E-Heza Data Solutions is a point-of-care digital health platform that improves maternal health outcomes by increasing a woman’s engagement in her care, easing workloads for frontline health workers, improving quality of care through implementation of best practice World Health Organization (WHO) guidelines, and promoting accurate data collecting and reporting while strengthening existing electronic medical record (EMRs) systems. E-Heza aims to be a reference implementation for the WHO Digital Adaptation Kit (DAK) for Antenatal Care (ANC) by aligning with the DAK while improving shelf-readiness by aligning with Instant OpenHIE to add an interoperability in order to provide a deployable package that can easily share data with other software.
E-Heza Data Solutions is a digital health platform created by TIP Global Health (TIP) to improve health outcomes by prioritizing the needs of frontline health workers and the families they serve as the starting point for effective and resilient local and national primary health care systems. E-Heza is the first point-of-care digital tool in Rwanda designed to optimize high quality care for families across the entire ecosystem of primary health care with the ability to integrate with national systems that are critical for public health decision making. E-Heza was designed alongside frontline health workers and the Rwanda Ministry of Health to improve data collection, provide decision support mechanisms, and ease reporting requirements. E-Heza’s functionality supports full scope Antenatal Care service provision by nurses and midwives in health centers, physicians in hospitals, and Community Health Workers (CHWs) in villages through person-centered point-of-care data collection, instant data analysis, clinical decision support, and a shared health record that supports behavior change and improve engagement in care. E-Heza’s Antenatal Care module is based upon the Rwanda Ministry of Health protocols, which are based on World Health Organization (WHO) guidelines for maternal health information systems. E-Heza provides direct care to 70,000 women and children across six districts in Rwanda, with plans to provide direct care to 200,000 across Rwanda and Burundi by early 2023.
E-Heza Data Solutions is a valued component of the Rwanda Ministry of Health’s EHealth Roadmap. Additionally, E-Heza will be expanded to Burundi through an emerging partnership with Village Health Works. While E-Heza aligns with most aspects of the eight components of the WHO Digital Adaptation Kit(DAK) focused on Antenatal Care(ANC), we will conduct a comparative analysis of each of the eight components of the WHO DAK for Antenatal Care with the corresponding components of E-Heza and to make the appropriate modifications based upon identified gaps. In doing so, we will ensure E-Heza software and all associated open-source documentation is aligned with both WHO standards and with local contexts in Rwanda and Burundi.
In expanding E-Heza’s core data elements, TIP Global Health will promote the exchange of aggregate and individual data with existing national data reporting systems in alignment with the Instant OpenHIE project. Although many of the core and calculated data elements currently exist within the E-Heza platform, we plan to perform a detailed inventory analysis to identify any gaps and also ensure all data elements’ IDs and labels are in alignment with the standard data dictionary. We will expand E-Heza’s indicators and performance metrics based on the WHO ANC monitoring framework and the WHO-UNICEF guidance for Reproductive Maternal Newborn Child Adolescent Health (RMNCAH) program managers, and align the definitions of each indicator with the global standards established in the DAK for ANC. E-Heza will align with the Instant OpenHIE project and the OpenHIE architectural standards to ensure that all ANC data collected at the point-of-care can seamlessly be reported to OpenMRS and DHIS2 in Rwanda. TIP will also partner with Village Health Works to determine the gaps in their ANC data collection and provide guidance to support their alignment with the DAK and interoperability with Burundi's national reporting systems. E-Heza is committed to alignment with Instant OpenHIE and HL7 FHIR and will continue to follow their processes and guidelines. In the future, TIP Global Health will align E-Heza Data Solutions with all WHO DAK’s to expand to all primary health care settings to support integration across services.
TIP Global Health will lead and oversee all aspects of the proposed project. The Rwanda Biomedical Center(RBC) will provide clinical and technical expertise to ensure country-level alignment of national protocols, data workflows, and interoperability standards with the DAK for ANC in Rwanda. Village Health Works will provide their expertise to ensure alignment with national protocols and reporting requirements in Burundi and the current data points collected in their local context. In collaboration with TIP Global Health’s software design and development team, Gizra will provide software development to support E-Heza’s expansion to align with the DAK and implement the Instant OpenHIE alignment.
TIP Global Health
TIP Global Health is a leading authority in developing lasting solutions on the frontlines of health. TIP’s transformative approach to collaborating with frontline health workers, alignment of its work with government priorities, and rigorous data-gathering, enables the scale-up of highly-effective solutions to extend access to life-saving quality care. In operation in Rwanda since 2008, TIP Global Health actively participates in meetings with the World Health Organization and provides our expertise towards their Global Strategy for Digital Health. TIP Global Health contributed to the World Health Organization (WHO) Health Workforce department’s guidance on the topic of health workforce readiness for digital health. TIP also serves on the Technical Working Group for the Maternal, Child, Community Health (MCCH) Division at the Rwanda Biomedical Center and the Digital Health Technical Working Group at the Rwanda Ministry of Health.
Contributors:
Theophila Huriro Uwacu, MBA- Director of E-Heza Data Solutions. Theophila oversees all aspects of E-Heza’s development, implementation, and expansion. She has extensive experience in data collection and management and collaborates closely with frontline health workers and other stakeholders.
