Both OpenMRS and Mobile WACh are critical components in providing care to patients, and collect data at different points in the healthcare system that should be shared with each other through a Shared Health Record (SHR) to improve decision making and patient outcomes. This project aims to 1) build FHIR support and OpenHIM mediators to send and receive data from both OpenMRS and Mobile WACh with the SHR, 2) test the resulting code in the Instant OpenHIE project, and 3) disseminate code and OpenHIE implementation guides for the broader global goods community.
Patient centered care (PCC) is defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions”, and was identified by the Institute of Medicine as a critical gap in achieving high quality healthcare and improving patient outcomes. Evidence shows that a shift to PCC in the US significantly improved patient outcomes and reduced costs, but global health has yet to make this shift, partly due to information silos. Digital health tools can serve to support PCC, but just having tools that involve patients does not equal PCC. Those tools must also be properly integrated across the ecosystem, making information about patients’ evolving needs, preferences and contexts accessible and usable across the longitudinal record to inform shared decision making by providers and patients.
This proposal identifies a specific use case to improve shelf-readiness of digital health tooling that can better support the shift towards PCC in LMIC. Our use case builds upon a provider-centered EMR, a patient-centered technology (PCT), and the longitudinal shared health record (SHR) that integrates the data and informs the patients’ needs, preferences, and contexts. Our provider-centered EMR, OpenMRS, is a high quality, open source platform used in over 5,500 health facilities in 64 countries, and is a founding block to the data needs across a health program. We will improve the OpenMRS interoperability capabilities by expanding the FHIR module to interact with a Shared Health Record using the OpenHIE architecture.
Our patient-centered technology, Mobile WACh, is a recognized digital health global good supporting patient centered care through bidirectional mobile messaging between clinic health care workers (HCW) and patient consumers. It is used for managing urgent, episodic, and chronic health conditions (e.g. MCH, mental health, HIV). Mobile WACh provides patients real-time personalized education, support, advice and referrals. Although Mobile WACh has successfully supported care within a siloed program, in order to be shelf-ready for maximally effective care and treatment in broader implementations, and to provide tailored support and guidance for patient decision-making about their health, Mobile WACh will need longitudinal data for a patient. In return, Mobile WACh collects critical patient-reported data, such as significant events, symptoms and concerns, that should be shared back to other care providers and the health record. We will improve the shelf-readiness of Mobile WACh by adding FHIR-support for interoperability with a Shared Health Record using the OpenHIE architecture.
The results contribute to a more complete longitudinal patient record that can be utilized within national implementations for improved continuity of care, and supports the shift towards PCC. Both products will also be able to be used by Instant OpenHIE for rapid deployment. The project includes leadership from University of Washington and Kenyatta National Hospital collaborating with OpenMRS, Mobile WACh, and OpenHIE communities; and leverages existing country-level projects in Haiti and Kenya to contribute to the requirements and ensure real-world applicability and implementability.
The Digital Initiatives Group at I-TECH (DIGI), University of Washington (UW) is composed of health informatics experts, digital health developers and implementers, data scientists, and digital health training specialists. DIGI faculty and staff lead multiple global goods communities of practice, have led national implementations of OpenMRS in multiple countries; and have extensive experience developing and implementing national eHealth architectures, including those leveraging the OpenHIE architecture and reference applications.
The Mobile WACh team is a multidisciplinary collaboration between researchers at UW and Kenyatta National Hospital (KNH) in Kenya. The team includes Ob-gyns and pediatricians at UW and KNH, nurses at KNH, and epidemiologists and digital health researchers at UW. Since 2012, the team has developed and implemented 7 projects using Mobile WACh to support maternal-child, HIV and reproductive health in Kenya, including 5 randomized controlled trials.
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