Notice E1 Client Registries

Notice E for promoting investments in digital health global goods

SantéMPI Client Registry

Two-sentence overview: 

This project seeks to improve several key areas of SantéMPI, a robust and proven online/offline capable Client Registry (CR) solution with a rich global history, to strengthen the ability of Low and Middle Income Countries (LMIC) to adopt, sustain, evolve and scale this technology as a global good by: improving installation and configuration processes including localization, enhancing tooling for end-users to more easily customize deployments, upgrading standards support from FHIR R3 to R4, improving operational support through analytics and expanding community documentation.


Our organization and partners will contribute to achieving these goals by leveraging and applying decades of deep expertise and experience in open source digital health software including: software innovation, development, large-scale implementation, support and capacity building; development and use of open standards such as FHIR, IHE and OpenHIE; along with our in-depth experience developing and implementing the original MEDIC CR solution and evolving it into the next generation SantéMPI CR.
 

Executive summary: 

Siloed digital health solutions implementing multiple patient identifiers (IDs) create significant barriers in LMICs to operationalizing strategies for achieving universal health coverage (UHC) including enabling holistic person-centered care, reducing the burden of indicator reporting on frontline health workers, improving the accuracy and timeliness of data, and establishing integrated, national digital health ecosystems. SantéMPI supports migration from paper based to fully automated workflows providing a pathway to implementing and achieving UHC.


A proven, robust, fully featured Master Patient Index (MPI) and Client Registry (CR) like SantéMPI is a strategic digital health building block which can be used to overcome these obstacles to data quality, harmonization and sharing, by acting as a cornerstone technology when implementing national health identifiers. SantéMPI implements all existing interoperable specifications and requirements related to Client Registry in the OpenHIE specification and supports Client Registry as a service. By implementing both modern HL7 FHIR standards and the widely deployed existing legacy HL7v2 standards, SantéMPI provides a proven platform for integrating existing solutions and future solutions. For example, SantéMPI integrates with WorldVistA EHR, OpenMRS and OSCAR EMR. SantéMPI has been field tested with millions of successful transactions in multiple jurisdictions and can operate standalone or as a launching point into a health information exchange.


The overall goal of this project is to enhance SantéMPI to become a reusable digital global good. This will enable LMICs to rapidly adopt and sustain SantéMPI at scale and will be achieved by improving key areas of this next generation online/offline capable MPI/CR solution. SantéMPI is a commercially supported open source derivative of the MEDIC Client Registry (CR) which was developed in a Canadian federally supported applied research centre to enable the Canadian national digital health program. The core MEDIC CR product development began in 2007 and since then has been expanded and hardened through millions of dollars of investment from public, NGO and private sector initiatives. MEDIC CR is a standards compliant Patient Identity System used as the reference implementation in the Canadian standards testing lab and has passed IHE North America Connectathon testing. The SantéMPI team is the original development team behind MEDIC CR, leveraging over 10 years of investment and experience developing and implementing MEDIC CR, including several deployments at regional and national scale, including national deployments in South-east Asia and Africa. SantéSuite Inc. offers development, deployment and support services for this next generation of MEDIC CR. 


Funding from this award will go toward software infrastructure improvements, upgrading existing interoperability standards capabilities, upgrading tooling used for integration, administration and testing and engaging stakeholders and the OpenHIE Client Registry community to refine deliverables and specifications. Key activities will include improving installation and configuration processes, enhancing tooling for end-users to customize deployments, upgrading standards support more easily from FHIR R3 to R4, and expanding, enriching community technical and policy documentation and creating a live sandbox testing environment to rapidly demonstrate and test Client Registry functionality.


SantéSuite will achieve the goals of this project by applying its team’s extensive experience in designing, developing and implementing MPI/CR and EMR solutions at national scale in LMICs; operationalizing interoperability standards; building local capacity through hands-on teaching, teaming and tooling; and co-creating digital health strategy, policy and operating procedures.
 