Valens Hafashimana, MD, MPH- Director of Health Innovation & Acting Country Director. Dr. Hafashimana contributes to the organization’s overall strategy, overseeing the expansion of our innovations, and providing leadership and mentoring to our staff. He is an exceptionally experienced and compassionate physician with an excellent record of patient service and satisfaction, experience in capacity building for management of health facilities, and deep knowledge in maternal child health.
Adam Stewart- Chief Technology Officer, E-Heza Data Solutions. Adam has 20 years of experience working with NGOs and IGOs to implement digital solutions to confront real world challenges. Adam oversees the development process of E-Heza, and works in collaboration with the implementation team to deliver a new, best-in-class solution.
Wendy Leonard, MD- Executive Director, TIP Global Health. Dr. Leonard has 20 years of clinical experience, and extensive experience as an end-user of electronic medical record systems. She serves on the OCHIN Infectious Disease Review Committee for EPIC use in OCHIN’s network of health facilities. Dr. Leonard supports the clinical aspects of E-Heza design, development, and implementation. She provides her expertise in health workforce readiness for digital health to the East Africa Health Research Commission and the World Health Organization.
Jeanette Pelizzon- UX Designer. Jeanette collaborates with the medical, implementation, and development teams to research Rwandan health protocols and translate them to a user-centric digital tool. She works closely with the development team to bring designs from ideation through QA testing to live deployment.
Diane Mahoro, Junior Software Engineer. Diane is a software engineer based in Rwanda and has five years of experience with PHP, Java, Javascript, and Elm languages. She also serves as the frontline caretaker of technical issues that arise from work in the field. She is skilled in planning, analysis, design, and implementation as well as maintenance of software.
Rwanda Biomedical Center
Rwanda Biomedical Centre (RBC) is Rwanda’s central health implementation agency. RBC was established in 2011 through a merger of fourteen key health institutions. RBC strives to improve the health of the Rwandan population by providing high quality, affordable and sustainable health care services. RBC conducts scientific research, provides diagnostics services, and implements innovative health interventions to protect the nation against diseases and other health threats. RBC will work with TIP to align the WHO DAK for ANC with Rwanda Ministry of Health protocols and E-Heza data elements.
Contributors:
Felix Sayinzoga, MD, PhD, MPH- Maternal, Child & Community Health Division Manager/Rwanda Biomedical Center(RBC). In his current role, Dr. Sayinzoga coordinates all health interventions and initiatives related to maternal and child health in Rwanda. He is responsible for the development of policies and guidelines related to RMNCAH, and has contributed implementation oversight to these policies through capacity building, mentorship, monitoring and evaluation of health facilities and community health interventions. He is the chair of the Rwanda National Reproductive, Maternal, Newborn, Child, and Adolescent Health Technical Working Group.
Sylvere Mugumya, MHI- Business Analyst, Rwanda Ministry of Health. In his role at the Rwanda Ministry of Health, Sylvere is responsible for enhancing the quality of Digital health services, analyzing data to inform business decisions, and finding technological solutions to healthcare needs. Prior to his current role, Sylvere worked for three years as the Senior Software Developer- Health System Digitalization at the Rwanda Information Society Authority (RISA).
VIllage Health Works
Village Health Works is a Burundi-based non-governmental organization founded in 2005 that focuses on primary health care services integrated with education, sustainable agriculture, and economic development. Their team of experts in antenatal care, digital health tools, monitoring and evaluation, and information technology will provide insight into the local context.
Contributors:
Mack Kigada, Director of Information Services Group. Mack oversees the evaluation, selection, and integration of digital healthcare technology and information management systems for Village Health Works. He leads and coaches a team of data, IT, program, and community health professionals to maximize efficiency via the use of digital and technology-based systems and processes.
Gizra Internet Solutions Ltd.
Gizra Internet Solutions Ltd., formed in 2009 and incorporated in the U.S. as Gizra USA, LLC in 2015, is a fast-growing international software development company with an extensive track record in software solutions and implementation of content management systems.
Contributors:
Anatoly Vaitsman, Web Developer and Team Lead. Anatoly is a full-stack web developer with a strong background of integration and delivery of complex systems. He is an experienced JavaScript developer and has senior level experience in Drupal theming, particularly in Drupal 8.
Amitai Burstein, CTO and Co-Owner. Amitai is the CTO and technology leader at Gizra. He is one of the top architects and contributors to Drupal 7 and Drupal 8 and a key architect behind the OpenScholar project. He also speaks regularly in DrupalCons and other open source events.
Aron Novak, Senior Developer. Aron is a full-stack senior developer with an emphasis on DevOps and has extensive experience with the UNICEF development team, having worked on a migration project and a long-term consulting and development project.
Background or Problem Statement
TIP Global Health aims to transform primary healthcare delivery by ensuring that frontline health workers have the tools they need to effectively provide high quality care, engage and inspire community members to participate in their care, and achieve desired health outcomes while maintaining their own personal wellbeing. TIP works in partnership with national and local government officials to align with their priorities, protocols, and existing structures to support self-sustaining and easily replicable solutions. Alongside frontline health workers and the Rwanda Ministry of Health, TIP Global Health created E-Heza Data Solutions to support the ability of frontline health workers to effectively implement Ministry of Health best practice protocols for maternal and child health care while engaging families in care, preventing health worker burnout, and ensuring accurate and timely data reporting to the existing national data reporting systems.
