohie.org/2018-07-31_Leadership_Governance_Where_to_Start)

Breakout Sessions

Leadership and Governance: Use of OpenHIE for BID Initiative in Tanzania - Brandon attended
"Unconference" Open Session - HIS Interoperability Toolkit - Elias attended
Implementers’ Experiences: DATIM Deep Dive - Brandon attended
"Unconference" Open Session - HacKonnect-Athon - Elias attended

Day 2: Country-Driven Success

Breakout Sessions

Implementers’ Experiences: Experience in implementing HIE at the National Level - Tanzania Story - Brandon and Elias attended
Implementers’ Experiences - Highlights from Ministry of Health in Ethiopia - Brandon attended
"Unconference" Open Session - Ukraine Experience - Elias attended
"Unconference" Open Session - Supply Chain subcommunity - Craig facilitated with Brandon support
"Unconference" Open Session - openIMIS for Universal Health Coverage & National Health Insurance - a valuable use case for the openHIE framework - Craig and Brandon attended

Day 3: Innovations breaking new ground in information exchange

Brandon went on a site visit to Usa River Health Center, primarily to see the TImR Android app used for EPI (vaccination) patient records and stock management. TImR is part of the BID initiative and submits monthly orders to VIMS (a version of OpenLMIS). For other programs besides EPI, paper records are used at the pharmacy and store room, but an accountant enters quarterly reports into eLMIS (on the one desktop computer there). Brandon has extensive notes and a few photos. Key issues: (1) There is heavy data burden because a paper immunization register is used in parallel with TImR (paper registry has been eliminated only at 55 sites so far); (2) The paper systems require about 4 paper register entries for each child immunized (because of a tally sheet, a monthly EPI report, and another monthly report, and a child card given to the mother) so there is lots of manual data entry and significant paper and Excel data that still go to the district for data entry by a HMIS focal person; (3) There is no electronic system for transactional stock management anywhere besides EPI; (4) There is no electronic health record or EMR for any other programs besides EPI (although the GoTHoMIS "unified solution" promises to offer a local patient health record); (5) Significant work remains to strengthen the culture of data use by facility staff.
On Day 4, Brandon went on a site visit to Shree Hindu Union Charitable Hospital, a private hospital that provides free immunizations and uses TImR Android app (which submits orders to VIMS). Similar issues emerged as in the site visit from the Day 3 visit above. Brandon has extensive notes and some photos.
"Unconference" Open Session - Indicator Reporting and Analysis - Elias and Craig attended
"Unconference" Open Session - Global Open Facility Registry (GOFR) - Elias attended
Interoperability and Standards: OpenHIE on FHIR - Craig and Brandon attended; Carl has helpful slides and promises to put together more training materials on FHIR
"Unconference" Open Session - How to assess and continuously improve maturity of health information systems for achieving better health outcomes - Brandon attended

Connect-A-Thon Day 4 and 5

OpenLMIS > OpenHIE Community Meeting 2018 - Trip Report > OpenHIE-Connect-A-Thon-2018-Arusha.JPG

At the Connect-A-Thon, Elias Muluneh, Craig Appl (Unlicensed), and Brandon Bowersox-Johnson had productive conversations with OpenHIE collaborators and technologists working in many countries.

Connect-A-Thon Notes (generic notes for all attendees/topics)
Documentation of the OpenLMIS-OpenHIE interoperability:
- OpenLMIS v3 - TZ Facility Registry with mCSD
- OpenLMIS Facility Registry Software Requirements Specification (draft)
- OpenHIE Facility Sandbox - Demo Installation Instructions for HEARTH in OpenLMIS integration
Discussed key areas of alignment:
- Facility Master List - we have a working prototype, draft specs, and a pattern
- Product Master List / Product Registry - we have a possible design for how OpenLMIS data could be aggregated and flow into DHIS2, using a FHIR Indicator Service and CQL for aggregation (developed with Carl Leitner)
  - We discussed specific challenges:
- An understanding of FHIR Measure and Measure Report FHIR Indicators (and HEARTH already has the resource available)
- Path forward on defining alternative location hierarchies within the same health system using FHIR (Luke Duncan is going to publish a paper with ITI)
- Better understanding of the Tanzania Health Information Exchange with a demo environment of OpenInfoMan, OpenHIM and Global Open Facility Registry Tool on Elias Muluneh machine
- Elias Muluneh has a prototype of running HEARTH within OpenLMIS as a microservice so we can capitalize on the FHIR structure that is available with the tool. This is connected to OpenLMIS using a lightweight node.js app that he wrote to translate each location into a FHIR resource. This potentially unlocks a number of new features that will ease the burden of integration with an HIE in the future.

Value to & Outcomes for the OpenLMIS Community

We trained multiple team members from JSI, Ona and VillageReach on the OpenHIE architecture and tool ecosystem. We learned a lot!
We developed a path forward for core Gap features around multiple integration points including integrating with a facility registry and potentially DHIS2 using FHIR
We have an understanding of future road map of multiple players in the space including the TZ MOH, IntraHealth, and Jembi to reduce the duplication of effort and synergize in the months to come.
We socialized the idea of a Product Registry and how it fits into the OpenHIE architecture with Regenstrief and the OpenHIE community
Good conversations with OpenLMIS developers/implementers in Malawi, Guinea, Tanzania, Zanzibar
We consistently pitched OpenLMIS, eLMIS, and the OpenSRP integration throughout the event, demoing and driving interest from new technical teams
We engaged with and developed momentum around the OpenHIE Supply Chain Subcommittee with a clear path forward until the end of the calendar year.
Laid groundwork for better collaboration on the Angola OpenLMIS and DHIS2 implementations. (Carl is traveling to Angola in August and is excited to implement the pattern we built at the Connect-A-Thon.)
The team really built our working relationships and understanding of work habits. This will improve our collaboration moving forward.

Next Steps

Budget for OpenHIE attendance again each year! It's critical to have multiple representatives of different types of employees (developers, PMs, etc). Encourage all OpenLMIS in-country developers from our implementations to attend this so they learn how to integrate OpenLMIS into the whole OpenHIE ecosystem.
Craig will provide a read out to Product and Governance Committees
Elias will provide a read out to the Technical Committee
We need to add the mCSD integration work to the immediate product roadmap for the Gap project and 3.5 release to capture momentum.
Craig and Brandon need to evaluate leadership/approach to moving the Supply Chain Sub-community work forward. (Jennifer asked each of us to co-facilitate the group with Regenstrief admin support.)