This work will be immediately applicable as part of the final phase of our eHealth reform project in Samoa (where we are delivering an eHealth reform project), but the work will be entirely scalable, with 4 other countries already using both Tamanu and Tupaia.
Tupaia is a free and open-source, multi-award-winning data aggregation, analysis and visualization platform used to map healthcare systems and disseminate information across low and middle-income countries. Tupaia is a mature software platform that is used (amongst many other functions) as the main BI reporting tool for our existing Global Good EMR Tamanu. This work will 1) improve the interoperability layer between these systems, to more tightly integrate Tupaia as a reporting and visualization layer and 2) improve shelf readiness, as well as empower local staff to ‘own’ their system more completely, beginning in Samoa where we are deeply involved in an eHealth reform project covering an entirely new eHealth ecosystem (including Tamanu, Tupaia and DHIS2). At least three other countries will then be able to rapidly adopt the changes and resources.
The work involves two packages of work:
1. A tighter integration of Tamanu summary reports into Tupaia, firstly by adapting our data model in both systems to conform with HL7 FHIR and then by adopting HL7 FHIR in our Tupaia API. These will improve interoperability across all data exchange (currently we only use FHIR to exchange patient data with external systems) and improving the flexibility of the system to exchange deidentified and non-sensitive data, whilst ensuring tight security around patient details and sensitive data. The Tupaia system in Samoa will also consume data from DHIS2 and mSupply.
2. Focus on improving our Global Good Maturity by providing (and improving where existing) complete:
a) product documentation for local staff end-users to be able to better adopt new platform automation tools (e.g. visualization builder and map overlay builder). These will include approachable, contextually-appropriate training guides.
b) developer and implementer documentation for use of the Tupaia API for developers/IT teams, to be published alongside our existing open-source repositories
The over-arching aim is for staff to more easily take point-of-care clinical data entered into Tamanu, route that data into Tupaia and produce standardized indicator reports. This should be achievable without input from our dev or project management teams.
The goal is to give country partners more autonomy in interacting with their data and providing contextually appropriate Business Intelligence. Until now, most visualizations and map overlays in Tupaia have required significant software development inputs and/or a deep knowledge of the Tupaia data structure. A recent investment (supported by DFAT) in Tupaia now allows users themselves to build reports and visualizations and to make these available with highly granular, password-controlled permissions settings.
We are uniquely placed to deliver this work – we have a medium-sized, vertically integrated staff of 40, including software development teams and a highly experienced delivery team of public health experts with deep experience in the Pacific. We have been working in the Pacific as BES since 2016 and our principals have each worked in the Pacific for 15 years. We have close and positive relationships with Ministries of Health in the Pacific and regional donors. We will deliver the work via in-country project managers and remote data stewards, ensuring that the software integrations work in context and that staff being trained are appropriate and receptive. In other potential countries, the situation is similar, with potential uses of this work in 4 other immediate countries.
Prime organization
Beyond Essential Systems is a medium-sized Australian company that creates and implements innovative software solutions for low-resource settings in the Asia-Pacific. They have managed large projects on behalf of partners including the Australian Government Department of Foreign Affairs and Trade (DFAT), New Zealand Ministry of Foreign Affairs and Trade (MFAT), Bill and Melinda Gates Foundation, World Food Program, Save The Children International, UNFPA, UNICEF and WHO. BES is an accredited B-Corp, with a full-time staff of 40, including specialists in public health, procurement, clinical services, project accounting, geospatial epidemiology and a full-time software development team of 22. Our team works across offices in Melbourne and Auckland, with project offices in Samoa, Tonga and Fiji. Our other platform, Tamanu, is already a Digital Square Global Good.
Our work in Samoa is strongly supported by the Samoa Ministry of Health, with funding from Australia’s DFAT and the World Bank. Other target countries for this work include Palau, Fiji and Nauru.
Team
Product owner (Tupaia): Erin Mitchell
Product owner (Tamanu): Megan Lane
Solution Architect: Kurt Johnson
Head of Engineering: Edwin Monk-Fromont
Software lead (Tupaia): Rohan Port
Software lead (Tamanu): Tom McLean
All CVs are attached and the staff roles are briefly described in the budget narrative. We have numerous redundancies built into our project team, with a full-time staff of over 40 people, including a total software development team of 22. We have worked hard to ensure flexibility across our 4 distinct software teams so that any of them could pivot to work on the build for this proposal at short notice. We also have multiple, highly experienced project managers who understand the context and who could step up project leadership.
Our work is strongly supported across our partner countries, such as Samoa and Fiji. We are not currently looking for collaborating organisations to partner on this proposal but we are highly open to other implementing partners in new geographies and to this end have worked successfully with governments, NGOs and the private sector on implementations.