The Rwandan Ministry of Health utilizes a Health Management Information System (HMIS) built on a District Health Information Systems (DHIS) 2 platform to support aggregated public health data reporting to the national government. OpenMRS software serves as a national electronic medical record (EMR) to collect individual level health information at district and regional hospitals. Unfortunately, these systems have faced implementation challenges in local health jurisdictions – health centers, health posts, and villages – where most antenatal care services are provided.
E-Heza efficiently builds upon the work of existing health record platforms in Rwanda by serving as an effective user interface that supports healthcare workers’ workflows and eases workloads, utilizes collected data to provide tailored health education to women that engages them in care, functions in settings of unreliable internet, and provides timely and accurate data to the Rwanda Ministry of Health. The user interface is designed based upon the Rwanda Ministry of Health (MoH) protocols for antenatal and pediatric care services provided at health facilities and in villages by community health workers (CHWs). Because Rwanda MoH protocols are based upon gold standard World Health Organization (WHO) guidelines, it can be shared with minimal adjustment to other national health programs. E-Heza is supported by rigorous training for users, quality-oriented assessments and monitoring, and a team of experts.
E-Heza has been implemented in six district hospital catchment areas in Rwanda, serving a combined population of 650,000. At the request of the Rwandan Ministry of Health, E-Heza will continue to be expanded across the country in 2022. Additionally, E-Heza Data Solutions will soon be expanded to Burundi through our partnership with Village Health Works. The alignment with Instant OpenHIE is an important next step to ensure seamless data reporting between local and national data reporting systems in both East African countries.
With support from local stakeholders and the Rwanda Ministry of Health, E-Heza Data Solutions was established to facilitate the implementation of Rwandan Ministry of Health’s Antenatal Care (ANC) protocols, which are based upon the World Health Organization’s most recently updated ANC guidelines. The publication of the WHO DAK for ANC has laid clear operational requirements for implementing WHO recommendations in digital systems. A comprehensive comparative analysis of E-Heza to the DAK components, as well as the needed adaptations, will ensure that E-Heza Data Solutions meets the clinical, operational, and interoperability needs of any national or local entity that provides antenatal care services based upon best practice WHO guidelines.
In addition to acting as an effective user interface that interacts with existing EMR systems, E-Heza can serve as a stand alone EMR for maternal and child care in settings without existing individual health records that would then send data directly into national HMIS systems. In each use case, interoperability is required for upstream reporting. By aligning with the WHO DAK for ANC, aligning with Instant OpenHIE, and adapting for use in both Rwanda and Burundi, this project will advance E-Heza’s shelf readiness and serve as a valuable reference implementation for the WHO DAK in multiple settings.
Digital Health Technologies
The overall purpose of this project is to align E-Heza’s workflows with the WHO Digital Adaptation Kit for Antenatal Care (DAK) and as such will use the blueprint provided to survey the existing architecture and workflows, identify gaps, align and construct the unique workflows and personas. This process greatly benefits E-Heza as it provides a dictionary-level framework for realizing our interoperability goals.
As such, we are planning to adapt E-Heza development practices and software architecture, to utilize the OpenHIE architecture as well as the Instant OpenHIE guidelines in order to decrease dependency on specific vendor tools and make investigation, adoption, and spin up easier for technical and non-technical users.
E-Heza, which has become a key point of service system for ANC Care in Rwanda, benefits greatly by situating itself to be leveraged efficiently by business domain services, such as HMIS systems which aggregate and share data, and shared health records, which allow multiple point of service systems to work with the same patient records. In our particular context, allowing accurately collected digital measurements to flow upstream to the country-wide HMIS (DHIS2) and shared with other point of service tools in hospitals (specifically, OpenMRS) is our desired end goal.
E-Heza has always used a containerized approach to development, using Docker images to support ease of installation and uniformity across platforms. More recently we have been working on Gitpod deployments, which non-developer users can use to spin up demos of E-Heza with the click of a button. This is an area of development to which our team is committed and we intend to learn from and contribute to the Instant OpenHIE initiative.
Instant OpenHIE affords our team the opportunity to abstract our approach to interoperability and to create a type of ANC reference application that can be used to demonstrate interaction with an OpenHIM utilizing the OpenHIE architecture to support transaction of data. Past efforts have been toward direct or indirect integrations to OpenMRS and DHIS2, which while beneficial, can be deeply enriched by a standardized and community-driven architectural approach. Our approach here would ensure that data shared between components would meet the FHIR standard and could ultimately be shaped into a FHIR-compatible resource. Our partners in Burundi- Village Health Works- are in the process of identifying a hospital-based electronic medical record (EMR). We will test interoperability of E-Heza with HMIS in Rwanda and with the chosen EMR in Burundi.
Once the code has been published which enables Instant OpenHIE compliance including Dockerfile, we will create and implement automated testing for interoperability with our partners in Rwanda and Burundi. In Rwanda, interoperability with HMIS will be deployed for testing. In Burundi, interoperability with Village Health Works’ hospital-based electronic medical record will be deployed for testing. Once tested and remediated, an implementation plan will be documented for production cases of partnership workflows.
