Notice F2: Shelf readiness with a focus on building local capacity and new teams.

Shelf Readiness of OpenELIS through Country-based Capacity Strengthening

Primary Author: Oliver Gadabu
Two-sentence Overview: 

OpenELIS Global aims to improve its Shelf-Readiness through establishing a structured capacity strengthening program and pathway that will enable country-based teams to engage quickly and easily in the OpenELIS Community and OpenHIE LIS COP to develop, integrate, and support OpenELIS implementation and interoperability in a national architecture. The investment will result in increased capacity of LMIC implementation teams to develop, integrate and support OpenELIS as a global good, achieved through 1) publishing of OpenELIS and QA learning materials and structured pathways related to i) software product development and quality assurance, and ii) interoperability), 2) establishing an OpenELIS capacity strengthening program that includes development of country-based OpenELIS mentors for south-to-south mentorship through the OpenELIS community; and as an end result of the program, strengthened quality of OpenELIS functions and interoperability and a broader community of OpenELIS developers and implementers to support nationally-scaled implementations of OpenELIS within interoperable digital health architectures.

Executive Summary: 

OpenELIS Global is recognized as a global good and the leading FHIR-first open-source enterprise laboratory information system (LIS). The software is used in hundreds of laboratories in Cote d’Ivoire, Haiti, Vietnam, and Mauritius as part of their national architectures, and in multiple public and private facilities across numerous countries as both a standalone implementation and as part of the Bahmni Hospital Management Information System.

As much as OpenELIS is scaling, the problem remains that most country-based teams are not sufficiently engaged in the OpenELIS community development and quality assurance processes, and remain reliant upon the OpenELIS Global stewards at the University of Washington (UW) for software development, interoperability engineering, and quality assurance development. This is especially problematic for those supporting scaled implementations, who need to be able to develop, test, and sustain software locally at the country-level while leveraging and contributing back to the OpenELIS Global community at large. The OpenELIS Global team will use the proposed investment from Digital Square to expand the OpenELIS community with engagement of country-based mid-level technical professionals, through establishing a structured capacity strengthening program and pathway. The program will include structured learning pathways, with measurable progress milestones, to guide the learning partnership between the mentors and mentees. The program will include a robust catalog of technical documentation, community process learning materials and contribution guides, and learning materials for OpenELIS development, QA, integration, and implementation and software support. The team will use a new community capacity program to identify and train country-based OpenELIS developer mentors to participate in the OpenELIS community in south-to-south mentorship of two different country-based teams that are currently supporting national OpenELIS implementations and to help provide community-based guidance to those just getting started with OpenELIS. This investment will enable the OpenELIS Global team to have dedicated effort to build out the capacity strengthening structure, pathway for engagement, and learning materials; and then use the program in real-world settings to expand local talent for supporting OpenELIS community and implementations. Because OpenELIS approaches in interoperability and quality assurance are standards-based and aligned with OpenHIE, and many of the capacity strengthening artifacts proposed can be generalizable for other LIS (EG: FHIR interactions with EMRs, etc), the team will partner with the OpenHIE LIS Community of Practice (LIS COP) to gather broader input in the design of these materials and disseminate them publicly through the OpenHIE LIS COP website and webinars.

Consortium team: 

The Digital Initiatives Group at I-TECH (DIGI), University of Washington (UW) is composed of digital health experts, experienced global goods developers, and country-level implementers in global public health who lead multiple digital health global goods communities of practice, and lead the identification of best practices and solutions that are the best fit-for-purpose in resource constrained environments. DIGI is the founder and ongoing steward for the OpenELIS Global codebase, supporting both the widely used OpenELIS code base and contributions, and the growing community at large. I-TECH DIGI is a well-known leader in development of high-quality training curricula for global health and the OpenELIS Global team would leverage this expertise by leading the efforts to build the capacity strengthening program structure, materials, and apply that program in real-world settings.

OpenHIE Laboratory Information Systems Community of Practice (LIS CoP) is an OpenHIE subcommunity bringing together laboratory informatics experts and software teams to advance LIS/LIMS best practices and standards for use in digital health implementations. The LIS CoP collaborated closely with DIGI in Notice C in the OpenLIS-OpenMRS integration work that led to the publication of the OpenHIE LIS-EMR architectural pattern. The LIS CoP is co-founded by a DIGI faculty co-lead. The LIS COP will serve as the dissemination host for the capacity strengthening program artifacts.

Project Description: 

