Notice C

Promoting the collaborative development of proposals for investments in digital health global goods

Digital Square supports investments in digital health global goods, which are tools that are adaptable to different countries and contexts. Mature digital health global good software is software that is (usually) Free and Open Source (FOSS), is supported by a strong community, has a clear governance structure, is funded by multiple sources, has been deployed at significant scale, is used across multiple countries, has demonstrated effectiveness, is designed to be interoperable, and is an emergent standard application.

We are using an open proposal process. Your concept notes and proposals will be publicly posted, giving you and other submitters the opportunity to find collaborators and provide and receive feedback from your peers.

Concept-Notes (48 total)

Displaying 21 - 25

Global Digital Health Index

Notice C Opportunity: 
Announcement C0: Global Good Software Development and Support

With the launch of the Sustainable Development Goals (SDGs) in 2016 and the rapid adoption of technology to strengthen health systems and achieve universal health coverage (UHC) by countries throughout the world, there is an opportunity to support countries to design and scale digital health solutions, develop supportive policies, increase opportunities for financing, and build local capacity to sustainably implement digital health.

TheGlobal Digital Health Index (GDHI) and maturity model is an interactive digital resource that enables countries to assess their maturity in digital health and benchmark themselves against other countries. Designed using the WHO/ITU eHealth Strategy Toolkit, GDHI empowers health ministries, funders, policymakers, and industry players with data to make informed strategic decisions and investments in the enablers of digital health such as governance, interoperability, privacy and security policies, workforce, and infrastructure as they strive to build sustainable digital health solutions at scale. GDHI launched with data from 10 countries, including Bangladesh, Benin, Jordan, Malaysia, Mali, Mongolia, New Zealand, Nigeria, the Philippines and Sri Lanka, alongside the World Health Organization Resolution on Digital Health in May 2018. The aim is to collect the data of up to 75 countries by the end of 2018.

GDHI has three objectives:

  • Empower: The Index is an interactive database that provides visibility into the status, maturity, and historical progression of key digital health performance indicators at a national and global level.

  • Evaluate: The Index benchmarks countries along a maturity model against standardized digital health indicators. It assesses the presence of national policies and strategies, investment risks, and coverage of key digital health platforms and provides a roadmap for maturing over time. It aligns with the World Health Organization Digital Health Resolution and can serve as a baseline to inform the development of a global digital health strategy and a tool to monitor progress against the objectives.

  • Motivate: The Index helps countries track progress and identify weaknesses within their digital health ecosystems. It incentivizes improvements in national digital health systems and more targeted global digital health investments that can benefit multiple countries. It facilitates learning and sharing of resources from and by countries that are further ahead in specific areas.

From the twelve countries currently represented in GDHI, trends are emerging in key areas of strength at a global level including the presence of national digital health strategies and governance, and needs including workforce, interoperability, cross-border data policies as well as support for nationally scaled services and applications. As more countries engage and we move from a single year of data to multiple years, the value of the tool and the insights it generates will increase. This request is to support the following activities: (1) onboarding and engaging additional countries in 2018 and 2019 and (2) the development of the Version 2.0, which will enable countries, regions, and global stakeholders to use the tool to track historical trends and progress by enabling the comparison of multiple years’ worth of digital health maturity.

Application Status: 
Approved - partially funded

Health facility registry mobile application using crowdsourced data, Open Street Maps and the OpenHIE Register

Notice C Opportunity: 
Announcement C0: Global Good Software Development and Support

Title: Health facility registry mobile application (Mobile Facility Mapper) using crowdsourced data, Open Street Maps and the Resource Map OpenHIE Register


1) Executive Summary: One of the primary barriers to health service access and data use in developing countries is lack of publicly available information about services and facilities or a Master Facility List (MFL), particularly in rural settings. Project Balance proposes to develop “Mobile Facility Mapper”, an intuitive, user friendly mobile application that collects crowdsourced facility location and services information by integrating with Open Street Map and Resource Map OpenHIE. Often GPS devices and GIS tools are technical in nature and difficult for non-technical individuals to implement. This application will provide a quick and easy method of capturing health facility information including GPS location, services provided, affiliation, and other meta data, both for public and official consumption. Should the user have suitable access to a national Resource Map OpenHIE registry, they can integrate and update to the national registry with relevant information about the facility.  National health ministries and their partners will be empowered with crowdsourced data made available by health professionals from all spheres including donors, partners and national ministry staff.


2) Consortium Team:

a)      Profile of organization’s relevant qualifications

Project Balance (project lead) is a small woman-owned company with extensive experience working in low resources settings in Africa and the Caribbean. Our team develops and deploys healthcare, agriculture and social welfare mobile and PC applications to collect and report on data funded by USAID, CDC and other international programs. Our expertise with open source technology tools and developing solutions that address real needs are the ingredients required to bring tangible tools and capabilities to communities in need.


Project Balance excels at project implementation. Our adaptive management and interactive approach optimize the team’s skills and keeps the team focused on delivering quality products and services. Our staff has complementary experience in Monitoring and Evaluation (M&E) and Information, Communications, and Technology. We provide leadership in management, monitoring and evaluation, and organizational support to improve how data is collected, managed and used. To increase data use, Project Balance develops innovative software products that incorporate data quality measures, intuitive user interface design, and solutions that meet the stakeholder requirements. We have successfully directed multi-million, large-scale, multinational, and offshore projects.


InSTEDD (technical collaborator) is a US-based non-profit organization (501.c.3) that designs and uses open source technology to help partners enhance collaboration and improve information flow and knowledge sharing, to better deliver critical services to vulnerable populations. InSTEDD is committed to the user-centered design, agile software development, and building local capacity to use technology for social good. InSTEDD is a founding member and leader of OpenHIE, and a recognized leader in the effective design and development of open source solutions related to GIS, mobile, and lab diagnostic solutions for global health challenges.


DAI (end-user stakeholder-Haiti) is an international development organization that tackles fundamental social and economic development problems caused by inefficient markets, ineffective governance, and instability. We work with a wide range of clients, including national and local governments, bilateral and multilateral donors, private corporations, and philanthropies. DAI’s Haiti HIS team, works closely with the Haitian Ministry of Health to consolidate and integrate Haiti’s disconnected health information assets. The team has both technical and non-technical who will give end-user feedback and help test the proposed application in the field.


b)      Profile of relevant experience and examples of related work

As a contractor to DAI (2017-Present) on the USAID Haiti national HIS project (2017-present), Project Balance is assisting DAI in managing the country’s two national instances of DHIS2 with up to 1600 data elements collected monthly from over 800 facilities across all 10 Departments in Haiti.  DAI and Project Balance have worked closely with USAID, the MOH and country stakeholders to manage version upgrades, data cleaning, data harmonization as well as implementation of the DHIS2 Tracker system for patient management.  Project Balance led a smooth transition from the prior DHIS2 system management team to DAI, working through 10 DHIS2 version updates, major server operating system updates and detailed testing.  In addition, Project Balance deployed a public key infrastructure (PKI) system on the public facing servers to secure traffic with TLS and developed and implemented a comprehensive, semi-automated disaster recovery process for the system including a full daily off-site backup of all systems.


Project Balance consulted on AIDSRelief Transition (2011-2016) to provide technical assistance for monitoring and evaluation of the HIV care and treatment program. Our staff worked with Palladium’s Strategic Information team to monitor project performance, provide quality assurance of monthly, semi-annual and ad hoc program reports including the PEPFAR Monitoring, Evaluation and Reports (MER) and identify ways to improve how data is used to inform program planning. There was a significant focus on monitoring and evaluation of the prevention of mother to child transmission (PMTCT) Option B+ model, community-based care and treatment models, and child and adolescent care and treatment. Project Balance was responsible for gathering requirements, business analysis, and managing the development of a ‘real-time’ geographic spatial information system to track PMTCT Option B+ services, pharmaceuticals and other commodities. This application and dashboard interfaces with JSI’s commodity tracking system and allows facilities to report stock levels and early prevention indicators. The interactive dashboard provides key stakeholders including the Ministry of Health (MOH) with indicators targeted at early prevention and interventions to improve patient and program outcomes.