Use Cases and User Stories
Work Package 1: Conduct a landscape analysis of E-Heza to determine alignment and gap between existing workflows, workflows in partner implementations, and workflow prescribed by the WHO Digital Adaptation Kit for Antenatal Care and produce the unique personas. (DAK components 2-4, 8)
- As a developer, I need to understand the workflows, personas, so that I can produce technical functionality according to the needs and in adherence to the WHO standards.
- As a stakeholder at a government agency or organization seeking to adopt a digital tool for ANC, I need to see clear evidence that E-Heza can handle, or be adapted to handle, workflows for my context and needs.
Work Package 2: Comparative analysis between E-Heza, partner implementations, and the WHO DAK for ANC clinical care-related components to determine gaps and bring E-Heza into alignment with WHO best practice clinical care protocols, health interventions and recommendations, decision support, and indicators. (DAK components 1, 6, 7)
- As a developer, I need to understand the health interventions, terms, and formulas to ensure that I can produce the technical functionality according to the clinical needs and in adherence to the WHO standards.
- As a stakeholder at a government agency or organization, I need to trust that E-Heza supports comprehensive health interventions, best practice clinical care activities, and decision support to provide effective antenatal care that leads to desired health outcomes.
- As a public health decision-maker, I need to have access to timely, reliable, and accurate aggregated health data, so that I can make informed policy decisions.
- As a frontline health worker (nurse, midwife. physician, community health worker), I need to use a digital tool that facilitates my specific responsibilities and workflows so that I can effectively provide care to my patients.
Work Package 3: Identify gaps in E-Heza and the existing data dictionary in the WHO DAK for ANC and document additions and amendments (DAK component 5)
- As a developer, I need to understand the data dictionary for E-Heza so that I know which elements need to be persisted to the database.
- As a stakeholder at an organization seeking to adopt a digital tool for ANC, I need to understand the data dictionary for E-Heza so that I know that the software is compliant with WHO standards and meets the needs of my context.
Work Package 4: Adapt E-Heza’s ANC module with updated workflows compliant with WHO standards and consistent with the WHO Digital Adaptation Kit for Antenatal Care
- As a nurse/CHW/woman (client), I can identify and register (be identified/registered) a pregnant woman so that she can proceed to the ANC consultation knowing that (or being made aware that) early detection of pregnancy and consultation leads to better health outcomes.
- As a nurse/CHW, I need to counsel and provide ANC services to pregnant women to support a healthy pregnancy and identify any issues that need referral.
- As a pregnant woman, I need counseling and ANC services in order to feel confident in a healthy pregnancy and get support and attention for any issues.
- As a nurse/CHW, I need to provide timely and appropriate referrals to a higher-level facility or health-care provider so that I can limit the impact of complications that may cause bad health outcomes.
- As a pregnant woman, I need to receive timely, clear, and appropriate referrals to a higher-level facility or health-care provider so that I can receive treatment or more easily adhere to anticipatory guidance that will produce good health outcomes.
- As a nurse at a health center I need to receive information with a referral that leads to efficient intake of a patient and allows me to proceed with recommended action in order to limit the impact of complications that may cause bad health outcomes.
- As a nurse/CHW, I need to provide routine health promotion and follow-up within the community to increase the likelihood of good health outcomes at a community level.
- As a nurse/data manager, I need to compile and submit relevant data contributing to indicators and other reporting needs on a routine basis to support surveillance of health outcomes in my jurisdiction.
Work Package 5: Alignment with Instant OpenHIE Initiative
- As a developer for an implementing organization, I need to deploy E-Heza alongside other pieces of Instant OpenHIE with a preconfigured recipe for deployment.
- As a developer for an implementing organization, I want to be able to package my implementation environment into a deployable package so that deployments are efficient and scalable.
Work Package 6: Documentation
- As an organization seeking integration and interoperability solutions, I easily browseable documentation on E-Heza so that I can rely on my knowledgeable software team to configure and deploy these tools without necessarily having to rely on an external development team with specialized knowledge.
Objectives and Activities
The recently established WHO Digital Alignment Kit focused on ANC offers a reference point for informing further development and adaptation of E-Heza to ensure alignment, improve care delivery, and strengthen primary health care systems. TIP Global Health aims to demonstrate E-Heza’s value as a critical digital health platform in the primary health care ecosystem that meets the qualifications to be considered a global good through alignment with the DAK for ANC and improving interoperability with a variety of existing EMRs. Our main objectives are four-fold:
- Alignment of E-Heza with all eight components of the World Health Organization’s DAK focused on Antenatal Care
- Alignment with the Instant OpenHIE initiative in order to provide a deployable package that can easily share data with other software that meets these guidelines.
- Identify unique needs and adapt E-Heza to meet the needs of Rwanda and Burundi within the context of the WHO DAK for ANC.
- Test and prepare for deployment of interoperability between E-Heza and HMIS (DHIS2-based) in Rwanda and hospital-based EMR in Burundi using the FHIR standard and deployable through Instant OpenHIE.
Work package 1: Inventory analysis of E-Heza to determine alignment and gap between existing workflows, workflows in partner implementations, and workflows prescribed by the WHO DAK for ANC and to produce unique personas as required. (DAK components 2-4, 8)
Objective 1.1: Review, assess and update E-Heza personas and user stories and associated workflows for ANC.
Activity 1.1.1: Persona Review Process
Activity 1.1.2: User Story Review Process
Activity 1.1.3: UX Design review feedback with user focus groups.