Problem statement

OpenELIS Global is an advanced, enterprise laboratory software that has a long history of robust features and integrations built into the software.  OpenELIS has been scaled in numerous countries and is seeing growing adoption as laboratories in LMIC seek to strengthen their information management to meet the demand for their services in an ever-increasing complex digital health landscape. OpenELIS Global is a complex software that has a fairly steep learning curve for teams, due to the complexity of laboratory workflows and laboratory quality assurance processes themselves, and due to the necessary complexity in a very advanced software to be able to support the lab processes. With the upgrade to 2.x in 2019, OpenELIS has seen major technological changes that include a modern underlying framework and new FHIR-first model for integrations. Although the technological upgrade has provided numerous benefits for the security, reliability, and scalability of the software, this technological upgrade has left country-based OpenELIS teams reliant upon the UW OpenELIS stewards for software development and interoperability. Alongside these efforts, the OpenELIS Global team began work on a rigorous quality assurance portfolio that includes automated software release testing, automated interoperability compliance testing, and continuous integration pipeline with dockerization deployment. This quality assurance portfolio was modeled after the OpenHIE QA and OpenMRS QA approach, and supported through the Digital Square Notice E0 award. In order to increase OpenELIS shelf-readiness, the core software must be sustainable beyond the current UW stewardship.  Country-based teams need further human capacity in OpenELIS development and integration, and specifically developing and conducting rigorous automated quality assurance, to participate in, contribute to, and sustain the OpenELIS Global product as a community. In addition, because they share the same code base, country-based teams stand to benefit substantially from the ability to engage in the open source community, using shared community processes. As OpenELIS implementation numbers continue to grow, the need for a replicable training and capacity building approach to address these challenges is becoming urgent. With Cote d’Ivoire and Mauritius at the forefront of scaling OpenELIS nationally into their complex ehealth ecosystems, it has become clear that those teams need capacity built on two key areas: 1) OpenELIS quality assurance for software product development and 2) integration/interoperability. Since their teams are expected to grow as the scale of OpenELIS and the ecosystem complexity increases, they also need the ability to have the OpenELIS community include regional mentorship for more timely knowledge sharing and guidance.  Lastly, these skill sets are highly needed for these teams to work with other HIS in their country and in the global goods domain, as the OpenELIS approaches to QA and interoperability are shared standards and best practices with OpenHIE, OpenMRS, and other global goods used in many low-to-middle income countries.


The OpenELIS Global team will achieve our goal through the following work packages. 

     Work Package 1

Work package 1 will create a capacity strengthening portfolio that contains a robust catalog of learning materials for OpenELIS QA and interoperability with structured, measurable learning pathways; and technical documentation and community contribution guide for OpenELIS software development and integration.  Besides learning materials for skillbuilding on the OpenELIS product, the portfolio will include materials for up-skilling for becoming a mentor.

Techniques/Process: The OpenELIS Global team will identify key learning objectives and practical, relevant content for skill building for rigorous QA processes, automated testing, and integrating OpenELIS using the OpenHIE pattern. Using a user-centered design approach, we will work with the target in-country teams and mid-level technical professionals, and with the OpenHIE LIS COP community to gain an understanding of the needs, identify existing content, design the course flow, and develop engaging, interactive content that addresses the key competencies and associated learning objectives.

Deliverables/Schedule: A catalog of learning materials and learner evaluation tools that provide essential background and interactive, problem-based exercises to increase knowledge of and adoption of OpenELIS QA and interoperability principles and practices. A subset of the catalog will include structured materials for mentorship training.   (6 months)

     Work Package 2

In this work package, the team will focus on identifying and fostering a country-based OpenELIS developer to build advanced community mentorship skillset. The work will include both structured learning and applied mentorship practice. In addition, this work package will use the capacity strengthening program from Work Package 1 in the real-world to strengthen local OpenELIS capacity in QA and interoperability by working with two country-based teams supporting national implementations that have expressed desire to more deeply engage in the community and build their skill set, Cote d’Ivoire and Mauritius. The mentor and teams will be paired in a mentor/fellowship model, so that the mentor will practice and continue to advance their new skills by supporting capacity strengthening and engagement of country-based teams through the OpenELIS Global community. 

Techniques/Process: The team will utilize the portfolio from work package 1 to work with the identified individual in a structured and measurable process. The individual will be assessed at baseline, to identify gaps in mentorship competencies and collaboratively define a learning plan towards their mentorship goal. The team will conduct collaborative, iterative assessments to ensure the individual is on target for achieving their goal, with the team putting in course corrections and support where needed. The individual will practice mentorship skills directly with in-country OpenELIS teams under the supervision of the OpenELIS Global team. The OpenELIS Global team will use multiple modalities for building capacity in the country-based teams with the mentor, including the use of the structured learning plans, learning materials, and competency assessments, as well as, applied practice in a mentor/fellowship model on real world problems the team is currently addressing in their implementations. This practice includes twinning, paired programming, peer review, and mentor/fellow learning sessions.

Deliverables/Schedule: Report out of mentorship skills improvement based on plans, competency assessments, and documented practice with local teams. OpenELIS code (software, interoperability, and QA code) contributions as a result of mentorship practice sessions with local teams. Report out of team competency improvement and community engagement based on plans, assessments, and documented practice with Cote d’Ivoire and Mauritius teams. OpenELIS code (software, interoperability, and QA code) contributions as a result of practice by Cote d’Ivoire and Mauritius teams. (12 months)

Risk Mitigation

There is some risk when working with country-based teams for their dedicated attention to work on learning new technologies and approaches. This risk will be mitigated by aligning the initial program focus and materials with the implementation goals of the Cote d’Ivoire and Mauritius teams. For example, both teams currently have a need to increase their ability to rapidly perform bug fixes locally, test the software, and build and deploy the system. The focus of the program to utilize quality assurance (both automated testing and continuous integration deployment) will align with their needs and priorities, and thus, enable them to dedicate efforts towards the program.

Application Status: 
Not Approved


Thank you for the application. For the full technical application, in addition to general recommendations per the email, please also:

-Ensure text also clearly maps back to "shelf-readiness" aspects of the work, e.g. QA and testing, OpenHIE alignment and contributions, etc.

-Include more on specifics on plans for engaging through the OpenHIE LIS COP.

-Include plans for documenting the capacity strengthening process and for sharing back of learnings from it, including on the initial collaborative identification of needs and priorities.