Project Balance was instrumental in managing the development of the SCA application for android tablets (mSCA) under the SIDALE project (2011-2014). The mSCA was developed on a tablet for both routine program monitoring and supporting the long-term sustainability of local facilities. Results from the SCA provide a clear picture of the healthcare site’s needs across clinical, strategic information, and management and finance areas, and allows facilities to prioritize technical assistance with greater emphasis given to low-scoring areas that require more attention. The mobile application allows program managers to conduct the SCA and review results in real-time on their tablet or phone while at the facility. This facilitates the development of action plans immediately following the assessments in order to address challenges and reduce barriers to quality services. mSCA works in online-offline modes to ensure usability at remote and unconnected facilities


Project Balance, with The Palladium Group (2013), consulted on the Clinton Health Access Institute’s facility services map visualization for Zambia (Zambia Health Access Tool). This tool displayed all of the Zambia’s health facilities on a map and allowed users to filter the map meta data to find different hospital types/levels, the entity that managed the facility and the services provided such as ART, PMTCT, EID and CD4 testing. This map was used by the ministry of health to determine gaps in service and future expected catchment areas. Because the map provided a lot of different types of data, usability of the filtering and section features as well as color coding was very important to facilitate understanding the end filtered selections.




c)       Qualifications of key members of the proposed project team

Team Member



Edward Robinson*

Technical team lead, Software Architect

Project Balance, South Africa

Michael Lu

Mobile application developer

Project Balance, South Africa

Kanchan Verma

Senior software tester

Project Balance, India

Lanette Burrows*

Project manager, public health expert

Project Balance, United States

Scott Teesdale

Consult on Resource Map application. Liaise with OpenHIE FR group.

Program Development Lead

InSTEDD, United States

Atwood Raphael

Interface with Haitian MOH for facility level testing

Deputy Chief of Party, HIS - Global Health, DAI, Haiti

Thierry Octave

Application testing from the end user’s perspective

DAI, HIS Systems Analyst, Haiti

* Indicates key personnel and CV is attached in Annex


d)      Number of years in operation

Project Balance has been in operation since 2003, over 15 years.


3) Project Description:

One of the primary barriers to health service access, delivery and data use in developing countries is lack of publicly available information about services and facilities or a master facility list (MFL).  “An MFL is the keystone for integrating health information from different actors, programs and monitoring systems.” [[1]]  Many health ministries in developing countries have out-of-date or incomplete master facility list or no formal master facility list at all.  Reasons for this include lack of access to adequate electronic tools, lack of processes and systems, poor human resource capacity and the huge cost attached to data management. A master facility list is an essential part of any health management information system, disease surveillance system and supply chain management system. [[2],[3]]


Open Street Map is the 'Wikipedia' of maps.  It is an open access, crowdsourced spatial database available to everyone. It is particularly popular with humanitarian and international development organizations where it has been used to record, update and present spatial data in a variety of ways including crisis response such as during the 2010 Haiti earthquake ( Furthermore, projects such as 'Missing Maps' ( use Open Street Map to pre-emptively map places around the world where the most vulnerable people live in anticipation of crises.  Due to the open nature, valuable data can be crowdsourced and made available to anyone requiring it in real time.

OpenHIE ( is a free, open, standards-based health interoperability platform which includes a scalable facility registry module, allowing the collection, curation and storage of standardized, up-to-date health facility and resource data at country level.  Resource Map (, developed by inSTEDD, is the latest implementation of the OpenHIE facility registry reference application and has the advantage of being generic and able to record more than just health facility entries.  It also has a free online portal hosted by inSTEDD that allows anyone to adopt the product without hosting costs.  Although our focus for this project will be mainly health facility related, Resource Map can be implemented in other sectors including agriculture, education, social services, etc.  We envisage that the mobile application we are proposing can easily be adapted and redeployed for other sectors in future.

a)      Technical approach to the issue and anticipated outcomes

Project Balance proposes to develop an intuitive, user friendly mobile application that collects crowdsourced facility information and integrates with Open Street Map and Resource Map, “Mobile Facility Mapper” (MFM). MFM will provide a quick and easy method to capture critical health facility information including GPS location, services provided, affiliation, etc. both for public and official consumption.  The main focus of this application is speed and ease of use which we believe will encourage uptake and use.  Users can be casual users who simply want to identify a facility on the map or they could be local or international professionals who want to capture more in-depth details about the facility for public or professional consumption.

Although we envisage the main users (data producers) to be health professionals from national ministries, partners and donors, the application will be available to the general public in the Google Play store and the Apple App store to allow anyone to consume the data using the mobile application.  The proposed application will allow for easy capture of health facility location data by import or capture of a geotagged photograph on the user's smartphone.  The user can capture additional data such as services provided, affiliation data, contact information, etc.  Basic facility information is then uploaded to Open Street Map and made available to anyone for use in the various Open Street Map applications including the public web and mobile apps or in other existing applications via the Open Street Map API.  Users will also be able to update existing facilities if changes to existing records are required – e.g. the facility has closed or no longer provides a certain service.


Should the user have suitable access to a national Resource Map registry, they can integrate the update to the national registry with relevant information about the facility.  This way, national health ministries will be empowered with crowdsourced data made available by health professionals from all spheres including donors, partners and national ministry staff.  The system can be configured to hold uploaded data in a staging database while data curators verify and approve its integration.  In addition to a national master facility list, Resource Map may be implemented individually by partner organizations with suitable capacity who want to store more granular detail than the national master facility list provides.  They may opt to feed their list of facilities from the master facility list while adding facility details not present in the master facility list.

The system would be available to use as a standalone Open Street Map integrated application or as both Open Street Map and (one or more) Resource Map facility lists.

Countries that lack Master Facility Lists can easily implement Resource Map and have staff capture facility data as they travel to sites using the mobile application.  We expect that availability of a mobile application that is both easy to use and integrates with the master facility list will encourage uptake of software such as Resource Map / OpenHIE in countries where no MFL exists.  Those that have existing Master Facility Lists using other database tools have the option of implementing Resource Map and exporting crowdsourced data from Resource Map to their existing systems.

The application will also be useful to local residents and health care workers to search for and locate facilities by service or other category for consultation, admission or referral.  The data generated can also be used in decision making by national or partner teams when designing interventions and distribution of services. We propose the application architecture and code base be designed and developed as an open source and flexible system, easy to adapt to other public or private sector industries such as education, agriculture and social services.


We envision that the system will have a discovery service that would, based on the user’s location, query a list of countries (maintained by the OpenHIE community) that have publicly available OpenHIE master facility lists and allow the user to incorporate the MFL data for search and as a layer on their map.  They would be able to find facilities based on the specific properties set up in the country-specific MFL (e.g. location, services, etc.).


We propose developing the system using a cross-platform development framework to reduce coding effort and maximize potential by releasing the application on both the iOS and Android platforms.  We anticipate that a significant percentage of the contributors from foreign funded organisations may use iPhones or iPads and we did not want them excluded.  We have investigated existing applications and platforms for suitability including ODK based systems and existing open source mobile based OpenStreetMap applications:


ODK has not been coded for iOS and would therefore require significant effort to use for this project and it is for this reason, ODK has not been chosen as the framework of choice. While ODK would provide useful building blocks for the data capture portion of the application, ODK has not been coded for iOS and would therefore require significant effort to use for this project.  Maps.ME is a free and open source OpenStreetMap based application designed for iOS and Android with an active repository.  We will consider re-using or integrating with the Maps.ME code base, though up front it appears to be a fairly large and mature project and more research is required.  The Maps.ME component would mostly provide mapping and navigation service portion to the application.  Our contribution would be to integrate OpenHIE and make the submission process health service centric.  We will reach out to the Maps.ME team to see if it’s possible to integrate this functionality as a plug-in to Maps.ME rather than a forked application or integrated.  Another disadvantage of Maps.ME is that it’s developed using an expensive ($450 per month) IDE – QT.


Our preferred software stack for developing this product is the modern React Native framework which affords the best of both worlds with regards native UI components and a unified code base for cross platform mobile application development.  Native UI components provide a superior user experience through a more recognizable and speedier interface which translates to increased application adoption and use.  React Native does not require a commercial development environment.


User workflow to add a facility and meta data through Mobile Facility Mapper

  1. Application startup: Splash screen with options to use the map, add a facility or configure the application
  2. Configure settings: Allow download of facility data from Open Street Map or Master Facility Lists that you are subscribed to.  Allow add / edit of MFL – these could be national ministry repositories or partner repositories, etc.  Allow data to be downloaded over WiFi only to prevent unnecessary mobile data charges
  3. Add a facility – take a geotagged photo of the facility to record location.  This can be performed from within the application at the splash screen or directly from the phone’s camera applications
  4. Add a facility – if adding a facility from the camera application, tapping the share button allows you to send it to the facility mapping application.
  5. Confirm Location – allows you to visually confirm the location using a satellite map background.
  6. Capture additional details of the site if you know them
  7. Select the repositories you wish to submit to.  General public will only be allowed to submit to Open Street Maps (they will need to sign up with Open Street Maps).  Partners, health workers, ministry staff, etc. will have appropriate rights to one or more facility lists that they can submit to.
  8. Once submitted, Resource Map curators receive notification (email and mobile notification) to confirm an additional record has been added or an existing record has been updated.  They then sign in to the online Resource Map application and confirm or edit the suggested changes in a new staging component of Resource Map and choose to integrate or reject the suggested changes.  This allows MFL curators to maintain full control of the data while allowing it to be crowdsourced.  This could be a national MFL or a partner’s own facility list.
  9. Though not included in the wireframe images above, we envisage a search and filter in the mobile application that allows users to find facilities by registry, facility type, Resource Map layer component (e.g. services provided).  Existing facility records would also be editable by staff with approved edit accessed
  10. An additional feature could include linkages to external applications, for example a visitor or supplier could search for a facility they are wishing to travel to and request navigation assistance via Google Maps.