Activity 1.1.4: Document working personas, workflows, and focus group feedback report.
Objective 1.2: Convene task group among local partners in Rwanda to assess local implementation needs
Activity 1.2.1 Assemble Rwanda working group and assess WP1 deliverables
Objective 1.3: Convene task group among local partners in Burundi to assess local implementation needs
Activity 1.3.1 Assemble Burundi working group and assess WP1 deliverables
Work package 2: Comparative analysis between E-Heza, partner implementations, and the WHO DAK for ANC clinical care-related components to determine gaps and bring E-Heza into alignment with WHO best practice clinical care protocols, health interventions and recommendations, decision support, and indicators. (DAK components 1, 6, 7)
Objective 2.1 Review, assess and update health interventions and recommendations, decision support, and program indicators for ANC.
Activity 2.1.1: Health Interventions and Recommendations review process
Activity 2.1.2: Decision Support review process
Activity 2.1.3: Program Indicators Review Process
Activity 2.1.4 Document revisions of E-Heza components to align with WHO DAK
Objective 2.2: Convene clinical task groups among partners in Rwanda to assess local implementation needs
Activity 2.2.1: Assemble Rwanda working group and assess WP2 deliverables
Objective 2.3: Convene clinical task groups among partners in Burundi to assess local implementation needs
Activity 2.3.1: Assemble Burundi working group and assess WP2 deliverables
Work package 3: Identify gaps in E-Heza and the existing data dictionary in the WHO DAK for ANC and document additions and amendments (DAK component 5)
Objective 3.1: Analyze and understand the DAK data dictionary
Activity 3.1.1: Clinical review of the dictionary
Activity 3.1.2: Technical review of the dictionary
Activity 3.1.3: Preliminary report on workflow or technical challenges and risks.
Objective 3.2: Provide a gap analysis For E-Heza
Activity 3.2.1: Map data fields in E-Heza to DAK
Activity 3.2.2: Identify missing fields and inconsistencies in field types and nomenclatures
Activity 3.2.3: Identify and map diagnosis codes
Activity 3.2.4: Provide work plan for covering the gap and the new schema for E-Heza
Work package 4: Adapt E-Heza's ANC module with updated workflows compliant with WHO standards and consistent with the WHO DAK for ANC
Objective 4.1: Develop backend platform and API handlers for new schema
Activity 4.1.1: Research and stakeholder discussion- identify personas, user stories, technical confirmations
Activity 4.1.2: Design
Activity 4.1.3: Design Review
Activity 4.1.4: Development Sprints
Activity 4.1.5: Quality Assurance testing and remediation
Activity 4.1.6: Acceptance testing and remediation
Activity 4.1.7: Publish code
Objective 4.2: Develop front end according to updated workflows
Activity 4.2.1: Research and stakeholder discussion- identify personas, user stories, technical confirmations
Activity 4.2.2: Design
Activity 4.2.3: Design Review
Activity 4.2.4: Development Sprints
Activity 4.2.5: Quality Assurance testing and remediation
Activity 4.2.6: Acceptance testing and remediation
Activity 4.2.7: Publish Code
Work package 5: Alignment with Instant OpenHIE Initiative
Objective 5.1: Engagement with the Instant OpenHIE Community
Activity 5.1.1: Participate in the OpenHIE Discourse and regular DevOps Subcommunity calls
Activity 5.1.2: Convene development team to identify areas to provide contribution
Activity 5.1.3: Execute contribution plan
Objective 5.2: Develop E-Heza to ensure that it can be deployed in an Instant OpenHIE implementation
Activity 5.2.1: Technical meeting to determine the technical requirements and resources
Activity 5.2.2: Evaluate technologies for orchestration and deployment
Activity 5.2.3: Develop the code which enables Instant OpenHIE compliance
Activity 5.2.4: Publish the code which enables Instant OpenHIE compliance including Dockerfile
Objective 5.3: Automate interoperability test cases for the FHIR module and Instant OpenHIE
Activity 5.3.1: Develop automated interoperability for test cases.
Activity 5.3.2: Create and implement automated testing for interoperability.
Activity 5.3.3: Acceptance testing among stakeholders for interoperability test cases and remediation.
Activity 5.3.4: Document implementation plan for production cases of partnership workflows.
Work package 6: Documentation
Objective 6.1: Design and Develop Implementers Guide
Activity 6.1.1: Draft documentation
Activity 6.1.2: Documentation acceptance testing
Activity 6.1.3: Incorporate feedback and publish
Objective 6.2: Design and Develop Clinical Guide
Activity 6.2.1: Draft documentation
Activity 6.2.2: Documentation acceptance testing
Activity 6.2.3: Incorporate feedback and publish
Objective 6.3: Design and Develop API Manual
Activity 6.3.1: Draft documentation
Activity 6.3.2: Documentation acceptance testing
Activity 6.3.3: Incorporate feedback and publish
Risk Mitigation
In order to mitigate risk associated with inappropriate context of standards, TIP Global Health will conduct user focus groups to ensure frontline health workers’ practice on the ground is aligned. This will help to effectively bridge any potential technical gaps as well. TIP Global Health has extensive experience in gathering user-centered feedback to support the design and development of E-Heza. Our team will work with our existing steering committee of nurses, midwives, mothers, and physicians to conduct preliminary focus groups. The steering committee will help to identify areas in which further stakeholder feedback is needed. Prior feedback sessions are documented and shared on E-Heza’s public documentation page. We will take a similar approach to our work with frontline health workers in Burundi through our partnership with Village Health Works. As a member of the Rwanda Ministry of Health E-Health Technical Working Group (TWG), TIP will gather feedback from TWG members and work with them to identify additional stakeholders from whom feedback will be helpful. Through collaboration with our partners in Rwanda and Burundi, we are able to widen our clinical support team to compare standards and protocols across contexts. TIP will publish the E-Heza API as part of the documentation process to allow community engagement around data standards implemented. To ensure alignment with current interoperability standards, TIP Global Health will participate in Instant OpenHIE community initiatives.
