Reply To: Focus of Interoperability: EMRs vs Aggregate systems

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Olusesan Makinde

Dear All,

Great points have been raised and I am indeed happy I did not miss this thread.

Just like previous commenters, the vision for an interconnected EMR for developing countries is still some distance away. Even the most advanced countries have not achieved this for various reasons. From my observation, those that conceive some of these ideas have little knowledge about what it takes to deliver them. Developing a system is not just the software, we need to talk about the people and the processes as well.

The MEASURE Evaluation Phase III project in Nigeria provided technical support to the Health Records Officers Registration Board of Nigeria to review the curriculum for training health information management (HIM) professionals. It had been observed that the HIM professionals encountered in the field had inadequate information and Communication Technology skills. These professionals are supposed to be the “techies” in health records management in health facilities. Yet an assessment found that fewer than 10% of them were skilled in database administration (not development). This is further elaborated on here

I also agree with Michael that we first try to connect the aggregate systems before venturing to link EMRs and like he said it is no joke. We identified the need to have a Health Facility Registry which serves as a hub for linking these aggregate systems as far back as 2013 and we proposed the idea to the government of Nigeria. This is described in our paper published here However, those to drive the system did not agree that we needed another system to manage these records and link in others. In fact, those managing the LMIS and HRIS were all working independent of those managing the DHIS. It took several sessions of explaining over a long time and persistent inability to achieve their goals before they saw reason to consider this and attempt to bring other partners in. Next comes the availability of resources to get this done. We managed to map the health facilities across a couple of databases in Nigeria but the success rates upon completion were also not encouraging because of lack of standardization in names and several other issues such as incomplete lists and multiple parties across 37 registries. For some states only 40% of health facilities in one list were available in the other.

Our recent publication titled “Potential use cases for the development of an electronic health facility registry in Nigeria: Key informant’s perspectives” available at is directed at identifying the most important use cases in the development of a health facility registry which will form the base of a Health Information Exchange in Nigeria.

From the discussion on another thread on enterprise architecture, the vision should be about building in standards that will allow you to grow your system over time. There is no country that can at one time identify all the processes that need to be built into the system at once.

My few cents.

Olusesan Makinde