Our goal is to make our FHIR native mobile and web application plug-and-play, through application and content configurations described through compatible FHIR implementation guides (IGs), based on the WHO SMART Guidelines. We will achieve these goals by building on our ongoing work in partnership with the WHO and Google to develop reference apps (based on existing WHO guidelines, the SMART Guidelines, and the Android FHIR SDK) that execute FHIR native content on smartphones.
This Digital Square investment will go towards extending the FHIR Core mobile application, the FHIR Web web application, and a library of HAPI FHIR extensions to support essential use-cases for digital health deployments. This investment will advance the shelf-readiness of the FHIR Core global good by adding app definition and loading through 1) FHIR IGs, 2) simple and complex scheduling and examples through FHIR PlanDefinition resources, 3) FHIR data management on the web, and 4) FHIR data access controls based on role. Each of these four work packages will include documentation, co-design and cross-collaboration with the Android FHIR and SMART Guidelines community, as well as narrative use case demonstration videos.
The goal of the project is to close the gap between the critical features for production digital health apps and existing FHIR native apps, using the OpenSRP FHIR Core, FHIR Web and HAPI extensions as the reference. We will achieve this goal by extending our existing proof of concept FHIR native applications and deploying them to the field with local health implementing partners. In our development process we will collaborate with the SMART Guidelines and FHIR communities to follow existing best practices and add new standards when encountering use-cases that are not already addressed by the FHIR standard.
As co-architects of the WHO SMART Guidelines approach, the Android FHIR SDK, and the technical lead for OpenSRP, Ona has an established track record in moving standards from the round table to the field, in a manner that empowers local technical teams and the health implementers they partner with. Our expertise in open source community building, health systems technical architecture from last mile to facility, and code quality, documentation, and open systems infrastructure management are the critical factors in making this work a success. Furthermore, the work packages we have designed are accretive with our existing and ongoing project and partner priorities and in direct alignment with the established work plans for the OpenSRP community of partner organizations.
Consortium lead: Ona
Ona is a technical social enterprise focused on global health and data solutions, based in Nairobi, Kenya. Ona has over 70 employees and extensive experience designing, developing and implementing health information systems that are used at national scale and integrate with existing government health information systems and open standards. Ona has developed numerous open source standard tools and libraries in the space that are used by mobile teams to add functionality to their existing technologies. Ona serves as the technical lead for OpenSRP, having co-created the platform with the World Health Organization.
For these proposed three work-packages, we will collaborate with the existing Android FHIR SDK and SMART Guidelines communities. If we have a need for additional support we will reach out to partners in those networks as well as in the OpenSRP community. We have also created 2 additional optional work packages that we feel could add value to the overall effort, if and when more funding from PATH or other external partners become available.
Ona has developed close working relationships with an expanding network of local technical partners. This includes BlueCode in Zambia, 1000Hills Solutions LTD in Rwanda, mPower Social in Bangladesh, VentureDrive in Pakistan and Softmed and D-Tree International in Tanzania who have all successfully developed and support the roll out of OpenSRP implementations in their respective countries. While all will not be directly involved in this initial effort, they are all committed to working with us to adopt FHIR Core on projects moving forward.
Profile of relevant experience and examples of related work.
We will work to ensure this work aligns with our existing, ongoing efforts to build a FHIR native digital health platform that incorporates Google’s FHIR Android SDK which we are actively supporting the development of. In Q3 2021 we worked with WHO to develop a Covid-19 Vaccine Certification app for WHO. We are now busy porting over our OpenSRP CHW app to the new FHIR approach. We hope to achieve the initial adaptation by June 2022, where we plan to use it to support the Ministry of Health in Liberia in their rollout of their national community based information system (CBIS) which will be focused primarily on child and maternal health. Later in the year, we also hope to adapt the WHO ANC reference app for CHWs in Rwanda.
For this project, we hope to build off this existing work on what we are calling the FHIR Core which is intended to ultimately replace our work with the OpenSRP platform. This can be found at: https://github.com/openSRP/fhircore/
At this point, Ona has a core, sizable team dedicated to this work. We are also working with external teams from VentureDive Pakistan, 1000Hills Solutions Rwanda, BlueCode Zambia and Google to do this work.