Community Feedback
E-Heza is an open source community project with an open source license under Apache 2.0 that is committed to engagement with the broader digital health community as well as all project users and stakeholders. The project roadmap is driven by the E-Heza Executive committee which meets bi-weekly and consists of members of TIP Global Health clinical and digital health teams, advisory members from the digital health community, and key organizational and governmental implementation partners. The committee will organize and solicit feedback for this project using three main methods:
- Our regular process of user feedback: TIP Global Health espouses an education model that includes listening, learning, integrating and co-designing. Training with frontline healthcare workers seeks to understand functional and design needs as much as they look to provide key skills and knowledge. Our training module has built in feedback mechanisms that influence the design and development process.
- A landscape study with our organizational and governmental partners in Rwanda and Burundi. The study, proposed as a work product, seeks to understand the healthcare ecosystems and to build for current interoperability needs and be predictive of future needs.
- Interaction with the wider digital health community, specifically the Instant OpenHIE project. The Instant OpenHIE initiative represents an extraordinary opportunity for E-Heza to build the interoperability tools today for the needs of tomorrow. We are eager to leverage this opportunity to be involved with the open source development community as a use case, to endure our own adherence to emerging standards, and to capture the aggregated knowledge of the community.
By realizing the goals of the work products in this proposal, we can provide a blueprint for how to achieve digital support for the Smart Guidelines and make it easier for others to support the WHO guidelines and an overall standardized data model.
Schedule
|
Activity |
Team Location |
Month/Quarter |
|||||||||||
|
Qtr 1 |
Qtr 2 |
Qtr 3 |
Qtr 4 |
||||||||||
|
M1 |
M2 |
M3 |
M1 |
M2 |
M3 |
M1 |
M2 |
M3 |
M1 |
M2 |
M3 |
||
|
Objective 1.1: Review, assess and update E-Heza personas and user stories and associated workflows for ANC. |
|||||||||||||
|
Activity 1.1.1: Persona Review Process |
TIP/E-Heza |
X |
|||||||||||
|
Activity 1.1.2: User Story Review Process |
TIP/E-Heza |
X |
|||||||||||
|
Activity 1.1.3: UX Design review feedback with user focus groups. |
TIP/E-Heza |
X |
|||||||||||
|
Activity 1.1.4: Document working personas, workflows, and focus group feedback report. |
TIP/E-Heza |
X |
|||||||||||
|
Objective 1.2: Convene task group among local partners in Rwanda to assess local implementation needs |
|||||||||||||
|
Activity 1.2.1 Assemble Rwanda working group and assess WP1 deliverables |
TIP/E-Heza & Rwanda MoH/RBC teams |
X |
|||||||||||
|
Objective 1.3: Convene task group among local partners in Burundi to assess local implementation needs |
|||||||||||||
|
Activity 1.3.1 Assemble Burundi working group and assess WP1 deliverables |
TIP/E-Heza & Village Health Works |
X |
X |
||||||||||
|
Objective 2.1 Review, assess and update health interventions and recommendations, decision support, and program indicators for ANC. |
|||||||||||||
|
Activity 2.1.1: Health Interventions and Recommendations review process |
TIP/E-Heza |
X |
|||||||||||
|
Activity 2.1.2: Decision Support review process |
TIP/E-Heza |
X |
|||||||||||
|
Activity 2.1.3: Program Indicators Review Process |
TIP/E-Heza |
X |
|||||||||||
|
Activity 2.1.4 Document revisions of E-Heza components to align with WHO DAK |
TIP/E-Heza |
X |
|||||||||||
|
Objective 2.2: Convene clinical task groups among partners in Rwanda to assess local implementation needs |
|||||||||||||
|
Activity 2.2.1: Assemble Rwanda working group and assess WP2 deliverables |
TIP/E-Heza & Rwanda MoH/RBC teams |
X |
|||||||||||
|
Objective 2.3: Convene clinical task groups among partners in Burundi to assess local implementation needs |
|||||||||||||
|
Activity 2.3.1: Assemble Burundi working group and assess WP2 deliverables |
TIP/E-Heza & Village Health Works |
X |
X |
||||||||||
|
Objective 3.1: Analyze and understand the DAK data dictionary |
|||||||||||||
|
Activity 3.1.1: Clinical review of the dictionary |
TIP-E-Heza |
X |
X |
||||||||||
|
Activity 3.1.2: Technical review of the dictionary |
TIP-E-Heza & Gizra |
X |
X |
||||||||||
|
Activity 3.1.3: Preliminary report on workflow alignment, technical challenges and risks. |
TIP/E-Heza & Gizra |
X |
X |
||||||||||
|
Objective 3.2: Provide a gap analysis For E-Heza |
|||||||||||||
|
Activity 3.2.1: Map data fields in E-Heza to DAK |
TIP/E-Heza & Gizra |
X |
|||||||||||
|
Activity 3.2.2: Identify missing fields and inconsistencies in field types and nomenclatures |