Consortium Team: 

The responding consortium is comprised of SantéSuite Inc. (SSI), a Canadian federally incorporated social benefits corporation and Hamilton Health Sciences/McMaster University Medical Centre, the second largest academic research hospital in Canada, a pioneer in evidence-based medicine and a globally recognized health innovator. 


SantéSuite Inc. – Prime Organization

The main proponent of this proposal is SantéSuite Inc (SSI), one of the world’s most experienced teams in global digital health research, development and implementation. SSI is a social benefits corporation (B Corp status pending) made up of passionate, broadly experienced people committed to improving the health of the world using digital technology. The directors of SSI are the original proven team that developed the MEDIC CR platform and completed several implementations of national scale MPI technology. The following is a summary of SSI’s team and key personnel’s experience.


SantéSuite Inc. Team Experience
The SantéSuite team is one of the worlds most advanced teams in digital health standards, specifically relating to Client Registry/Master Patient Index, combining decades of research, development and real-world implementation experience around the globe. Members of SantéSuite assisted in the authoring of the underlying HL7 and IHE standards that are used as the basis for the OpenHIE Client Registry specification. Our team were early contributors to HL7 FHIR and even implemented and released the first iOS reference implementation of FHIR. Our team has made significant contributions to the IHE community as well, authoring enhancements to the IHE PIX and PDQ standards, including leading the authoring of the first version of the mobile version of those profiles (PIXm and PDQm). Members of our team have participated in IHE Connectathons for decades, including supporting the interoperability showcases at the HIMSS conference and the Canadian eHealth conference as interoperability leaders. Members of our team were involved in establishing the first FHIR Connectathons and hosted the national FHIR Connectathons for Canada (“FHIR North”).


The SantéSuite team was formed to bring together the collective experiences of several experienced digital health professionals. Combined, the founding members of SantéSuite bring over 50 years of digital health systems development and deployment experience. National deployments in Canada, Jordan, Tanzania, Southeast Asia have seen millions of patients cared for through leveraging solutions deployed by the SantéSuite team members. SantéMPI is currently in the first phase of national deployment to support Myanmar’s Ministry of Health and Sports (MOHS) national digital health roadmap, which complies with the OpenHIE architecture. The first wave of integration is focused on providing a cloud based and distributed MPI/CR service linking over 120 OpenMRS HIV/TB instances. This national MPI/CR initiative is funded by the Global fund through UNOPS and UNAIDS, with the participation of all key development partners that are active in building the digital health ecosystem. Additionally, the founding members of SantéSuite have demonstrated skill in the design, implementation and maintenance of proven digital global goods and open source solutions including: the Everest Framework, which has enabled dozens of other software projects to implement HL7 standards; the MEDIC CR, leveraged as the basis of CR in Ontario’s Innovation Lab and Tanzania; OpenIZ, assisting with the immunization of millions of patients in east Africa; SantéMPI, linking HIV and TB programmes in Southeast Asia.


The SantéSuite team is composed of several members of the original team that developed the MEDIC Client Registry as well as the OpenIZ national scale immunization solution. This project involved several complex requirements to be able to support better health outcomes for the citizens of the United Republic of Tanzania with the Ministry of Health in Tanzania, PATH, and the Bill & Melinda Gates Foundation. From a technical architecture standpoint, the system has been designed to perform at a national scale. The development of the Tanzania project started in May of 2016 and rollout began in mid-2017 to various regions. The solution now stores data for 1 million patients, 5 million vaccination records, and is in use within over 2000 clinics with more clinics being on-boarded each day. MEDIC CR provides the MPI functionality for this national scale solution.


Key members of the SantéSuite team have also participated as the lead developer of the provincial immunization solution for the Ministry of Health in Province of Ontario, Canada, a solution for tracking the immunization progress of nearly 14 million patients.