Diagram of the workflow


Wireframe/mock up:

Overview of data submission process to national repository
Note to reviewer - Please kindly see the correct placement of these images in the accompanying pdf file.















































































4) Use Cases, User Stories: the list below summarizes the key user stories for the Mobile Facility Mapper (MFM)

  • As an end-user, I want to download the MFM application onto my smartphone from the Google Play store or the Apple App store, so that I can use the application locally.
  • As an end-user, I want to download a local regional map and facility information, so that I can refer to the information off-line
  • As an end-user, I want to log into the MFM application on my smartphone so that I can locate health facilities on the map in either online or offline mode.
  • As an end-user, I want to search my locale for a specific facility, so that I can find it on the map in either online or offline mode.
  • As an end-user, I want to discover facilities nearby by services provided in either online or offline mode, so that I can find an appropriate facility to visit.
  • As an end-user, I want to get the driving directions from my current location to a specific facility, so that I can travel to the facility in either online or offline mode.
  • As an end-user, I want to add a new facility with a geotagged photo, so that I can contribute accurate local information.
  • As an end-user, I want to add a geotagged photo that has been previously saved to my smartphone of a new or existing facility, so that I can contribute accurate local information.
  • As an end-user, I want to enter meta data (services, hours open, etc.) about an existing facility in a form on my smartphone, so that I can contribute accurate local information.
  • As a facility administrator, I want to approve, edit or delete a facility or updated information submitted by an end-user about a new or existing facility, so that I can curate information for public display.


Feature list:

  • Download the application from the Google Play Store / Apple App Store
  • Link my Open Street Map account and / or one or more OpenHIE / Resource Map based facility registry accounts within the application;
  • Display facilities with their meta data on an Open Street map based tile layer using Open Street Map data or OpenHIE / Resource Map based facility registry data.
  • Search for a facility with a particular location, services type, hours open, etc.
  • Upload a geotagged image, add meta data about a facility and create a new facility record to be submitted to OpenStreetMap and an OpenHIE / Resource Map based facility registry.
  • Add or edit meta data about an existing facility record and submit the updated record to OpenStreetMap and / or an OpenHIE / Resource Map implementation.
  • In the Resource Map web interface, review, update, accept or delete data submission by an end users.


5)      Use of Digital Health Technologies:

The application will use conventions and standards included in Resource Map which is built on OpenHIE facility registry. Standards and conventions implemented in OpenHIE / Resource Map:


  • mCSD – mobile Care Services Delivery Profile.  The mCSD, developed by Integrating the Healthcare Enterprise® (IHE), is a standard that supports queries across related directories containing data about organizations, facilities and services.
  • FHIR (pronounced ‘fire’).  Fast Healthcare Interoperability Resources is a standard for exchanging healthcare information electronically.  It was developed based on emerging industry approaches to health data exchange around the 20+ year old HL7 standard.  It has emerged as a standalone data exchange standard but can be integrated with other existing standards.  It is open source and does not require HL7 membership to use and implement it.  Generally speaking, it is a machine-readable implementation of a REST API server specifically geared towards health information systems.  The system will communicate CSD entity data using FHIR.


The OpenHIE CSD and FHIR implementations as included will be leveraged for various functions of addressing entities and communicating data between Open Street Maps and Resource Map facility list implementations.


6) Community Feedback:

Project Balance has invited DAI, who works closely with the Ministry of Health in Haiti on harmonizing and maintaining health information systems, to provide end-user input and testing of the Mobile Facility Mapper tool. Haiti does not have a Master Facility List application; they maintain their master facility list through DHIS2. As part of this project, some or all of the facilities in DHIS2 will be loaded into the Mobile Facility Mapper tool. This will be a starting point for the crowdsourcing data collection. DAI will review the requirements from an end user’s perspective and also what is needed in Haiti. The DAI team members will provide feedback on the ease of use, accuracy of the data collection mechanism and how the data can be administered through a simple version of the OpenHIE Registry.


DAI has both technical and programmatic experience and are ideal partners to give user feedback. Furthermore, Haiti is a challenging environment to work in and collect information so the testing will be realistic and uncover any major user experience issues or defects.


Project Balance has joined the OpenHIE Facility Registry community and will solicit ideas and reach out for help where during the requirements phase and report to the group at key milestone points. Furthermore, we have reached out to InSTEDD who is heavily involve with managing the OpenHIE FR community to aid in soliciting ideas and feedback from the group to help us build a quality tool that meets standards and can be further enhanced by others. Project Balance will publish the Mobile Facility Mapper application as an open source contribution to this repository. This team will follow any required or recommended coding rules to conform to the community’s requirements.


7)   Self-Assessment on the Global Goods Maturity Model:

Link to OpenHIE / Resource Map assessment here


8)   Digital Health Atlas:

A preliminary, published Digital Health Atlas project has been published and can be found at this URL:


9)   Workplan and Schedule:

Below is the proposed workplan and schedule.

The workplan is separated by work bundles or packages. Please see the number of days per work bundle. We estimate this project to take about 6 months – 5 months to complete the key deliverables and one month of testing, polishing and defect fixing.

RACI Chart – This chart shows the responsibly matrix by project phase

Key Activity








Requirements and Design




R, A




Initial integration prototyping








Mobile application development








Integration testing and defect fixing








Application Deployment

R, A







Post deployment maintenance and enhancements

R, A







        R = Responsible; A= Accountable; C = Consulted; I = Informed



7)   Project Deliverables - This chart shows the project deliverables by phase and by consortium partner with timeframes per phase.

Key Activity


Months from Start

Requirements and Design

Data dictionary, Data entry flow, User interface wireframe, risk mgt plan, communication plan

1.25 months from start

Initial integration prototyping

Technical design document, API integration documentation for Resource Map and Open Street Map, database updates documentation (ERD)

1.25 months from start

Mobile application development

Mobile application, test cases, test list

3.5 months from start

Integration testing and defect fixing

UAT test cases, UAT result, defect tracking

4.5 months from start

Application Deployment

Deployment instructions, package scripts

5.1 months from start

Post deployment maintenance and enhancements

Enhancement list, development schedule, defect list, defect tracking

6 months from start


11) Tagging:

  • Open Street Map
  • OpenHIE
  • Resource Map
  • Identification registries and directories
  • Community-based information system
  • Facility management information system
  • Geographic information system (GIS)
  • Open Source
  • Crowdsource
  • Master facility list
  • Mobile


12)  2-sentence overview:

A) A description of your global good for a non-technical audience.

Mobile Facility Mapper is a map-centric mobile application that allows easy capture of GPS location, services provided and other health facility information by a large number of individuals or organizations (crowdsourced) for the common goal of updating a national registry for use by local residents, healthcare workers and other organizations. A publicly available map will display the location of facilities by service or other category for consultation, admission, referral or other general public use.


B) What this investment from Digital Square will specifically fund.

Digital Square will fund the development of an intuitive, user friendly mobile application that integrates with the OpenHIE based Resource Map and Open Street Map so that facility data including location, services and affiliation of health facilities can easily be updated for public, private, NGO and government use. This solution leverages crowdsourcing to continually update a standards based master facility list that can be used by other software applications and organizations as the most complete and accurate facility list.


Annex A – Key Personnel Resumes


Lanette Burrows, MPH, PMP                                                               


Experienced program manager and certified PMP with over 15 years of experience providing leadership in program development, information, communication and technology, public health, and organizational support of international and domestic community development projects.

  • Accomplished in project development and implementation; significant experience in human resources management to ensure team collaboration in remote settings
  • Proven success in diverse, multicultural settings and garnering senior and executive level support for strategic initiatives
  • Expert in budgeting and financial management; significant operations experience to ensure results are met on time and within budget
  • Outstanding problem solving skills; flexible; able to handle multiple tasks in fast-paced work environments and work collaboratively with other team members
  • Experience in grant writing, growing existing contracts and fostering relationships to win new business
  • Critical thinker with a focus on evidenced based decisions and ability to design systems that collect quality data and manage data with the intent to improve use of the information
  • Global work experience in Burkina Faso, Ethiopia, Guyana, Haiti, India, Kenya, Nigeria, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe



Seasoned professional with extensive program management and operations capability executing multi-million, multi-country, and complex projects.