TIP/E-Heza & Gizra |
X |
X |
||||||||||
|
Activity 3.2.3: Identify and map diagnosis codes |
TIP/E-Heza & Gizra |
X |
X |
||||||||||
|
Activity 3.2.4: Provide work plan for covering the gap and the new schema for E-Heza |
TIP/E-Heza & Gizra |
X |
|||||||||||
|
Objective 4.1: Develop backend platform and API handlers for new schema |
|||||||||||||
|
Activity 4.1.1: Research and stakeholder discussion- identify personas, user stories, technical confirmations |
TIP/E-Heza & Gizra |
X |
|||||||||||
|
Activity 4.1.2: Design |
TIP/E-Heza |
X |
|||||||||||
|
Activity 4.1.3: Design Review |
TIP/E-Heza & Gizra |
X |
|||||||||||
|
Activity 4.1.4: Development Sprints |
TIP/E-Heza & Gizra |
X |
X |
||||||||||
|
Activity 4.1.5: Quality Assurance testing and remediation |
TIP/E-Heza & Gizra |
X |
|||||||||||
|
Activity 4.1.6: Acceptance testing and remediation |
TIP/E-Heza & Gizra |
X |
|||||||||||
|
Activity 4.1.7: Publish code |
Gizra |
X |
|||||||||||
|
Objective 4.2: Develop front end according to updated workflows |
|||||||||||||
|
Activity 4.2.1: Research and stakeholder discussion- identify personas, user stories, technical confirmations |
TIP/E-Heza & Gizra |
X |
|||||||||||
|
Activity 4.2.2: Design |
TIP/E-Heza |
X |
|||||||||||
|
Activity 4.2.3: Design Review |
TIP/E-Heza |
X |
|||||||||||
|
Activity 4.2.4: Development Sprints |
TIP/E-Heza & Gizra |
X |
X |
||||||||||
|
Activity 4.2.5: Quality Assurance testing and remediation |
TIP/E-Heza & Gizra |
X |
|||||||||||
|
Activity 4.2.6: Acceptance testing and remediation |
TIP/E-Heza & Gizra |
X |
|||||||||||
|
Activity 4.2.7: Publish Code |
Gizra |
X |
|||||||||||
|
Objective 5.1: Engagement with the Instant OpenHIE Community |
|||||||||||||
|
Activity 5.1.1: Participate in the OpenHIE Discourse and regular DevOps Subcommunity calls |
TIP/E-Heza & Gizra |
X |
X |
X |
|||||||||
|
Activity 5.1.2: Convene development team to identify areas to provide contribution |
TIP/E-Heza & Gizra |
X |
|||||||||||
|
Activity 5.1.3: Execute contribution plan |
TIP/E-Heza & Gizra |
X |
|||||||||||
|
Objective 5.2: Develop E-Heza to ensure that it can be deployed in an Instant OpenHIE implementation |
|||||||||||||
|
Activity 5.2.1: Technical meeting to determine the technical requirements and resources |
TIP/E-Heza& Gizra with MoH/RBC & VHW |
X |
|||||||||||
|
Activity 5.2.2: Evaluate technologies for orchestration and deployment |
TIP/E-Heza & Gizra |
X |
|||||||||||
|
Activity 5.2.3: Develop the code which enables Instant OpenHIE compliance |
TIP/E-Heza & Gizra |
X |
X |
X |
|||||||||
|
Activity 5.2.4: Publish the code which enables Instant OpenHIE compliance including Dockerfile |
Gizra |
X |
|||||||||||
|
Objective 5.3: Automate interoperability test cases for the FHIR module and Instant OpenHIE |
|||||||||||||
|
Activity 5.3.1: Develop automated interoperability for test cases. |
X |
X |
|||||||||||
|
Activity 5.3.2: Create and implement automated testing for interoperability. |
X |
||||||||||||
|
Activity 5.3.3: Acceptance testing among stakeholders for interoperability test cases and remediation. |
X |
X |
|||||||||||
|
Activity 5.3.4: Document implementation plan for production cases of partnership workflows. |
X |
X |
|||||||||||
|
Objective 6.1: Design and Develop Implementers Guide |
|||||||||||||
|
Activity 6.1.1: Draft documentation |
TIP/E-Heza |
X |
X |
||||||||||
|
Activity 6.1.2: Documentation acceptance testing |
TIP/E-Heza |
X |
X |
||||||||||
|
Activity 6.1.3: Incorporate feedback and publish |
TIP/E-Heza |
X |
X |
||||||||||
|
Objective 6.2: Design and Develop Clinical Guide |
|||||||||||||
|
Activity 6.2.1: Draft documentation |
TIP/E-Heza |
X |
X |
||||||||||
|
Activity 6.2.2: Documentation acceptance testing |
TIP/E-Heza |
X |
X |
||||||||||
|
Activity 6.2.3: Incorporate feedback and publish |
TIP/E-Heza |
X |
X |
||||||||||
|
Objective 6.3: Design and Develop API Manual |
|||||||||||||
|
Activity 6.3.1: Draft documentation |
TIP/E-Heza & Gizra |
X |
X |
||||||||||
|
Activity 6.3.2: Documentation acceptance testing |
TIP/E-Heza & Gizra |
X |
X |
||||||||||
|
Activity 6.3.3: Incorporate feedback and publish |
TIP/E-Heza & Gizra |
X |
|||||||||||
Deliverables
|
Deliverable |
Month/Quarter Due |
|
Activity 1.1.1-1.1.4 Documentation of generic working personas, user stories, and workflows, as well as the process taken to establish these products, based upon |
M2/Q1 |
|
Activity 1.2.1 Report documenting feedback from the Rwanda working group that includes unique personas identified for the Rwandan context. |
M3/Q1 |
|
Activity 1.3.1 Report documenting feedback from the Burundi working group that includes unique personas identified for the Burundi context |
M1/Q2 |
|
Activities 2.1.1-2.1.4 Report documenting revisions that includes all spreadsheets for DAK components 1,6, and 7. |