Qualifications of key members of the proposed project team
Ona has outlined in the table below an indicative list of staff that are likely to work on this project. Please note that in terms of roles such as software architects, engineers, SRE engineers, QA engineers, PMs, TPMs etc, that we have bigger teams than what is listed out here and it may be that these individuals are engaged on other projects, but we endeavour to support this work to the best of our abilities, in partnership with Digital Square.
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Matt Berg |
CEO and Co-Founder |
Matt is the CEO of Ona. Matt was born in Cameroon, grew up in Senegal and has lived and worked in Africa for over 15 years. Prior to founding Ona, Matt served as an ICT Director at the Earth Institute at Columbia University and was the country director for the Geekcorps’ Mali program, where his work focused on promoting ICT and information access in rural Mali. Matt is a PopTech! Social Innovation Fellow and was named to the 2010 Time 100 List for his work in Africa. Matt also served as an adjunct Professor at the School of International and Public Affairs (SIPA) at Columbia University. He is based in Burlington, Vermont. |
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Peter Lubell- Doughtie |
CTO and Co-Founder |
Peter is the CTO of Ona. He focuses on building systems that turn raw data into information that can improve and save lives. He has worked with UNEP to train Haitian data scientists, with Prayasam in Kolkata to conduct mobile surveys, and with the Earth Institute in Nairobi to build data management systems. Peter has presented work on data science and engineering at both international development and machine learning conferences. Before founding Ona, he led the data engineering team at Intent Media, served as the CTO at search start-up Helioid, was a machine learning researcher in the CITP at Princeton University, and led the development of data systems at Modi Research Group at Columbia University. He is based in Connecticut, USA |
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Dickson Ukang’a |
Director of Engineering and Co-Founder |
Dickson is based in Nairobi and is the Director of Engineering at Ona. Previously he worked at the Modi Research Group where he led the development of Formhub. Before this he was a core engineer of the ChildCount+ system, which uses SMS messages to facilitate and coordinate the activities of community-based health care providers. He was also involved in the development of the online Safaricom IPO platform. He is based in Nairobi. |
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Roger Wong |
Director of Design and Co-Founder |
Roger leads product design, research and creative strategy at Ona. He has worked on health and social impact projects in Nigeria, India, and the US. Prior to Ona, Roger co-founded an app company and was a designer for the Modi Research Group at Columbia University, frog design, Pentagram, and Razorfish. Roger is a proponent of human-centered design, rapid iteration, and agile product development environments. He is based in Washington DC. |
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Martin Ndegwa |
Engineering Team Lead: OpenSRP |
Martin is a software developer specializing in Android and Java. He has over 7 years of experience implementing software systems in java backends and their integration into web and Android applications. He holds a Bsc in Computer Science from the University of Nairobi. He is based in Nairobi. |
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Francis Otieno |
Technical Project Manager and FHIR Lead: OpenSRP |
Francis is a Technical Project Manager at Ona and is - together with our CEO and CTO - spearheading the FHIR strategy in Ona. He is passionately involved with cutting edge technology and contributing to rigorous research and innovation in the ICT space. With a wealth of experience consulting, developing, and leading teams, he is a subject matter authority in understanding customer needs & challenges across parts of Africa and Europe. He has a solid empirical, theoretical, analytical, and technical background that aids in gaining valuable insights through market research and data analytics to support decision making and coming up with innovative solutions. He is based in Nairobi. |
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Ephraim Kigamba |
Senior Software Back-end Engineer: OpenSRP |
Ephraim is a Software Engineer at Ona with a Bsc. in Computer Science from Kenyatta University. He has been a technical lead on 3 projects. He has provided technical leadership for a team developing countrywide release of a medical app containing 4 electronic registers. He has also worked across 2 teams on 8 projects as a Software Engineer and has collaborated with external teams on open source projects. He has contributed to the ODK community & a mapping tool for health service tracking during external collaboration(DSME Community). He was also a professional speaker at droidConKe which is an android engineers conference. He is based in Nairobi. |
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Benjamin Mwalimu |
TPM |
Mwalimu is a Technical Project Manager responsible for coming up with technical implementation solutions from business requirements and directing engineering teams on how to implement these solutions. He has over five (5) years experience in software engineering. His skills and expertise include Java (Spring Boot, Hibernate, Struts among others), Android, Kotlin, Node JS, angular JS, SQL (MySQL & PSQL), NoSQL (MongoDB). Technical Project management leveraging Agile Software development methodology. Prior to joining ona Mwalimu worked at BandaHealth where he was responsible for adapting the health EMR OpenMRS to suit the Kenyan hospitals, He was involved in adapting the DHIS2 mobile app to suit the MOH (Kenya) requirements. |