  • Opened 10 offices in Africa and the Caribbean which included facilitation of local registration, leasing office space and setting up utilities, infrastructure at office, opening bank accounts, ensuring security measures, developing operations policies and manuals, vehicle leasing, hiring technical and operations staff, and payroll
  • Effectively executed close out of large and small CDC, USAID, HRSA funded projects across multiple countries and ensured sustained knowledge management of project activities and reports
  • Developed staff professional development plan and performance review templates for field-based teams; facilitated performance improvement and professional development discussions with staff
  • Created interview guides and practical written interviews to improve our hiring process; carried out hiring and terminations for operations and technical staff
  • Developed budgets in line with the scope of work and to ensure project results; managed burn-rates and forecasts to limit cost overruns and under-spending
  • Reviewed and approved monthly expenditures and invoices specifically reviewing for US government cost principals
  • Forecasted level of effort for more than 85 staff working across multiple countries and projects; developed tools and updated processes on a quarterly basis
  • Development and review of policies and standard operating procedures in a variety of topics ranging from ensuring privacy of protected health information to child protection
  • Conducted in depth contract negotiations that spanned a wide range of areas including: reporting, audit, intellectual property, budget, budget flexibility and payment terms, scope of work and deliverables, and procurement



PROJECT BALANCE, LLC     Greater Boston                                                                                                             2014 – Present 

Managing Partner, Owner

  • Small woman owned company focused on supporting organizations to improve how they collect, manage, and use data through process improvement and software development. Provide excellence in business analysis, development of visualizations, requirements gathering and documentation, project management, and software development. Work collaboratively with domestic and international clients to execute projects to help our clients deliver and obtain results.
  • Strong experience in developing data capture tools and software with reporting and dashboards for decision support. Work together with clients to critically analyze and define business rules for data transformation and reporting.
  • Develop and manage a large data warehouse; map the extract, transform and load (ETL) process from five source databases and create business rules. Manage changes and enhancements to ensure availability of critical reports and information.
  • Provide quality assurance for software development projects including test plan and test case development, execution of test plans.
  • Manage the development of an interactive analytics tool and dashboard to slice and filter data for over 500,000 longitudinal records. Work collaboratively with clients to identify key stories for visualizations and uncover unanticipated trends. Review data and processes for data quality issues and identify mitigation strategies.
  • Client list available upon request


FUTURES GROUP     Washington, DC                                                                                                                        2003 – 2014        

Project Director & Principal Investigator                                                                                                                             

  • Led and oversaw plans and execution of annual $7 million contract to provide monitoring and evaluation (M&E) and health informatics solutions for HIV care and treatment in ten countries. Managed up to 15 additional multi-country health informatics projects simultaneously.
  • Supervised team of approximately 85 to build capacity at over 240 health facilities via training and technical assistance; improved clinical and program outcomes by enabling collection, analysis, and use of strategic information
  • Directed development and execution of revenue, program, and operational activities; monitored activities and provided guidance to ensure results were achieved and performance targets met
  • Established key success indicators and managed trade-offs between scope, quality, time and cost
  • Coordinated development of International Quality Solutions (IQSolutions); IQSolutions ( is a library of electronic medical records, mhealth applications, dashboard solutions and data reporting tools that provide the key components for adaptive patient management, healthcare quality and clinical sustainability. IQCare and IQSMS received honorable mention in the 2010 Stockholm Challenge. Successfully managed an off-shore development team to develop software that meets field and donor requirements. IQSolutions is currently implemented in 10 countries across more than 700 facilities.
  • Managed annual budget and oversaw contract compliance and assured fiscal responsibility; experience in cost reimbursable, time and materials, and firm-fixed price budgets
  • Received spectacular Service Award in 2010 from the AIDSRelief project for exceptional achievement, innovation and leadership for the success of the project


Senior Project/Technical Manager                                                                                                                                         

  • Managed field and headquarters operations and reporting for annual $2 million contract
  • Oversaw short term technical assistance, mobilized resources to the field, maintained partner relationships with the prime grant recipient and other partners, and ensured accurate client reporting
  • Supervised activities and supported field level project processes in knowledge management, finance, work plan development, reporting, materials development, and program development
  • Directed technical activities, developed training modules and manuals, assisted in data analysis, and developed and implemented health management and information systems
  • Collaborated with Points of Service (POS), consortium members, and internal teams to develop system requirements for the patient monitoring system
  • Led the development of a joint needs assessment tool and coordinated data management and development of an assessment database


Business Development Associate                                                                                                                                            

  • Coordinated proposal development including technical, non-technical and cost components; collaborated on five successful applications
  • Researched development opportunities, collaborated with staff to write and submit unsolicited proposals, and helped maintain and update corporate files and capability statements
  • Developed cost applications for up to $19 million
  • Backstopped a regional HIV/AIDS policy and advocacy project including financial administration and initiating tracking systems


PLANNED PARENTHOOD OF MARYLAND     Baltimore, MD                                                                            2003

Grants Research Intern

  • Researched foundations for funding reproductive health programs, organized previous research material, and developed a database for storage of this information
  • Evaluated current budgets and action plans to understand the significance of foundation grants
  • Wrote proposals for Adolescent Teen Services, Medical Services & Latino Outreach
  • Attended Corporate and Foundation Grant Writing Workshop sponsored by Johns Hopkins Medical Institute
  • Presented funding opportunities to Education and Development Departments


BOSTON PUBLIC HEALTH COMMISSION - AIDS PROGRAM     Boston, MA                                               2001-2002

Program Coordinator

  • Provided technical and monitoring assistance in the implementation of outcome measures and assured that funded programs attained contracted goals and objectives
  • Developed procedures for continuous monitoring of activities including program site visits.
  • Planned and developed monitoring and reporting systems for performance of funded programs
  • Prepared quarterly and annual reports on program activities
  • Worked collaboratively with grant and fiscal staff to ensure system accountability
  • Assisted in preparing the Ryan White CARE Act Title I application and local RFPs


PEACE CORPS VOLUNTEER     Burkina Faso, West Africa                                                                                  1999-2001

Community Health Educator

In addition to daily responsibilities in village health clinic and pharmacy:

  • Managed the implementation of a pharmaceutical depot -- from creation of project proposal to completion of construction including writing successful grant funded by USAID thru Peace Corps
  • Launched a hygiene and sanitation project with regional hospital to provide education program and complete construction of latrines in six villages
  • Coordinated a three day regional conference in which 26 girls at the secondary school level participated in discussions on self-esteem, gender roles, female reproduction, and career orientation
  • Wrote and implemented yearly action plan and budget for the health clinic and pharmacy; tracked performance of health clinic through weekly, monthly, and annual reports
  • Developed project description and budget used for successful funding solicitation through the Peace Corps Partnership Program
  • Conducted assessment survey in a rural village to identify health care priorities and aided the health staff to perform six social mobilization activities on these needs
  • Enabled health clinic to record and organize data for baby weighing, vaccinations, pre- and post-natal consultations, and family planning consultations


HALLMARK HEALTHCARE     Saugus, MA                                                                                                                                1998-1999

Financial Counselor

  • Evaluated clients’ financial capability to pay for medical bills and designed sliding fee payment options
  • Authorized optional payment plans and reductions in bills for clients showing need
  • Counseled and aided patients to find health insurance and verified health insurance information


PLANNED PARENTHOOD OF BOSTON     Boston, MA                                                                                        1998-1999

Clinical Assistant

  • Counseled patients on decisions regarding pregnancy outcomes, including abortion procedures and contraception options; screened vital signs


STOCKHOLM WOMEN’S STUDY CENTER     Stockholm, Sweden                                                                  1997


  • Researched literature on women's issues of abortion, equal pay, job opportunities, and maternity leave



PROJECT MANAGEMENT PROFESSIONAL (PMP), Project Management Institute                                               2008

PMP Certification


JOHNS HOPKINS UNIVERSITY, Bloomberg School of Public Health     Baltimore, MD                                        2003

Master of Public Health, Concentration in International Health,


PEACE CORPS TRAINING     Bobo-Dioulasso, Burkina Faso                                                                                              1999

Intense training in community health development, program planning, French, & culture


COLGATE UNIVERSITY     Hamilton, NY                                                                                                                                    1998

B.A. Major in Psychology; Minor in Education


STOCKHOLM UNIVERSITY     Stockholm, Sweden                                                                                                               1997

Advanced Placement Swedish Program, Junior Year Abroad



M. Etienne, L. Burrows, B. Osotimehin, T. Macharia, B. Hossain, R. R. Redfield, A. Amoroso. “Situational analysis of varying models of adherence support and loss to follow up rates; findings from 27 treatment facilities in eight resource limited countries” Tropical Medicine & International Health. Volume 15, Issue 1, pages76-81.

P. Bass, L. Burrows, B. Jefferson. “Building Sustainable Strategic Information Systems in Low Resource Countries” Abstract accepted for the 2009 Unite for Sight Global Health Conference.

P. Bass, L. Burrows, B. Jefferson (presenter). “Building Sustainable Strategic Information Systems in Low Resource Countries” Presented at the 2008 Global Health Conference, Washington, DC.

