Scaling up Interoperability

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    • #559

      Dear RHINO colleagues,
      Thanks for registering in this new RHINO Forum on interoperability.
      Our moderators had posted seven topics at this stage. I would like to open a new topic on scaling up interoperability.

      While some Asian countries such as Philippines really moved into nationwide interoperability between data systems based on a well established HIS architecture, many countries of Asia and Africa are far from that goal. They often have developed a limited number of data systems and subsystems, mainly HMIS and LMIS, and have not organized the HIS or eHealth architecture. Also, often they have no master facility list or metadata dictionary. Also, interoperability need to be established between institution based data sources and population based data sources Recently, Liberia did a HIS Strategic Planning exercise, and planned simultaneously of a period of five years for the development of various new data systems, such as HRIS and CHIS, as well as to undertake a HIS architecture design. So, scaling up interoperability is a challenging enterprise, that can easily take a couple of years.

      So my question is if some of the participants registered to this forum could share the current situation in their country on interoperability, and if limited, if they have planned for scaling up for fully interoperable data systems.

      I hope that many of you who have registered will make a contribution to the dicussions.
      Theo Lippeveld, President of RHINO.

    • #568
      Vikas Dwivedi

      RHINO Greetings Theo!

      From our experience of working on interoperability in Tanzania, USA and being engaged in some other global discussion, we have learnt that before implementation of any solution, we need to design for scale! Once we are in the planning stage, it is crucial to develop a shared architecture and document long-term requirements. This is helpful in selecting a solution that has a potential to scale. The principle of working with the health system under the Ministry of Health’s leadership and strong governance are like essential spices/ingredients for scale.

      my two cents…

    • #574
      Sam Wambugu

      What I have learnt in a number of countries is that, before we can work the technical aspects of interoperability, we need to first ‘interoperate’ the stakeholders – especially those that wield money and power. The major stakeholders include obviously the government, the donors, the Implementing partners and the private sector. These have to come to the table and agree on the interoperability as a concept, a plan of action and rally their support behind a national interoperability plan. Without this type of agreement and commitment, we shall be making three steps forward and 4 backwards and meaningful interoperability will remain a mirage.

    • #576

      Thanks Sam for this excellent contribution. Stakeholder analysis and consensus building are essential before even thinking on designing the HIS architecture in a country. We just lived that experience in Liberia. Do we have examples from other countries?

    • #578

      Definitely agree with Sam. That is the ideal approach to be followed but some times due to some political reasons or Health Ministries structural reasons the HIS architectural approach becomes difficult to maintain that is why we adopted Data Warehousing in our country for fragmented information systems which are out of our control. This Data Warehousing is one of types of information systems which are categorized based on Distributed Databases Criteria as follows:

      1. Monolithic Information system : Fully integrated
      2. Distributed Information System: Fully interoperable
      3. Cooperative Information System and P2P Information System: Goes to Data Warehouse.

      We in our country have three types of information systems such as {Distributed, Cooperative and P2P } that is why we adopted Data Warehousing.

      Dr.Lutfullah Shifaa
      MIS Manager
      HMIS department

    • #581
      Romain Tohouri

      Thank you Theo for bringing this interesting topic!
      I want to share here the experience from my country where MOH is very application oriented. There is already a fully rolled out application to manage the LMIS, HMIS, Laboratory Information System, Disease surveillance, HIV patient and even OVC. There is also a lot of new initiatives that are taking place to computerize one aspect or another of the national HIS.
      We can say that this has somehow paid off since despite the close proximity of two Ebola affected countries remains Ebola free. Unfortunately those systems are still working in silos making it difficult to get a comprehensive view of the health information produced. The country is beginning to understand the problem but given that “owning the data” mean “owning the power and thus the money” each party is not seeing integration or interoperability as something good for them. In this context, I think the interoperability process should start by a behavioral change agenda…

      my two cents to the debate,

      HMIS Advisor MEASURE Evaluation/JSI

    • #582
      Alvin Marcelo

      Hello all…Thanks for mentioning the Philippines.

      Our story started at the Asia eHealth Information Network ( way back in 2011 when we formed the network with support from WHO. At a 2011 conference on health information systems interoperability in Hoi An, Vietnam, all of the participants had come to the conclusion that there was no interoperability even within Ministries of Health. As such, how can the MOH ask private sector to interoperate with public sector when within itself, the latter was not integrated?

      In AeHIN, we resolved to bring together eHealth advocates from different countries and create a space for discussing how we can solve the interoperability problem. It may seem funny looking back but the learning process was more important than the content:

      1. Training on Standards (2013) — a basic analyses of non-interoperability would point to lack of standards as the culprit. So AeHIN opted to get training on HL7 — a health information standard. However, after training 26 people from 13 countries on HL7, we came to the conclusion that HL7 was indeed an important standard but it was very comprehensive and complex. We needed to have a blueprint to know how to use HL7 effectively. A simple analogy is that you may think of HL7 as a standard “hollow block” but you still need a blueprint to tell you how to arrange the hollow blocks to serve your purpose.

      2. Blueprint (2014). AeHIN then thought of blueprints and sought training for enterprise architecture (which allows you to create blueprints). Thirty people from 9 countries underwent TOGAF – an EA methodology. After this, we thought we could be interoperable (HL7 plus TOGAF). But no, when we started asking the EA participants to start crafting the blueprint, they said there should be a clear governance structure and mandate behind the EA activity or else it will be moot.

      3. IT Governance (2015). AeHIN sought out IT Governance training and found COBIT5 ( Thirty participants underwent COBIT5 training and this is how the Philippines got to adopt COBIT5 for its national eHealth program. IT Governance provides a systematic framework to address system complexity and gives assurance to all stakeholders that the information system is organized to address this complexity.

      In July 2014, a multisectoral governance steering committee (patterned after the WHO-ITU National eHealth Strategy Toolkit) chaired by the Philippine Minister of Health and co-chaired by the Minister of ICT adopted COBIT5 as their IT Governance framework. From thereon, various aspects of the framework were activated and invested on.

      One specific aspect of COBIT5 is APO03 or “Manage the enterprise architecture”. For this, the national steering committee established a Health Enterprise Architecture Expert Group which advises them on EA matters. The current EA of the Philippines is patterned much after the OpenHIE architecture ( with local extensions.

      In summary, information systems within a facility is complex in and of itself — what more for national-scale health information systems?

      The solution: IT Governance which provides mandate for enterprise architecture which in turn serves as a guide to the many stakeholders in the country.

      And our story continues — I would be happy to keep RHINO informed of the developments —

      Alvin Marcelo
      Member, National eHealth Governance Technical working Group (Philippines)
      Executive director, AeHIN

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