2017 GDHF

HMIS/LMIS Integration Basics
- Alfred: explains integration DHIS2 and eLMIS; LLIN dashboard in DHIS2
- Alpha: explains TZ OpenHIE framework (with slide diagram); HIM=Health Information Mediator. FUTURE STATE: Interoperability layer routes stock status to DHIS2
- Ssanyu Nyinondi: describes governance and eHealth strategy needed with government

Q&A
- Question: Are private facilities covered?
  Answer: yes for DHIS2. But only "ordering facilities" are in eLMIS. Government facilities who get stock from central medical stores.
- Question: What about reporting electronically?
  Answer: Of 5000 facilities in eLMIS TZ, roughly 600 report directly.
- Question: Integration uses Batch Files? 1-directional batch updates?
  Answer: Monthly batch file from eLMIS is sent to DHIS2 peer-to-peer. But they are now replacing that peer-to-peer with a mediator. The HIM architecture is their future state. For now it uses file with SFTP.
- Question from UNICEF MALAWI : What about when you upgrade the system? Does that break the integration?
  Answer: We are working on matching the facilities list and products lists at the Central Medical Stores, which is where the eLMIS workflow ends. We are talking about a new concept: product registry.
- Question: Why not capture the data directly into DHIS2 first, and then push into eLMIS after?
  Answer: it is logistics data; DHIS2 is only at the district level. Whereas the logistics data in eLMIS originates at the facility level. The people generating the data are different in both systems. Ssanyu answered: it also involves customizing DHIS2--eLMIS was designed to be implemented at the facility level.
- Question: Is there a national facility registry? National data dictionary?
  Answer: HFR is one of the key items. Parts are in operation, other parts on the map are still being rolled out. EPICOR 9 is also in play. eLMIS orders go directly there for fulfillment. In Phase 1 of the OpenHIE integration they are starting with 9 initial systems.
- Question (from Nicola Hobby/BAO): What is the data reconciliation time?
  Answer: Some data comes in monthly, but consumption data comes in quarterly. So trying to flatten and reconcile that. Trying to get good reporting rates in both systems so the data will match. So trying to change the frequency of reporting from quarterly to month. That reduces the supply chain cost.
- Question: What about Vaccines?
  Answer: VIMS is the 'vaccine module' of OpenLMIS also used in Tanzania and part of the OpenHIE setup.
- Question: Will DHIS2 be able to hold the data from all these different systems?
  Answer: For some key use case indicators, we have existing dashboards, so use DHIS2. For now we believe it will be able to support other data.

Problem:
Pharmacy management tools were largely paper based. Manual aggregation and analysis was a huge challenge with huge turn-around times. This caused poor re-supply decisions; stock-outs of ARVs; hoarding and pilferage.

Solution: 
1) Electronic dispensing tool (EDT) and facility electronic stock card (FESC), LMIS reporting & Syspro ERP CSV reports
2) Enhance data transmission - mobile phone network plus USB memory sticks
3) Enhance data processing

Tools and Best Practices:

FESC is web-based (actually he later told me they are re-doing it to be web-based); it has modules for managing stock.
EDT is for patient and stock management at ART sites; it is a Windows application.
–> See both tools here: http://siapsprogram.org/tools-and-guidance/

His slides (slide 9 and 13) show good examples of the Namibia PMIS Dashboard (PMIS = Pharmacy MIS). It consolidates data at national, regional and facility levels. They update and use it on a monthly basis! It is comprehensive and timely (much better than paper). Significant features for the ART program as well as for planning (more reliable data for forecasting; facilitates re-distribution and reduces wastage; early warnings for stock-outs and over-stocking).

Problems:
National - lack data; District; Health Facility - stock outs; Community.

Solutions:
cStock transmits logistic information through SMS messages with computer responses for re-supply
- first introduced in 2011 in 6 districts then nationally
- EPI program uses cStock in Malawi with JSI and Save The Children
- using MCSP funding to scale up from the first pilot
- cStock process has a series of meeitngs, orders and responses during the monthly and quarterly cycles
- see also: OpenLMIS notes about cStock opportunities since Dimagi wants to retire cStock: /wiki/spaces/OO/pages/84574228

Results:
improved EPI product availability (reduced stockouts)

Note: Erick Mwale is new at Save The Children. He is based in Blantyre. He was a neighbor of Zachariah Jezman from VillageReach!

Jodi explained that they started doing e-learning years ago under MCHIP before MCSP.

• Use Moodle and Moodle Mobile as their open source learning platform.
  • they find most people are already familiar with Moodle or have used it before
  • it also has an offline mobile mode as well as a Windows client
• midwifery schools are the target users
• work with MOH eLearning Secretariat in Ghana
• trying to get technology into the curriculum in schools
• eLearning content development uses a holistic approach
  • with a focus on what the MOH can sustain and keep using later
• Malaria content covers, EG, how to repair a bed net
• Jhpeigo has info on website
• translating content for use in Madagascar next -- lots of work is required in adaption/translation!