I. Wanyeki, R. Ng’ethe, W. Kamau, L. Burrows. “Improved Data Use Minimizes ART Defaulter Rates” Poster at the 2008 International AIDS Conference, Mexico City, Mexico.

I. Wanyeki, L. Sekimpi, J. Balaba, T. Tulli, M. Nawa, L. Burrows. “Cohort Analysis of 12 Month ART Mortality and Retention Rates Across 11 Facilities in Africa” Poster at the 2008 International AIDS Conference, Mexico City, Mexico.

W. Kamau, R. Ng'ethe, I. Wanyeki, E. Robinson, S. Rana, B. Jefferson, L. Burrows, P. Bass. “Adaptive Management Leading to Enhanced Data Use Among Clinical Staff for Informed Clinical Decision Making” Poster at the 2008 International AIDS Conference, Mexico City, Mexico.

M. Etienne, L. Burrows, B. Osotimehin, T. Macharia, A. Amoroso. “Effect of Varying Models of Adherence Support on Lost to Follow Up Rates; Findings from 34 Treatment Facilities in Eight Resource Limited Countries” Poster at the 2007 International AIDS Conference, Toronto, Canada.

Y. Shimada, L. Burrows, B. Jefferson, P. Bass, F. Cleghorn. “Providing Sustainable Solutions for Patient Monitoring and Management: The AIDSRelief Experience” Poster at the 2006 Annual PEPFAR Meeting, Durban, South Africa.

Edward Robinson

Project Balance, Austin, TX                                                                                                          2004 to 2016

Technical Director                                                                                                                            East London, South Africa

Design of bespoke information systems interventions for international development in various sectors.  Requirements and existing systems assessments for intervention planning.  Design, deployment and management of secure cloud services in various contexts including international and in-country (emerging economy context).  Cybersecurity analysis and implementation.


The Palladium Group, Washington DC                                                                                    2004 to 2016

Regional HMIS Advisor / Country representative                                                                               East London, South Africa

Information system design for various sectors in emerging economies including healthcare, social services, agriculture and education.  Management of a software development team and country office in South Africa.  Resource planning and implementation of international information systems projects across Africa, Middle East and the Caribbean.  Worked on the 9 country CRS led AIDSRelief project from 2004 to 2010.


Networks,                                                                                                                                           1997 to 2004

Proprietor                                                                                                                                           East London, South Africa

Design and implementation of server and network solutions – LAN/WAN.  Hardware, networking and operating systems support (Windows Server, Novell Netware, Linux).  PC and network sales and support.


Coopers and Lybrand                                                                                                                     1995 to 1997

Systems Administrator                                                                                                                  East London, South Africa

Server deployment, maintenance and support for Coopers and Lybrand’s Eastern Cape region (4 offices).  Client and internal systems support.  Novell Netware, Windows, DOS, Linux, OS/2 and Lotus Notes deployment and support.


SC Computer Systems CC                                                                                                             1994 to 1995

IT Support Engineer

PC hardware, software and networking installation and support (DOS, Windows, Netware).


Key Technical Skills

  • Information systems architecture, design, documentation, deployment and support in developing world context including occasionally connected or offline environments.
  • Innovative use of technology to solve problems in low resource environments.
  • Systems integration and data exchange.
  • Design and deployment of analytics solutions including web based dashboards.
  • Field systems assessments.
  • Mentoring and capacity building.
  • Working with staff at various levels in different political contexts.
  • Extensive experience in Health Information Systems, particularly HIV Care.
  • Android Development
  • .NET Development (C#),
  • Web Development (ASP.NET, MVC),
  • Forms Development,
  • SQL Server Development (SSIS),
  • UML and Requirements elicitation,
  • Microsoft Visual Studio
  • SQL Server Management Studio
  • MySQL
  • Maps and Charts Development (OpenLayers, Chart.js)
  • GIMP
  • Inkscape
  • Adobe Premiere Elements



  • Drones for International Development: A Paradigm Shift Ahead for the Cyber-Physical Gap in International Humanitarian Aid
  • IQMerge: Improved reporting and data use through aggregation of patient level indicators from IQChart ART scale up potential in the Nyamasheke district of Rwanda






Application Status: 
Approved - partially funded

Healthcare Fraud, Waste and Abuse (FWA) Module for openIMIS

Notice C Opportunity: 
Announcement C1: Modular transformation of openIMIS


Executive Summary

Healthcare Fraud, Waste and Abuse (FWA) is a global problem; and it is a common problem for all healthcare payers.  Most of the healthcare purchasers, is facing similar or same challenges, and are aiming to improve FWA detection.  Globally, this figure is at an average of 6.99 percent (Gee and Button, 2014).  Most global insurance payers perform a post-payment audit claim process; that is, they undertake audits very late in the claims process, as it is often takes place after all reimbursements have already been made to the provider. Also, human resource capacity has often been highlighted as a possible challenge, which can also lead to limited quality and quantity in a claims audit process.

An electronic claims audit process could help identify FWA problems more efficiently. Claims management systems can benefit from the assistance of new affordable information, communication and technology (ICT), such as business intelligence and machine learning tools. Implementation of these tools could dramatically improve early detection of risky claims and enhance the processing of claims audits. This module will apply such tools in the case of FWA detection under the auditing of the claims management system and integrated module of openIMIS claim management functionalities.     

This proof of concept project will analyze claim data structure and claim adjudication rules for a fee-for-service based payments model. During the project, the openIMIS claims data structure will be studied and analyzed with the understanding of typical FWA patterns that are able to lead to the development of a customized expert decision system for FWA detection.

Consortium Team 

AUDENTA Consulting - Audenta consulting firm was founded in 2011 with the goal of consulting related to the business and management in health care and health insurance with a special focus to the application of advanced technologies in the health care system. In this project Audenta Consulting will be responsible for project management, claim management business rules and FWA detection models for claims system.

ZAGREB EXCELLENCE INSTITUTE (ZEI) is NGO network established by the group of senior healthcare consultants with extensive management experience in mandatory health insurance, focusing on business excellence and improvement of national health systems. ZEI in this project will be responsible for Solution architecture and design, Machine learning and integration and project management, FWA detection models and use cases in fee-for-service based payments.

SORSIX is a technology company headquartered in Sydney, Australia, with offices in Skopje, Macedonia and Dublin, Ireland. Sorsix provides bespoke software development services, consulting services, and its proprietary health platform Pinga and proprietary database technologies to customers in the healthcare, infrastructure, and telecommunications industries.Sorsix’s team has extensive experience in serving customers in the healthcare sector, at all levels – from GPs and administrative staff through to insurance providers at the state level. In this project, Sorsix will be responsible for assisting the consortium in solution design, and for providing the software development to build the FWA prevention tools and module into OpenIMIS.

Project Description

Claims management systems with the assistance of new affordable information, communication and technology (ICT), such as business intelligence and machine learning could dramatically improve detection of risky claims and enhance processes of claims auditing.  This module will apply such tools in the case of FWA detection under the auditing of the claims management system and integrated module of openIMIS claim management functionalities.

This proof of concept project will analyze claims data structure and claim adjudication rules in fee-for-service based payments. During the project, openIMIS claims data structure will be studied with the understanding of typical FWA patterns that are likely to lead to the development of customized expert decision system for FWA detection.  System and enhanced claims audit process will be piloted and adjusted with claims data model from primary, secondary and tertiary care. By relying on machine learning capabilities, the system/module should be expected to be constantly improved by increasing the number of cases that will be processed and detected as potentially “suspected” cases. 

With FWA detection module, it is expected that a few auditors will be able to assess far many claims audit cases than through a random-based process like it is done today in the most payer organizations.  A qualitative and quantitative analysis will be carried out at the end of the project to lead to a management decision on the results of this intervention. 

Technical description

A description of how your solution is interoperable with national health information architectures

The claim management process is one of the core business processes in the insurance business and is the core part of IMIS. FWA detection and prevention is essential for effective and successful health insurance business and should be a vital part of national health information architecture. FWA detection module should be incorporated in claim management system of the initial process of receiving and analyzing claims data structure and claim adjudication rules and giving prompt feedback to providers about technical or analytical claim issues and need for possible corrections. If FWA module should be integrated part of openIMIS and therefore interoperable with healthcare providers information systems.

Description of how your solution furthers the development of openIMIS and fits within the priorities and roadmap

We believe that FWA is the common problem for all health insurance organizations and developing FWA detection and prevention module as an integrated module in openIMIS should meet its the priorities. With this proof of concept project, all aspects of integration issues and roadmap priorities would be assessed and defined.

Project management approach

In this project, the market experience and project experience of the consortium members will be partnered with the software development capabilities of Sorsix. Sorsix has extensive experience providing software development in the healthcare and healthcare administration sector to a variety of customers. 