Background
Tamanu EMR is a Digital Square Global Good designed as a birth-to-death health record for patients in the most remote settings in the world. It allows health workers to track individual patients, providing clinical support and enabling consistent, long-term management of patient conditions. Tamanu is ONC certified and is an existing approved Digital Square Global Good. Whilst Tamanu has a reporting module that can export raw and summary data to Excel, it provides a great deal of its reporting through a partner software, Tupaia.
Tupaia is a highly powerful data platform, integrating with systems including Tamanu, mSupply and DHIS2 and providing high quality, mapping-led visualizations with multiple data hierarchies and granular permissions-based access. Tupaia meets the criteria of a Global Good; it an existing software currently deployed in 12 low resource contexts, it is open-source and freely accessible, it is available under an open license and used to improve or analyze health data management processes.
Previously, building visualizations and map overlays in Tupaia was time consuming and required software development input, resulting in bottlenecks when building reports for country requests. The system also robbed countries of autonomy for, whilst they could access and edit their own data in Tupaia, it was nearly impossible for them to build new visualizations.
We have recently invested heavily in Tupaia’s new visualization builder, which allows data stewards to easily build dashboards and map overlays and make them available through the same highly granular permissions model the platform has always had. We have also recently built an API between Tamanu and Tupaia, which allows deidentified data to be routed to Tupaia in real time.
These developments provide the platform for us to massively improve reporting health data from Tamanu. Firstly, we want to tighten the integration by having it conform with the HL7 FHIR data standard. At present, we have another API for exchanging patient details which conforms with HL7, but this project will make it easier for others to build out data exchanges and make it easier for us to exchange the same data from Tamanu to systems such as DHIS2.
Secondly, we want to provide on-the-ground training to partners in Samoa on using the new visualization builders in Tupaia. This will provide us with valuable lessons and the feedback loop will improve the system. Equally importantly, it will provide a training model for us to expand to other countries. There are currently 11 other countries actively using Tupaia and 4 of these are using Tamanu in some way or another.
Objectives
The goal of this project is to give country partners more autonomy in interacting with their data and providing contextually appropriate Business Intelligence. Hitherto, most visualizations and map overlays have required significant software development inputs and/or a deep knowledge of the Tupaia data structure. A recent investment (supported by DFAT) in Tupaia now allows users themselves to build reports and visualizations and to make these available with highly granular, password-controlled permissions settings.
Our first partner country for this work is Samoa, where we are deeply involved in an eHealth reform project covering an entirely new eHealth ecosystem (including Tamanu, Tupaia and DHIS2). This work will more tightly integrate Tupaia as a reporting and visualization layer and empower local staff to ‘own’ their system more completely at the end of the project in 2024.
Objectives:
- Adapt the Tamanu – Tupaia API to conform with HL7 FHIR
- Build adaptable training materials for the new visualization builder in Tupaia (including online tools)
- Deliver on-the-ground training to data stewards and key staff in Samoa, as a model for delivering similar training to other countries.
- Our Monitoring and Evaluation will be centred around specific testing of staff to gauge their familiarity with the system, as well as the number of new visualizations they are able to create.
Deliverables
- Updated data model across Tamanu and Tupaia
- Published API (conforming with HL7 FHIR)
- Training materials made freely available online (including manuals, training videos and webinar)
- Improved developer and implementer documentation for deployment of Tupaia
Schedule
February – December 2022
Risk mitigation
The training will provide a feedback loop for us to improve the new tools if they are not fit-for-purpose. We aim to ‘fail quickly’ and iterate if staff find the early versions of the tool difficult to work with.
This funding support would augment existing funding streams from World Bank and DFAT, so we would be using to provide this supplemental activity rather than as core funding.
The work is adaptable to at least 4 other countries almost immediately so we should be able to demonstrate quick scalability.
Comments
Digital Square comments
Thank you for the application. For the full technical application, in addition to general recommendations per the email, please:
-Ensure text clearly maps back to "shelf-readiness" aspects of the work, modeled around the shelf-readiness framework.
-Is the FHIR-related work specifically about mapping data elements to FHIR as a data model or are there other processes happening? Expand on how FHIR (and other technical standards will be incorporated). For the former (data-related only), speak to others in the OpenHIE community on what tooling may exist for this/is being developed.
-Are there additional opportunities for increasing technical ownership and development by local teams that can be included?
Many thanks - one final note,
Many thanks - one final note, we feel we could have prepared something more comprehensive and that there are certainly gaps in our technical documentation but the last few weeks have been very challenging in Australia with COVID cases spiking extremely quickly. Our team are responding to outbreaks in Fiji and Palau and additionally, the last two weeks especially have seen many staff out sick or required to quarantine - this is not an excuse or a request for an extension, just a small explainer. We would welcome the opportunity to clarify any issues further however if they are unclear.