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Richard Kareko |
Senior Software Front-end Engineer: OpenSRP |
Richard is a software engineer with over 8 years experience. His technical expertise spans both mobile application development as well as backend API design and development, leveraging these skills to build robust, secure and scalable systems. He holds a bachelor's degree in Computer Science. He is based in Nairobi. |
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Emmanuel Tarus |
Senior Software Engineer: SRE |
Emmanuel has over 8 years of experience in Java web and android mobile applications. His skills and expertise are around Java, android, Spring MVC, Databases PostgreSQL MySQL, Internet Technologies angularJS, HTML5, CSS, JavaScript, XML, jQuery, SOAP and, REST. Manu is the SRE lead for all OpenSRP-based deployments. He is based in Nairobi. |
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Josphat Muindi |
Senior Software Engineer: QA / SEIT |
Josphat is Senior Software Engineer in Test (SEIT) at Ona - specifically working in the Digital health team. He has over 7 years experience in manual, automated and other non-functional forms of testing. Josphat holds a Bsc in Software Engineering from Kenyatta University and worked for Cellulant Group and I&M bank prior to joining Ona. He is based in Nairobi. |
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Joyce Chen |
Director of Delivery |
Joyce is the Director of Delivery at Ona. She joined Ona in April 2021 with over 12 years of global development experience, working on initiatives in sub-Saharan Africa, South Asia, Central America, and Eastern Europe. Previously, she led the delivery team at Simprints, a nonprofit technology company, and was an associate director at the Earth Institute, Columbia University. Joyce holds a dual master's degree in international affairs and social work. She is based in Iceland. |
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Marcha Bekker |
Strategic Partnerships Lead |
Marcha joined Ona in July 2019 as Strategic Partnerships and Operations Lead. Prior to this, Marcha spent 11 years at South African ICT4D organisation, Praekelt.org, where she was the first official employee and through the years held roles as a project manager, operations manager and for the last 5 years - head of business development. Marcha has spent her whole working career spanning nearly 2 decades, working in development - mainly across Africa - and is a passionate advocate for how mobile and digital platforms can improve people’s lives. She holds a Masters Degree in HIV/AIDS management and Honors in International Relations from Stellenbosch University in South Africa. Marcha is based in Johannesburg, South Africa. |
The Project
Project Background or Problem Statement
In our work building digital apps for frontline health workers for nearly a decade, we have experienced first hand how difficult, time consuming, and frustrating it is to have to reinvent the wheel when adapting existing digital health apps. Adaptation could include adding new health verticals, or adding nuances of the use-case in a specific geography, or adding healthcare worker roles in a specific healthcare setting. We are firm believers that the community is better served by building atop the knowledge accumulated through decades of digital health learning.
Through HL7 FHIR, the global community of healthcare and health information technologists laid the foundations to structure and replicate health workflows. In collaboration with WHO and other partners we began to define healthcare use cases in FHIR and load these OpenSRP. However, the underlying storage in OpenSRP’s existing mobile application and (to our knowledge) in all digital health mobile app global goods, does not store operate directly on FHIR resources, i.e. it is not “FHIR native”, leading to a ad-hoc non-standard transformations to and from FHIR standard data and workflows. In 2019 we partnered with WHO and Google to address this by:
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defining WHO global health standards in FHIR,
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creating an Android library to operate directly on FHIR, and
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creating a reference implementation to load and run FHIR based health protocols.
Since then there is now a health guidelines authoring and implementer community built around the WHO SMART Guidelines with multiple weekly calls led by the WHO, and a developer community around the Android FHIR SDK library and FHIR Core reference application with multiple weekly calls and contributing partners from organizations around the globe. We at Ona have a dedicated team of around 10 engineers, architects, project managers contributing to creating the first (as far as we are aware) FHIR native Android app for frontline health workers.
The software is currently in the deployment and testing phase with a commitment to be in production use at a national scale in at least one country in the middle of 2021, and in regional use in several others. In the shelf readiness framework and global good maturity model, the FHIR Core smartphone, web app, and HAPI extensions have been introduced and embraced by the OpenSRP community. OpenSRP is at the high level of maturity on two thirds of the criteria and normal on the remaining third.