Sorsix development teams follow a hybrid Agile approach, enabling adherence to a strong product vision while maintaining flexibility for changes within this vision to ensure development never stalls. As part of the hybrid Agile approach, Audenta and ZEI, with consultation from Sorsix and the OpenIMIS community, will generate a high-level scope of work and requirements. Sorsix teams will break this down into a detailed technical scope and execute this development with an Agile approach, enable fast builds from regular sprints to be demonstrated to the consortium and community for feedback.

Project Timeline 

The project estimation is 10-12 calendar months, with 2 months of project preparations, 6 months of SW development, 2-4 months of uploading test claim data with machine learning adjustment and improving the scoring algorithms, producing project result reports and recommendations.

Potential obstacles and plan to overcome them

For a successful proof of concept, it is important to have realistic test claim data. Our target is to use actual historical anonymized health insurance claim data, over three to five consecutive years. To effect this, we will engage with the community and establish a project partnership with one or more health insurance organizations. Ideally it will be an organization already using openIMIS, simplifying the transition and use of data for this process, and supporting the openIMIS community. The support of openIMIS community will be important in providing contact and access to the appropriate kind of historical anonymized data. An alternative possibility could be to use data from some other country/payer and to transform the claim data in openIMIS format. Provision for the data engineering necessary in such a step has been made in determining the size of the project.

Another potential obstacle may be enabling the key value-added components of the FWA tool to adapt to different regulatory environments. We plan to mitigate this by adapting to existing configuration options in openIMIS and engaging with the broader openIMIS community to ensure that workflows that have been experienced by openIMIS users have been met. 


* Claim management

* Fee-for-service

* Fraud, Waste, Abuse (FWA) detection and prevention

* Machine learning

* openIMIS

* Health insurance information system

* Interoperability

* Proof of concept


Application Status: 
Approved - partially funded

Integrating Care: Bringing Interoperability to Life

Notice C Opportunity: 
Announcement C0: Global Good Software Development and Support

Integrating Care: Bringing Interoperability to Life

Executive Summary

LMIC’s are at an early stage of their digital health journey with a variety of disconnected systems and an early challenge with interoperability, seen across the world. To avoid a siloed healthcare IT scene in LMIC’s, impacting front line staff and patient care, baking interoperability into the fabric of Digital Goods being developed and deployed at this key time, is essential.

QEWDjs is an open source web development and integration framework supported by the non profit Ripple Foundation and is being used in the NHS in England and elsewhere to address the wicked challenge of interoperability.  The Ripple Foundation wish to work with the openHIE initiative and Jembi Health Systems NPC to compare, contrast and collaborate with openHIM towards a global interoperability showcase. QEWDjs already offers key advantages;

  • Easy to implement and scale- QEWDjs leverages the language of the web, Javascript and NodeJS - to run on a Raspberry Pi microcomputer, while very capable of supporting the big integration challenges in healthcare across a secure federation of organisations.

  • Adaptable to different countries and contexts - by leveraging the ubiquity of Javascript, and its vast international community, along with the powerful Universal DB technology that powers key medical software today (“MultiDimensional Global Storage”) QEWDjs is uniquely placed to simplify and support many healthcare integration challenges today.

  • Supports interoperability engine capability with other technologies via standard web based technologies (RESTful APIs, Websockets) plus leverages the multitude of  adaptors/connectors available on the world’s largest software registry known as NPM

  • Open sourced, publicly and freely available online, under the leading Apache 2.0 license

While we understand and expect the Global Goods initiative could/should will offer a broad range of tools, given the critical role that interoperability and integration  plays at the frontline of healthcare, we advocate that comparing, contrasting and collaborating on interoperability between QEWDjs and openHIM should help improve either or both tools as an internationally leading interoperability showcase, a key challenge for Digital Square.
The primary outcome we seek is to bring to life, to showcase, a globally leading integration & interoperability framework in healthcare, between real clinical systems, that will benefit patients and clinicians, which healthcare developers want to use.
The secondary outcome we seek is a library of easily shareable set/library of interoperability mediators/components that can be widely shared around the world.

Consortium Team

The team behind this Integrating Care : Bringing Interoperability to Life Showcase is based with the Ripple Foundation, London, United Kingdom. The Ripple Foundation was born in England in 2015 out of lessons from the multi-billion £ NHS National Programme for IT as well as lessons from the frontline in the busy Leeds Teaching Hospitals NHS Trust & Leeds City area, who delivered one of the leading Integrated Care Records in the NHS.
The Ripple Foundation was established as a non profit foundation Community Interest Company (C.I.C.) in 2016 to further the mission towards an open platform in healthcare. QEWDjs and the Qewd-Ripple framework is one of 3 key open source tool sets that the Ripple Foundation is supporting as part of its mission towards an open platform in healthcare. These technologies are now beginning to be adopted in a number of regions/states in the United Kingdom with interest growing wider as the market shift to an open platform begins to gain traction.

The makeup of the team that is supporting QEWDjs and would lead on this project is as follows;

  • Dr Tony Shannon, Director/Architect, Ripple Foundation

    • Emergency physician by background and Clinical Lead behind the integrated Leeds Care Record and the Ripple Foundation technologies, with an interest in healthcare reform, improvement and an open platform to support the clinical frontline. Main point of contact

  • Phil Barrett, Head of Development, Ripple Foundation

    • Co Director of the Ripple Foundation and passionate advocate for change in the health IT market. Oversees those projects that Ripple Foundation support.

  • Rob Tweed, Technical Architect & Lead Developer QEWDjs

    • Many years of experience in healthcare IT across the US and the UK, with many years working with integration and database technology in both the web and healthcare. Lead Developer on the QEWDjs technology and the Technical Architect behind the QEWD-Ripple framework used by the Ripple Foundation.

  • Alexey Kucherenko, Quality Assurance Lead, QEWDjs

    • Oversees the test coverage and continuous integration of  QEWDjs.

As tackling interoperability and the development of an open platform to transform 21st Century Healthcare is key to the Ripple Foundations mission, we are actively seeking collaborators with us during this project, in particular the openHIE and openHIM teams.

Project Description

The Ripple Foundation technologies have been developed as a set of open source health IT technologies for the modern age, to be reused for multiple purposes in healthcare, such as a Person Held Record app, an Electronic Patient Record application or a broad and deep Electronic Health Record that can span a city/region/country.

Within that stack, QEWDjs and Qewd-Ripple has been developed as a powerful yet lightweight integration and interoperability technology .
As integration was a key requirement in the Ripple Foundations open source showcase stack in healthcare, QEWDjs was chosen to fulfil the requirement of a quick and easy technology for healthIT novices to get started with (using the hugely popular Javascript and NodeJS) , while being capable of scale of quality at an enterprise level when appropriate.

Our proposal is a focused one, on efforts to showcase interoperability between the Ripple Foundations showcase EHR stack and the openHIE groups reference technologies, to ensure the combined learning from both the open source Qewd-Ripple framework and openHIM framework can ensure a top class interoperability framework is available as a Global Good via;


  • Compare/Contrast/Improve with existing/other Interoperability oriented Global Goods -
    In line with the Implementable & Interchangeable principles of the OHIE Architecture, we would suggest a focused piece of work exploring the overlap/differences between the approach taken to healthcare integration by QEWDjs and the leading edge open source integration technology known as openHIM, in particular how to connect these leading technologies (NB both NodeJS based) as well as to compare approaches to connectors/mediators between them.

  • Integration Showcase within the context of existing Digital Square technologies
    As the Ripple Foundation are already using QEWD-Ripple to support key integration & interoperability (inc FHIR) with legacy healthcare systems in the NHS environment. We propose testing its versatility, power and potential to exchange data via QEWDjs + openHIM to/from the openHIE reference technologies (inc openMRS) with FHIR exchange and openEHR data persistence as aspects of the interoperability showcase. 
    We believe the best way to test and prove interoperabilty is to bring the integrated care challenge to life with working software, so the main focus of our proposal is working software that shows how the challenge of interoperability between systems can be brought to life between real clinical systems, hence we propose to tackle "Integrating Care: Bringing Interoperability to Life"

  • Educate towards greater Interoperability Capacity/Capability - In tandem along with this interoperability showcase, we suggest working with a supplier like Jembi Systems NPC to grow the interoperability capacity/capability in the challenging area of healthcare integration

Our own Ripple Foundation open source showcase stack is the early stages of being deployed in 3+ countries.

England, Ireland, Germany, India, Vietnam

Our code is all available as a Global Good on public repo, under an OSI approved open source license , the focus of this proposal is available here

Our software is being applied to the health domain.