M3/Q1 |
|
Activity 2.2.1 Feedback report from Rwandan working group that outlines adaptations for Rwandan context |
M1/Q2 |
|
Activity 2.3.1 Feedback report from Burundi working group that outlines adaptations for Burundi context |
M1/Q2 |
|
Objective 3.1-3.2 and Associated Activities Report on data dictionary inventory analysis and work plan to cover gaps and new schema for E-Heza |
M1/Q2 |
|
Activity 4.1.7 Publish code for backend platform and API handlers for new schema |
M1/Q3 |
|
Activity 4.2.7 Publish code for front end according to updated workflows |
M1/Q3 |
|
Activity 5.1.3 Execution of contribution plan for Instant OpenHIE initiative including report that outlines contribution commitments and work plan |
M2/Q3 |
|
Activity 5.3.4 Document implementation plan for interoperability production cases of partnership workflows with HMIS in Rwanda and EMR in Burundi. |
M3/Q4 |
|
Activity 5.2.4 Publish the code that enables Instant OpenHIE compliance including Dockerfile |
M3/Q3 |
|
Activity 6.1.3 Publish Implementers Guide for WHO DAK compliant E-Heza software for ANC |
M2/Q4 |
|
Activity 6.2.3 Publish Clinical Guide for WHO DAK compliant E-Heza software for ANC |
M2/Q4 |
|
Activity 6.3.3 Publish API manual |
M2/Q4 |
Global Good Maturity Model Assessment
TIP Global Health’s E-Heza Data Solution shows a high level of maturity across the Global Goods Maturity Model. You can find the link to the assessment here.
Digital Health Atlas
https://www.digitalhealthatlas.org/en/-/projects/926/published
E-Heza Documentation
https://tip-global-health.github.io/eheza-documentation/
Comments
Alignment with Instant OpenHIE
Thank you for the concept note. For the full technical application, in addition to general recommendations per the email, please also include a strong narrative on how you plan for alignment with Instant OpenHIE.
Comments
Thank you for your note, Caitlin. We will be sure to address both the general recommendations and our plans for alignment with Instan OpenHIE. Thank you for the opportunity.
Thank you for a great
Thank you for a great application. Please elaborate on:
Thank you very much for your
Thank you very much for your questions. You will find our answers below. Please feel free to reach out should you have additional questions or need more clarity.
How will the applications expected to align and strengthen the shelf-readiness.
E-Heza has been focused on shelf-readiness for the past two years and as such exhibits strong traits across the global goods maturity model in Global Utility, Community Support, and Software Maturity. In particular, E-Heza has assembled strong documentation for users, developers, and implementers and maintains an open source code base with clear paths to community participation and contribution. In addition, E-Heza has been maintained with containerized deployment that makes starting development or deploying to a server a push-button operation.
This grant will help us continue our work in this area by supporting our work toward Instant OpenHIE alignment ensuring that E-Heza can be deployed within an OpenHIE ecosystem without any barriers and will support interoperability between systems based on FHIR standards.
How will the application expected to incorporate key data standards and align to workflows.
E-Heza will incorporate key data standards and align to workflows by conducting a comprehensive comparative analysis of the WHO DAK and E-Heza's existing data definitions and workflows. E-Heza already collects most of the data defined in the WHO DAK, although our data definitions may vary. Our team will review all workflows and data definitions in the WHO to ensure alignment, and adjust E-Heza to ensure consistency with these standards. In situations in which data is missing or workflows differ, our team will adjust E-Heza to include all relevant data points with appropriate definitions and to support all workflows.
How will you ensure that the applications can fulfil the data exchange needs of the DAKs.
Data exchange needs of the DAKs will be fulfilled by ensuring alignment of our data definitions and workflows to the definitions and workflows outlined in the DAK.
How will you ensure alignment with OpenHIE approach and interact with other solutions.
The Instant OpenHIE initiative represents a significant opportunity for E-Heza in that it helps software solutions to abstract OpenHIE alignment and provides a roadmap to interoperability. TIP Global Health – as a work product of this grant – can more deeply operationalize our commitment to alignment and collaboration with the Instant OpenHIE initiative so that its interaction efforts with other software in the health care delivery ecosystem have global utility rather than specific integrations.