The gaps in shelf readiness relate to bundling definitions of app content and configuration, web interfaces to control this content and view collected data, and having a FHIR-based framework for limiting access to data. By addressing these gaps we will address the problem of having to either use non-standards based information in digital health applications, or create a new application for different digital health projects. These features will give the community a single application that is configured through FHIR resources persisted on a FHIR API compatible server and managed through a server and app agnostic FHIR web interface.The larger context in which the project will take place
Where is the work taking place?
The team working towards shelf readiness will be conducted by our global team including contributors based in Kenya, Indonesia, Liberia, South Africa, USA, Iceland, and the Netherlands.
The work will be integrated with on-going projects, the beneficiaries include projects located in Liberia, Tanzania, Tunisia, Indonesia, Bangladesh, and Zambia.
What is the current phase/stage of the project?
This work is to extend and expand an existing project in order to accelerate its use in ongoing projects and its adoption within the existing OpenSRP community.
The current OpenSRP FHIR Core project is in pre-production with production usage planned to begin in February 2022. It is under active development with contributions from multiple teams, including active contributions from DTree, Google, and Ona. Multiple OpenSRP partners have planned production deployments based on FHIR Core in 2022, starting in Q1.
Is this an ongoing or discrete project?
This is an ongoing project that we, our technical partners, our implementation partners, and the OpenSRP community are heavily invested in and fully committed to. We are using this project for all future OpenSRP deployments at Ona and transitioning technical members of the OpenSRP community to do the same.
Digital Health Technologies, Standards and Health Tools that the project will be utilizing
Our proposed solution is 100% based on the HL7 FHIR (Fast Health Interoperability Resources) https://www.hl7.org/fhir/ standard. The core data set which we use is based on HL7 FHIR International Patient Summary (IPS). The underlying technologies used to power the reference application of this application are based on native FHIR technologies (OpenSRP FHIR Core and Google’s Android FHIR SDK).
How Previous Investments by Digital Square will be leveraged
This work builds on 4 previous Digital Square investments to Ona, namely the
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Digital Square OpenSPR Global Goods Grant to the value of $ 154,880 that ran between March 2019 and March 2021. Through this grant we were able to rebuild OpenSRP Web to OpenSRP FHIR Core, and we were able to make various improvement to OpenSRP like increasing the test coverage from less than 20% to over 80% relaunching a more inclusive and representative OpenSRP Governance Body and relaunch a new OpenSRP Website. This grant also afforded us the opportunity to formalise working relationships with partners like VentureDive, BlueCode, mPower Social and SID.
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Digital Square Notice D - mADX on FHIR on Android Grant to the value of $ 77,000 that ran from March 2021 to February 2022. How this grant is contributing to this project is that it allowed us to be able to define measures that are used to generate measure reports to track varios ANC indicators and which will be re-used and built upon, for this project and other projects for clinical reporting, monitoring and evaluation as required
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Digital Square Notice E0 - Shelf Readiness Grant - that ran from May 18,2021 to December 31,2021 and had a value of $31,137.50. This grant enabled us to add robust testing, expanded interoperability support, and increased security and privacy features to enhance the shelf-readiness of OpenSRP. The outputs of this work means we can more easily deploy OpenSRP and offer better support in our current and future deployments, with the goals of broader adoption and interoperability aligned with the OpenHIE architecture
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Malaria G6PD RDT project - this grant was to the value of $ 45,000 that ran from February 19,2021 to March 31,2022 and was around the interpretation of G6PD rapid diagnostic test results, to determine the severity of the malaria infection in an individual. This work enhances our RDT applications , via the various RnD that we have been able to do and innovate around Optical Character Recognition for Image to Text recognition and evaluation of threshold results for clinical decision support for diagnosis and treatment.
Concept Note Feedback from the Community
During the Concept Note stage, Ona has received the following questions from the community:
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Ensure potential dependencies on outside groups are clearly identified with mitigation plans, where needed, as well as dependencies across work items/sequencing of work. Ona’s response: There are a number of external risks associated with the development of the Android FHIR SDK that will affect our ability to deliver this project. For we are dependent on the FHIR SDK to support both CQL and the $apply function before we can integrate it into FHIR core and convert to a working app. Since submitting the initial application the $apply function has been added to the SDK reducing some of the risk for the project. There is still a lot of work required to implement code around the $apply feature and ensure that it works as intended. Ona has been working closely with Google and WHO technical partners to ensure these will be in place hopefully over the next two months. There are also a number of implementation decisions in FHIR like the best way to define activities in a PlanDefinition that still need to be researched and decided upon in our FHIR implementation community.