Registration on Digital Health Atlas


Community Feedback:

---------- Forwarded message ---------
From: Carl Fourie <>
Date: Mon, 3 Sep 2018 at 07:34
Subject: Re: Let me know when suits you to connect re openHIM & QEWD
To: Tony Shannon <>
Cc: Tariro Mandevani <>, <>

Hi Tony,

Apologies around not responding sooner; Looking at the proposal I think we could very nicely dovetail in the idea of looking at how we could position QEWD and OpenHIM as a packaged solution for low resource settings. We have quite a full plat at the moment but I think within the pipe and activities we could look at the following under your area of:

Integration Showcase within the context of existing Digital Square technologies
- find a strong FHIR translation usecase - maybe doing the ADX on FHIR workflow -- that is transforming the existing ADX measures into FHIR Measure reports -- this is the direction that Carl L is thinking for the next way of how data could be exchanged to DHIS2. Look at packaging the QEWD and OpenHIM to have a deployable example of this and be an option for the "transformation" libraries that I remember QEWD has. We could also look at identifying a roadmap of future "transformation" that could be written around patient data saving and or lookups?

I hope this isn't too late and again apologies around the delay in responding. Either way -- I would like to have a chat later in Oct (when we get our HIM work up and going under Notice B) in reference to the above idea.

Carl Fourie
Senior Programmes Coordinator
Jembi Health Systems NPC | SOUTH AFRICA


We look forward to sharing QEWDjs and QEWD-Ripple with the wider world as a Global Good.

Application Status: 
Out of Scope

Integrating openIMIS with Bahmni: A Nepal-Based Proof-of-Concept Project

Notice C Opportunity: 
Announcement C1: Modular transformation of openIMIS


Executive Summary

Possible is an innovative, experienced healthcare delivery organization in Nepal working to transform rural healthcare to make it work for underserved populations. Our integrated hospital-to-home healthcare model includes:

  1. improved quality of care at government-owned facilities;
  2. community-based care delivered by a trained professionalized cadre of community health workers (CHWs); and,
  3. an Electronic Health Record (EHR) that includes facility-level and community-level data to enable care continuity, a holistic picture of healthcare needs, and continuous improvement of healthcare delivery.

Our facility-based EHR, NepalEHR, is Nepal’s national EMR system and is built on the OpenMRS platform, Bahmni, with embedded protocols and the ability to track patient, supply, laboratory, radiology, and pharmacy data seamlessly. Following the recent passage of Nepal’s National Health Insurance Act, Possible is beginning to accept health insurance from patients and processing claims for reimbursement. As such, in line with the openIMIS product roadmap, we are working to integrate openIMIS with Bahmni through a proof-of-concept claim submission module. The development of this solution will support the openIMIS Initiative vision of making openIMIS interoperable with national health information architectures and, ultimately, support Nepal’s path to universal health coverage.

Consortium Team

Possible has a dynamic team of experienced technology innovators that support our efforts to transform health systems for underserved populations. Anant Raut, Possible’s Director of Informatics, led the rollout of our EHR system at our hospital hubs and oversees our innovative digital systems design and quality improvement efforts. He helps improve health outcomes and patient experience through innovative digital systems design and quality improvement and leads a robust team of three developers and five implementers who have been working on these open source projects for several years.

Possible will also work closely with the Bahmni Coalition to ensure the interoperability of its solution in contexts outside of Nepal. The Bahmni Coalition is a group of 15 organizations that collaborate in an open source way around the Bahmni hospital information system. Bahmni and its coalition received Digital Square funding through Notice B, and you can read more about the coalition in that proposal:

Bahmni’s Product Architecture Team will participate in the design and review of this Bahmni-openIMIS integration, and core Bahmni product developers will participate via pair programming and code reviews to ensure that this proof of concept is built so that it can be incorporated into the core Bahmni distribution in the future.

Possible is also eager to collaborate with organizations who are working to add the relevant FHIR APIs to openIMIS as a part of this project.

Project Description

In a major step towards achieving Universal Health Coverage, Nepal piloted its national health insurance program in 2016 in a few districts, and is now rolling it out nationwide. Nepal uses openIMIS to manage its national health insurance program. Bahmni is gaining traction at public health facilities around the country as NepalEHR, and this presents an opportunity for synergy between the two interdependent yet separate systems.

a) Technical Approach and Outcomes

Currently, Bahmni does not integrate an insurance workflow. The manual workflow to submit claims for those insured in openIMIS is time-intensive and inefficient. Developing a Bahmni-openIMIS Integration system will streamline processes around checking/validating patients with insurance, submitting claims, and tracking claims status.

Once this module is developed, one will be able to determine the validity and available balance of a person’s insurance account from within Bahmni itself. Users will be able to submit claims and track the status of these claims as “approved” or “rejected” within the system.

Concurrently, billing encounters for each patient will be synced with Odoo (OpenERP) and differentiated either as insurance claims or non-insurance bills. Managers will be able to generate reports on claims/non-claims from Odoo and utilize features like sorting and filtering for improved costing and planning.

To accomplish this, Possible will carry out the following steps:

1. Conduct Bahmni EHR User Interface changes to support collecting and displaying insurance related information of patient.

2. Develop IMIS-Connect java based rest application which can be plugged in as a service on existing Bahmni environment and acts as a gateway for communication with insurance system (openIMIS), with Bahmni. Major functions include:

  • Validity check
  • Balance check
  • Submit claims
  • Track status of the claims
  • Resubmit the rejected claims

3. Build IMIS-ERP module to tag the billing encounters of the insurance-eligible patient as  claimables or billables.

4. Change Odoo UI as required for claims processing features.

5. Change Odoo UI for generating reports for claims and non-claims


Figure 1: Bahmni-openIMIS Integration system

b) Anticipated Timeline

Possible anticipates completing the integration of openIMIS with Bahmni by August 2019.

c) Monitoring and Evaluation

We will carry out the integration of openIMIS with Bahmni in phases, using an agile development approach. We will work closely with the Bahmni coalition and its various implementers across many countries to ensure this module is of global relevance.

d) Interoperability with National Health Information Architectures

Possible’s Bahmni product (NepalEHR) serves as Nepal’s national EMR system. As a result, once we are able to successfully develop the openIMIS module within Bahmni, it will immediately interoperable with Nepal’s national health information architectures.

Additionally, as an open source platform used globally, Bahmni is already embedded within national health systems. As such, developing our solution will allow for other Bahmni implementing partners to begin submitting and tracking insurance claims in countries that have insurance products. For example openIMIS is also in use in Tanzania, and we would expect that the University of Dar es Salaam Computing Center would soon adopt this integration for their national rollout of Bahmni.

e) Furthering the development of openIMIS

Possible’s solution firmly fits within the openIMIS Initiative’s priorities as outlined in Section 3.5: Build on existing software in the openIMIS roadmap. By building on existing tools, Possible is contributing to the global knowledge base to ensure widespread adoption of openIMIS as countries begin to offer insurance products for their citizens.


  • Interoperability

  • Bahmni

  • OpenMRS

  • OpenIMIS

  • Insurance

  • Integration

  • Bahmni Coalition

  • Possible

  • Nepal



Executive Summary

See response in Concept Note section above.

Consortium Team

Possible will serve as the lead organization for the proposed project. With a ten-year history of operating in Nepal, Possible has a dynamic team of experienced technology innovators that support our efforts to transform health systems for underserved populations. Anant Raut, Possible’s Director of Informatics, led the rollout of our EHR system at our hospital hubs and oversees our innovative digital systems design and quality improvement efforts. He helps improve health outcomes and patient experience through innovative digital systems design and quality improvement. Before joining Possible, Anant led various projects innovating user-centered solutions for Hospira, P&G and Samsung, and was previously as an analyst at Zurich Financial Services. He completed his M.A. in Engineering Design & Innovation from Northwestern University, and has a B.A in Mechanical Engineering from Trinity College (CT). Anant leads a robust team of three developers and five implementers who have been working on these open source projects for several years.

Possible’s EHR team has significant expertise in designing architecture for complicated systems that require interoperability between various interfacing components (see CVs, attached). Our team has customized our EHR to meet the needs of our hospital staff and optimize the use of data for improved decision-making. For instance, earlier this year, we successfully integrated the Nepal Ministry of Health’s District Health Information System (DHIS2) with NepalEHR, allowing for seamless and automatic reporting of facility data to the central government health database. Direct integration of facility-based OpenMRS and national DHIS2 is the first of its kind anywhere in the world. DHIS 2 is the open-source information system with dynamic visualization features including mapping of diseases and customized dashboards that allow clinicians to look for trends and scan for epidemics in real time. It is also the preferred health management information system in 46 countries and helps governments better manage healthcare delivery efforts. This integration greatly simplifies the data management process, eliminating the burden of reporting on the clinicians whose time is better spent on patient care.

The Director of Informatics will lead Possible’s Nepal-based EHR team in the development and implementation of the Bahmni-openIMIS integration system. The two Java developers will lead the development and testing of the application, incorporating user feedback in further refinements throughout the project. Possible’s two systems engineers, Sr. EHR Associate, and Sr. Data Registration Assistant will work together to lead the deployment of the integration application at two public hospitals over the course of the year-long project. They will also support the training of users and administrators and conduct ongoing maintenance and support for the application.