Mary Rocheleau, Engineering Manager, Vecna Cares Charitable Trust
- installed 6 hardened servers at clinics throughout a large refugee camp to track patient records
- interoperable EMR: reports for UNHCR and MOH
-- problem: had independent data collection and storage and generating parallel reports to different organizations
-- NOW: collect the same data, use it to create all reports; lower burden to maintain data
- Q&A: patient record merging based on unique identifiers; currently a manual confirmation of possible matches
- why did they build custom hardware? it was hard.

Amanda BenDor, PATH "Sharing Implementation experiences from Senegal" (presenting for Papa Sokhna)
- GHSA - Global Health Security Agenda covers many countries including Senegal, TZ, DRC; collaborates with CDC
- in Senegal, working to improve surveillance
-- digital tools for surveillance: DHIS 2 (first for TB, HIV, Malaria); plus Lab data feeding into DHIS 2
--- two copies: DHIS 2 MOH and DHIS 2 Lab
-- HSISD = Health and Social Information System Division
--- working at Hospitals!
--- training on ICD10
--- harmonizing data collection forms
-- at the Labs, they are doing mapping/landscaping to identify the equipment and workforce at the Labs

Marcos Mzeru, ICT Officer MOHCDGEC, Tanzania mzeru@moh.go.tz
NOT Mr. Hermes Sotter Rulagirwa, Head of ICT, Ministry of Health, Tanzania
- he also had worked for a software provider/vendor there
- TZ has a national health vision
- one-to-one integrations between systems got to be a mess (including VIMS, eLMIS, DHIS2, etc etc)
- Tanzania HIE "to be" model has a Health Information Mediator and Enterprise Service Bus model
-- use case #1: start with client level data exchange for hospitals (4 key indicators)
-- use case #2: sending aggregate data to DHIS2 including from eLMIS, VIMS, E9 (EpiCor 9 at Central Medical Stores) and HRHIS
-- use case #3: health facility registry data extract to post into Interoperability Layer
- HIM Administrator's landing page
-- started with 5 hospitals and eLMIS
- Questions?: Unique IDs, Data Curation
- ALPHA: These systems were not enterprise-ready when they were first built/deployed.

JSI created online game-based e-learning called Health Games. Below are steps on how to register free. The slides below also show the kind of analytics and tracking that their game platform gives.

Go to www.health-games.org
Use Registration Code 4949
Create an Account

This training uses a tool called Yeepa from Germany. I cannot tell if it works well offline, but still a good example of turning learning into a game and tracking learner achievements.

(Brandon shared this with Joseph for SCOR training and Bull City team.)

Introduction: 

Michael Downey, Director of Community, Open Source Center, Digital Impact Alliance at United Nations Foundation

- open source is a "hedge" against maintainer burn-out; to survive organizational strategic shifts over time; single points of failure; to catalyze contribution

- http://osc.dial.community/

Carl Leitner on Financing Mechanisms:

- Deputy Director - Global Goods, Digital Square / PATH

- "let a thousand flowers bloom" -> problem for Uganda in 2014 leading to the moratorium

- "software monocultures" is also a problem -- open source tools that are used in many many places at scale

- OpenHIE solves both -- a blueprint for a way of talking and sharing

- Digital Square includes: 

 -- governance and advocacy

 -- aligned funding

 -- global good commons? (WHAT IS THAT?)

 -- community coordination

 -- GGMM = Global Good Maturity Model

    -- was developed with input from HDC Health Data Collaborative team

    -- 3-axis maturity model

    -- example google spreadsheet for self-assessment: http://bit.ly/2AvjV1z (self-assessment in Google sheets)

  --> NEXT STEP: we should test and give feedback on their self-assessment tool

 -- "Notice B" for 6 awards totaling $600,000 to help global goods proceed along the GGMM "for sustained development"

 -- How do we prioritize limited funding? Demographic data (impact/scale); GGMM; Digital Health Atlas; TCO of GGs

Tenly Snow on OpenLMIS:

Tenly Snow (Deactivated) do you want to add your script and slides?

Dave Potenziani about IntraHealth's new iHRIS Foundation

David Potenziani, Senior Informatics Advisor, IntraHealth International

- "we cannot do it alone and we should not try"

- context: global health worker crisis -- shortage of millions of health workers

- "if somebody gives you a kitten, it's great, BUT it is the gift that eats"

Q & A:

- Documentation: Dave/iHRIS: WE want to write the documentation first, then write the code after we have thought through it.

- Balance building new features versus investing in improving/evolving/sustaining existing platforms?

 -- Dave: code bounties and projects are often skewed towards the "new and shiny". BUT you have to realize one of the things that requires care and feeding are the people you have already won over. Taking care of those people is not the glamorous, shiny work. 

- Language Barriers? How to overcome? Tenly example of holding events in Senegal to bring in perspectives.

- Dreams for the Holidays: more creative ways to do collaborative funding; start to fund innovation even it might fail; more summer of code type programs; want a stronger workforce in countries to manage these tools.