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Ensure activities to identify user needs, acceptance criteria, to design with users, etc. are clearly identified in deliverables/the schedule. (For work that's already been done, this can be noted as inputs to the work.) Ona’s response: For past / ongoing work in ANC Reference app adaptation in countries like Malawi, Rwanda, Zambia, Ona works through local implementing partners who are based in-country to provide us with first hand user feedback, and that feedback then gets incorporated into the development and iteration of the platform. In countries like Liberia, we have now placed 3 staff members permanently in-country to help build a national community health system, and we are testing out this approach in terms of being more hands-on, in-country and being able to seek more user feedback and hear that user feedback first-hand (and not via an external implementation partner). We believe that this approach may prove to be valuable in terms of increasing our understanding of how users are using and experiencing the technology platforms and tools.
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Ensure it's also clear how this work is expanding local capacity and adding new teams, beyond what would already likely be happening. Ona’s Response: For the past one+ year Ona has been working with a growing group of local teams, from Pakistan (VentureDive), Rwanda (1000Hills Solutions), Tanzania (Dtree International and Softmed), Zambia (BlueCode), South Africa (DeCode), to work on various components of the transition to OpenSRP FHIRCore. We remain committed to build the capacity of local teams as we collaborate with them on this journey towards rebuilding OpenSRP to OpenSRP FHIR Core.
Use Cases and User Stories
Project Manager Use Case
As a Project Manager I would like to build and modify the health workflows and health content, including how data is collected, displayed, scheduled, and processed. I would like to do this using common health standards to benefit from the community of experts that created those standards and existing digital health systems that interpret those standards. I would like to be able to enter, view, and control access to these health workflow definitions and data gathered against them off-line on a mobile phone and on-line through a web browser.
In my story, I begin with an existing app definition for a HCW implementation for one or many health verticals, for example a child vaccination app definition. I review the FHIR resources defining this app and adjust them for my specific implementation, I change the name to the country and region for the implementation, I update the location hierarchy and practitioners, I modify the specific vaccines and the schedules for them based on national and local health regulations. I then upload the app definition configured for my health implementation to a FHIR server.
I use the FHIR Core app to log in and enter the app ID for my health app, it retrieves the related app definition files I have uploaded and adjusts the user experience and health workflows as they specify. I review the workflows, make additional adjustments to the app definition files on the server until I am satisfied. I then work with my supervisors to configure phones with the app for HCWs, if needed based on their technical knowhow.
Health Care Worker (HCW) Supervisor Use Case
As an HCW Supervisor I would like to be able to use a single mobile app to manage the health projects I am involved in, including viewing my supervisees and any clinical information it is appropriate for me to have access to. I would like to be able to configure a single mobile app on phones used by my supervisees so that it loads the health workflows appropriate for their assigned project.
In my story, I begin by configuring phones for use by supervisees by loading the latest version of the app onto their phones and entering the app ID for the health care project we are working on. As my supervisees collect data, I use my phone to view my list of supervisees, the tasks they are assigned, and the status of those tasks.
HCW Use Case
As an HCW I would like to use a single mobile app to complete health workflows for the projects I am participating in. I would like to use this app to create and view the patients I am responsible for, view the care plans assigned to those patients, and the tasks assigned to me in service of those patients. I would like my access to be limited to only those patients that I am allowed to see. I would like the information I am collecting to be viewable by my supervisor and project managers so they can provide timely and helpful feedback.
In my story, I begin by logging into the mobile app configured by my supervisor on my assigned mobile device. I then begin my particularly health project in the facility or community by registering or loading patients, enrolling them in CarePlans, and completing forms related to them. I review and complete Tasks assigned to me in the application, I interpret and act on the guidance based on entered information, for example conducting assessments and providing vaccinations according to the schedule presented by the app.
Comments
Kindly find herewith our full
Kindly find herewith our full technical application for Notice F2 - OpenSRP FHIR Shelf Readiness
Thanks
Ona Team
Kindly find herewith our full
Kindly find herewith our full application for Notice F2
Thanks
The Ona team