Our team of technology innovators will work closely with Possible’s finance team who will support claims status tracking and help develop relevant reports to track reimbursements for claims. Finally, Possible’s medical staff will provide valuable input and feedback into the workflow from checking patients’ insurance enrollment to submitting and tracking claims.

Possible will also work closely with the Bahmni Coalition to ensure the interoperability of its solution in contexts outside of Nepal. The Bahmni Coalition is a group of 15 organizations that collaborate in an open source way around the Bahmni hospital information system. Bahmni and its coalition received Digital Square funding through Notice B, and you can read more about the coalition in that proposal:

Bahmni’s Product Architecture Team will participate in the design and review of this Bahmni-openIMIS integration, and core Bahmni product developers will participate via pair programming and code reviews to ensure that this proof of concept is built so that it can be incorporated into the core Bahmni distribution in the future.

Project Description

In a major step towards achieving Universal Health Coverage, Nepal piloted its national health insurance program in 2016 in a few districts, and is now rolling it out nationwide. Nepal uses openIMIS to manage its national health insurance program. At the same time, Possible’s NepalEHR is gaining traction within public sector health facilities throughout the country, and this presents an opportunity for synergy between the two interdependent yet separate systems.

In 2017, Nepal’s Ministry of Health released their National e-Health Strategy that outlined their goal of harnessing the potential of Information and Communication Technology (ICT) technologies to improve health services, health governance and management. With the government’s expressed commitment to digitizing healthcare, the demand for cost-effective and easy to implement and use products is increasing among private and public healthcare providers. As the developer of the first integrated EHR in Nepal with a demonstrated track record of delivering technology-enabled longitudinal care, system efficiencies and quality improvement, we are uniquely positioned to respond to the growing interest in digitization and partner with the Government to expand the use of NepalEHR within the public health sector.

Along with refinements to NepalEHR, promoting implementation of the EHR in the public sector will be a priority for Possible over the next three years. We have already taken steps in this direction. For instance, beginning in December 2017, Possible, in collaboration with the German development agency, GIZ, began the process of implementing our EHR product at Nepal’s Trishuli District Hospital in Nuwakot District. This is an important milestone since it allows us to demonstrate the use and uptake of the EHR in government hospitals that are not under Possible’s management. We are also currently considering other similar opportunities to scale use of our EHR within the public health system. With this fertile environment for innovation and potential for national scale, the integration of openIMIS with NepalEHR presents an exciting opportunity to accelerate Nepal’s progress towards universal health coverage through a seamless system for public sector health facilities to accept insurance and receive reimbursements. Furthermore, the integration of the two open source systems will have global implications for other countries attempting to launch new national health insurance schemes.

a) Technical Approach

Currently, Bahmni does not integrate an insurance workflow. The manual workflow to submit claims for those insured in openIMIS is time-intensive and inefficient. Developing a Bahmni-openIMIS integration system will streamline processes around checking and validating patients with insurance, submitting claims, and tracking claims status.

Possible’s proposed solution is an integration of openIMIS with the existing Bahmni EHR to support a seamless and unobtrusive insurance workflow. Possible will install the application, a REST-based API service, within the existing Bahmni EHR system. The Bahmni EHR will interact with this application through the API, and the application will then connect with IMIS-APIs for processing the claims.

As a component of Bahmni EHR, the application will interface directly with openIMIS for processing claims through the claim life cycle. Possible will also execute UI changes within its Bahmni EHR platform to display relevant insurance details of patients. In addition, we will add insurance TAGs on the Odoo (OpenERP) UI for invoices and process buttons.

Once this module is developed, one will be able to determine the validity and available balance of a person’s insurance account from within Bahmni. Users will be able to submit claims and track the status of these claims as “approved” or “rejected” within the system. Possible will be able to generate reports for the insurance-tagged Bills/invoices from Odoo and send claimable invoices to the openIMIS system.

Concurrently, billing encounters for each patient will be synced with Odoo and differentiated either as insurance claims or non-insurance bills. Managers will be able to generate reports on claims/non-claims from Odoo and utilize features like sorting and filtering for improved costing and planning.

b) Use of Digital Health Technologies

Figure 1 (below) shows the overall interactions between the IMIS-connect application, the EHR system and the openIMIS System. The IMIS-Connect application will act like a gateway to the openIMIS system.  

Figure 1: Bahmni-openIMIS Integration system

The application is targeted for Linux/CentOs Machines and will be an RPM-based installation. It will be built as a component service for Bahmni EHR. The existing server for Bahmni EHR will be capable of running this service in terms of memory, CPU utilization, and database space.

c) Workplan and Schedule

Possible anticipates completing and implementing the integration of openIMIS with Bahmni within 12 months of project commencement. To date, Possible has completed several activities in preparation of this integration project. We have conducted an initial requirement analysis in collaboration with Nepal’s Ministry of Health and GIZ. In addition, we have observed the current insurance and hospital workflow at one of our implementation sites, Bayalpata Hospital in Nepal’s Achham district, and interviewed users to understand their technical needs. Finally, we have drafted a systems requirement specification document that was shared with the broader Bahmni/OpenMRS community.

The Gantt chart below outlines the phases, activities, and timeline for achieving each activity over the course of the 12-month project.

d) Digital Health Atlas
Possible has registered 
NepalEHR in the Digital Health Atlas, as shown here:

e) Project Deliverables

Over the two phases of the project, Possible will achieve the following key deliverables:

Phase I: Outpatient workflow

  1. Registration billing feature in Bahmni complete;

  2. openIMIS integration module for OPD workflow developed;

  3. Training and deployment at Bayalpata Hospital in Achham complete;

  4. Technical documentation of OPD insurance integration including product architecture and installation guide for implementers complete.

Phase II: Inpatient and Emergency workflow

  1. Billing feature developed in Bahmni;

  2. openIMIS integration module for IPD and ER workflow complete;

  3. Technical documentation of OPD insurance integration including product architecture and installation guide for implementers complete;

  4. User Training Manual complete.

Two-Sentence Overview

  1. In Nepal, where the government recently passed a National Health Insurance Act, citizens and healthcare providers require novel systems to efficiently process insurance claims, reimburse providers, and, ultimately, achieve the country’s vision of universal healthcare coverage. Possible is developing an application that will seamlessly integrate the leading open source EHR (Bahmni) and the openIMIS insurance system to improve access to healthcare for the insured and reimbursement funds for providers. Once developed and tested, this application can be utilized to scale up insurance uptake nationally within Nepal and easily adapted to additional countries where Bahmni and openIMIS are currently in use.

  2. The investment will go towards the design and development of the application. It will also go towards the implementation and refinement of the application at two public hospitals in Nepal.

Community Feedback

Possible will engage with the broader digital health community through the Bahmni Coalition, a network of 15 organizations from numerous countries that collaborate around the Bahmni hospital information system. We will work with the Bahmni Coalition to obtain feedback and input, especially with regard to the architecture and design of our application prior to starting development. Once we develop the application, much of the architecture and components should be universally applicable in other settings where Bahmni and openIMIS are being implemented.

We will continue to incorporate feedback from the broader community following development and implementation of our application. In collaboration with the Coalition, we will identify other organizations and national governments that are attempting to utilize openIMIS for insurance enrollment, reimbursement, and claims processing. We will share any lessons learned with partners and continue to iterate on our application based on the insights gained by other organizations implementing the application.

Use Cases, User Stories

There are three types of users that will interact with the system: Registration desk staff at our hospitals, finance staff and claims submitting users. Each of these three types of users will use the application differently; as such, each will have their own requirements.

Registration desk staff will use the Bahmni UI to collect NHIS numbers from patients, check for the validity of the insurance account, and determine the balance left in the account, if valid. They will use the Bahmni UI to do the same for revisiting patients if their insurance details have not already been collected.

The claim submitter (a to-be-identified staff member at each hospital location) will use Odoo to submit the insurance-tagged invoices for further processing. They will also be responsible for the tracking the status of claims and resubmitting the rejected claims after correction (in case of known mistakes in claims). The UI in Odoo will be modified for supporting these actions.

Finance staff will be able to check the reports from Odoo for the claimed and billed amounts. They will be able to generate different periodic reports based on the requirements such as total claim reports, non-claims and not-claimable reports.

Figure 2 below shows the actions of the various players and openIMIS in the new workflow post implementation.

Figure 2: Insurance Workflow

The appendix includes a figure (Figure 3) detailing the step-by-step decision-making process from assessing a patient’s insurance status to processing a claim and tracking the status.

Self-Assessment on the Global Goods Maturity Model

Possible has completed the self-assessment here:


See response in Concept Note section above.

Application Status: 
Pending Review & Investment