SantéSuite Inc. Key Personnel


Executive Leadership
Duane Bender
Duane is an award winning strategic digital technology executive with 24 years of global industry, academic and public sector experience and is considered to be one of Canada’s leading experts on digital health technology by Canada Health Infoway (Peer Leadership award 2016). Duane has been the director of over $100M in digital health transformation projects around the globe since 2010. Duane brings with him a deep research relationship with McMaster University where he completed a Masters Degree in Digital Health systems as well as an undergraduate degree in Software Engineering. Duane is a professional software engineer (P.Eng.) and digital systems architect with extensive practical knowledge of digital health, research, cloud & mobile systems and highly secure & private systems design. Under Duane’s leadership the MEDIC lab at Mohawk College was ranked in the top 3 applied research centres in the world in 2018 by the World Federation of Polytechnics.


Joseph Dal Molin
Joseph is an internationally recognized, award winning strategy and software development expert, and pioneering founder of open source communities for digital health. His accomplishments include, as trusted adviser to Jordan’s Royal Court, architecting Hakeem, Jordan’s groundbreaking and highly successful national digital health initiative. This included developing and implementing the technology architecture, capacity building plan, guiding pilot implementation, and helping launch EHS, Jordan’s stakeholder owned, non-profit national digital health organization. Jordan’s successful national patient centered digital ecosystem, provides a single comprehensive, nationally available electronic health record for all its citizens. Joseph has also developed and implemented national digital health strategies for Kirbati – primary care digital health roadmap; Tanzania – online/offline immunization management system; Myanmar – master patient index; NHS England’s open source strategy and governance model; US Centers for Medicaid and Medicare – open source EHR; USAID/Vietnam – methadone maintenance EHR. Joseph is co-recipient of Wired Magazine's 2007 Rave Award for Medicine, for innovation in digital health.


Technology Leadership
Justin Fyfe
Justin Fyfe is an acknowledged expert in health information interoperability and open source software development. Justin was an early contributor to the development of the HL7 FHIR standard and has authored or contributed to several IHE interoperability profiles. For over a decade before joining SSI Justin was the lead technical architect at the MEDIC lab where he designed the MEDIC CR along with several other open source digital health products and platforms. 


Product Management and Service Delivery
Madeline Barber Dal Molin
Madeline is a certified Project Management Professional and Scrum Master with more than 9 years of experience managing and delivering complex digital health projects. In addition, Madeline brings 6 years of product management expertise and experience taking early stage digital health products to market, including Methadone Maintenance Treatment EMR to support reduction of HIV/AIDS transmission and opioid addiction across Vietnam, a community centered virtual quality of life care coordination platform. Before joining SSI, Madeline was the lead Project Manager for the OSCAR Electronic Medical Record (EMR) team, at McMaster University’s Department of Family Medicine, where she led integration with Ontario’s Better Outcomes Registry Networks maternal, infant and child health EMR modules, along with several other open source digital health initiatives. Madeline plays an active role in both WorldVistA, a US not-for-profit, and OSCAR EMR community, in Canada, and is a member of the DH&I Gender Small Working Group.


Hamilton Health Sciences Corporation – Supporting Organization

Hamilton Health Sciences Corporation (HHSC) is the second largest academic research hospital in Canada. Based in Hamilton, Ontario, HHSC operates a network of hospitals, a cancer center, and an urgent care center, including the McMaster University Medical Centre, one of the global pioneers in evidence-based medicine. The company serves as a regional referral center for cardiac, stroke, burns, trauma, neurosurgery, pediatrics, digestive diseases, high-risk obstetrics, cancer, orthopedics, and rehabilitation services.

HHSC has long played a key role in innovating and transforming digital health solutions across South West Ontario, for example the HHS digital health office designed and operates Ontario’s online clinical viewer “ClinicalConnect™”, used to view health records from otherwise disparate sources across the province. In addition to hospital, oncology and Home & Community Care records, ClinicalConnect also aggregates data from five provincial repositories and launches from various primary care point of service systems, enabling teams to immediately share a tremendous amount of data amongst healthcare providers to optimize healthcare delivery, patient care, and safety. 


HHSC’s Centre for Data Science and Digital Health (CREATE) was founded to support research and innovation at Hamilton Health Sciences. Our multidisciplinary team is made up of specialists in health systems, data engineering, data science, software engineering and interoperability. Our mission is to partner with scientists and innovators to invent the future of health care.


Key personnel from HHSC’s CREATE team will support SSI’s team in the following work packages by:
•    Work package 1: Assisting with the enhancement of integration interfaces and participating in the IHE and HL7/FHIR Connectathons
•    Work package 3: Providing assistance to fine tune and strengthen SantéMPI’s matching capabilities
•    Work package 5: Providing assistance enhancing SantéMPI’s current administration tooling which to better support future deployments


Hamilton Health Sciences Corporation Team Overview & Key Personnel
Solutions Architect:
The role of both the Solutions Architects is to develop, deploy, and support the software solution, which will integrate with the data model. The Solutions Architect is expected to assume the accountabilities related to change management, software development, and software quality.


Nityan Khanna, Solutions Architect - Bachelor’s Degree, Software Engineering, McMaster University in progress; Advanced Diploma, Software Development and Network Engineering, Sheridan College


Mohammed Ibrahim, Solutions Architect - Bachelor’s Degree, Software Engineering, McMaster University in progress; Advanced Diploma, Software Development, Mohawk College

Data Scientist:
The key purpose of a Data Scientist is to design and implement advanced analytical approaches (such as machine learning/artificial intelligence) to healthcare data to support research, decision making and digital application development. The Data Scientist is to provide programming and analytical support during the design, analysis, and reporting phases. Additional responsibilities will include ad hoc data set and analysis generation in Python and R, and support of data management activities, which may involve database validation, data review, and quality control.

Shuang Di, Data Scientist - Master of Science in Statistics, University of Toronto

Walter Nelson, Junior Data Scientist - Bachelor of Science in Bioinformatics & Computational Biology (Specialty), Neuroscience (Major), University of Toronto
 

Digital Health Atlas: 

See attached PDF of screenshot of registration. The following is the link to the SanteMPI Digital Health Atlas registration:

https://digitalhealthatlas.org/p/00Jxbo4zdg

 

Geographic Reach: 

Myanmar in first phase of national deployment.

Tanzania - the first generation MPI component (MEDIC CR) SanteMPI is based on, is an integral part of nationally deployed TiMR EIR

WHO Classification: 
Identification registries and directories
Application Status: 
In Scope
Application Tags: 
openhie
packaging and deployment
FHIR
universal health coveage
client registry

Comments

Hi Joseph,

Thank you for submitting a concept note for Notice E1. Please note, concept notes should be 3 pages or less. Final concept notes are due May 22 at 5pm EDT.

Thanks,
Caitlin

Thanks, great concept note. Some thoughts: 

  • Will be good to highlight countries, in addition to Tanzania that are using the system.
  • What are the client matching algorithms/features that exist and what need to be developed? 
  • What are some of the risks?

  • Will be good to highlight countries, in addition to Tanzania that are using the system?

To clarify, Tanzania is using the same underlying CDR/DB as SanteMPI as part of the underlying TiMR EIR platform which is nationally deployed. In addition SanteMPI is currenly in the first phase of a national deployment initiative, in a country in South East Asia. Please see Concept Note for futher details.

  • What are the client matching algorithms/features that exist and what need to be developed? 

The current matching engine supports blocking records against the database then scoring each result against a configured series of attributes, classifying them as match, probable match and non match. This is then used by the MDM engine to link local records to a master record (which can further be adjudicated to a record of truth).
Individual attributes can be matched on: levenshtein difference, soundex, metaphone, double metaphone, alias/synonyms (i.e. Will = Bill), and date differences.

Partial scoring of each resulting match vector is also supported using distance.

  • What are some of the risks?

Please see the Concept Paper for a description of risks and their mitigation.