October-December 2015 issue
The official publication of the Asia eHealth Information Network
Participants of the Conference on MA4HealthAP and AeHIN 4th General Meeting held in Bali, Indonesia.
Over 250 participants join 4th AeHIN GM Bali, Indonesia -- The Asia eHealth Information held the Conference on Measurement and Accountability for Universal Health Coverage in the Asia Pacific and AeHIN 4th General Meeting (hashtag: #MA4HealthAP) from October 26-30 in Bali, Indonesia where over over 250 state and non-state actors gathered to discuss how they can improve health service delivery and measure health outcomes in the post-2015 development era. The #MA4HealthAP and AeHIN 4th
General Meeting built on previous AeHIN conferences that spurred interest in ICTenabled change in health services and effective M&E systems to achieve UHC goals. The conference galvanized a multi-prong approach to better health care with stronger political will and unified multi-stakeholder engagement needed for operationalizing iCTen! practices (person-centric ICTenhanced investments) underpinning better M&E and health information systems for evidence-based decision-making (country
M&E and HIS roadmap investments). The opening ceremonies was graced by the representatives from the local government of Bali, AeHIN, World Health Organization, Asian Development Bank, UNICEF and the Ministry of Health Indonesia. It was followed by sessions where use of mobile applications to send questions and faccilitate discussions were employed to make participations more interactive. In the afternoon, the market place with 22 stations was held. (Continued on page 2)
AeHIN Levels Up with COBIT5 Implementation Bangkok, Thailand -- A total of 20 AeHIN members from 8 countries underwent a rigorous 3-day certification training on IT Governance. Thailand played host for COBIT®5 Implementation, the next level in ISACA’s IT Governance certification series. COBIT®5 Implementation takes off from where the Foundation training ended. It brings the participant to a deep dive on the role of frameworks in the governance and management of complex enterprise-wide IT projects. Last April 2014, thirty participants from nine countries underwent the COBIT®5 Foundation certification training. A number of successful participants from the first group were joined by seasoned practitioners to form this second group in Bangkok. The AeHIN supported COBIT®5 Implementation training was conducted by Mr. Rocky Lam , Certified COBIT trainer. COBIT®5 provides an end-to-end business view of the governance of enterprise IT, reflecting the central role of information and technology in creating value for enterprises of all sizes. COBIT®5 helps business leaders address
Participants at COBIT 5 Implementation Training
the needs of all stakeholders across the enterprise and ultimately maximize the value from information and technology. The three days training covered the topics such as analyzing the enterprise drivers, applying the implementation challenges, their root causes and success factors, assessing current process capability (As Is), determining target process capability (To Be), scope and
The Hexagon in AeHIN symbolizes “‘interoperability of systems” and when viewed in the context of the organization, it means “working together”. Though the hexagons are differently colored and sometimes overlapping, they still fit together. In AeHIN, like The Hexagons, there are many components to arrive at solutions in many eHealth problems in various countries in Asia. When AeHIN members work together, in every way, problems are solved and capacities are enriched.
plan improvements and consider practical implementation factors, identifying and avoiding potential pitfalls, leveraging the latest good practices, applying the COBIT® 5 continual improvement lifecycle approach to address these requirements and establish and maintain a sustainable approach to governing and managing enterprise IT as “normal business practice”. An added bonus were the study tours at the Ramathibodi Hospital and the Bangkok Hospital. On both occasions, AeHIN members were shown the IT initiatives of two of the busiest healthcare facilities in Bangkok. 1
Over 250 participants... (Continued from page 1) On the second day, a live demonstration led by Engr. Derek Ritz and Mr. Jai Ganesh Udayasankaran supported by a team from Mohawk College, Canada was held. Three stories that matched real-life situations faced by frontline health workers and program managers were presented. The demo showed the benefits of interoperable systems specifically how data and information can flow across disparate systems. Four stations were prepared in the plenary hall; each with laptops connected to large TV screens showing various electronic medical records and mobile phone-based applications communicating through a standards-based interoperability layer. The live demonstration focused on the maternal and child continuum where the following were featured: flow of encounters at multiple points of service delivery (e.g., PHC to hospital setting); good practices in longitudinal patient monitoring linkages with lab/pharma/billings and claims/other systems; tracking through unique IDs and registries; effective use of paper-based data collection forms related to interoperable ICTenabled platforms; rolling up equity stratified data into routine HIS; and integrating multiple data sources and using data standards to
Engr. Derek Ritz together with the team from Mohawk College Canada explaining the skit presented in the live session.
interoperate across systems. On the last day of the conference, the AeHIN Country Interoperability Labs (COIL) and Regional Enterprise Architects (REACH) were officially launched. This was followed by an overview of the MA4Health Country Roadmap. The plenary was then divided into groups to discuss and suggest priority actions. The last session was a development partner forum where funding schemes were discussed and commitments by AeHIN,
McDonald visits UPM to give a lecture on HIE
country, and partner commitments were reiterated. Special workshops followed the conference on 29-30 October 2015 to (1) address National Health ID development and implementation; (2) convene a special session of the Pacific Health Information Network; (3) form a AeHIN focus group on Routine Health Information Systems; and (4) launch the new AeHIN Geographic Information Systems (GIS) Lab.
JTMI releases Special AeHIN Issue AeHIN was featured in the most recent issue of the Journal of the Thai Medical Informatics Association (JTMI) -- Volume 1, Issue 2, July-December 2015. The issue contains five papers showing how ICT for health has been developed and implemented. Included papers are the AeHIN special editorial and position paper on AeHIN’s response to MA4Health 5-point Call to Action.
Dr. Clem McDonald with the participants of the Health Information Exchange forum.
Manila, Philippines -- Dr. Clement J. McDonald, Director of the Lister Hill National Center for Biomedical Communications, US National Library of Medicine, and one of the pioneers of Health Information Exchange (HIE) in the USA shared his insights about HIEs and how latecomers like the Philippines can fast track their implementation, in his lecture entitled, Health Information Exchange: History and State-of-the-Art.’ About 50 attendees participated in Dr. Clement McDonald’s lecture held at the Buenafe Hall (3rd Floor) Calderon Building, University of the Philippines Manila. The event has been important to the university now that health information exchanges are becoming increasingly popular as potential solutions to the diversity of the health IT marketplace. The event was opened by UP Manila Chancellor Carmencita Padilla. The event was organized by the Asia eHealth Information
Network (AeHIN) along with the UP Medical Informatics Unit (MIU), and the UP Manila National Telehealth Center (NTHC). The Asia eHealth Information Network (AeHIN) is a unique multi-country forum of professionals that promotes appropriate use of information and communication technology (ICT) to achieve better health. It supports countries in their efforts to develop their national eHealth strategy towards meeting country health and development objectives. AeHIN is open to all eHealth, health information systems (HIS), and civil registration and vital statistics (CRVS) professionals from various sectors within Asia—maximizing a regional approach for attaining greater country-level impacts. Members and experts are from the government, academe, civil society, the private sector, developing countries, and development partners working in low, middleincome countries.
The Hexagon is the quarterly newsletter of AeHIN. If you have eHealth updates and initiatives from your country that you would want to share with the network, feel free to drop us a message at secretariat@aehin.org. For more updates on AeHIN activities follow our social media accounts: Facebook: http://facebook.com/aehin| Twitter: @aehin2011 | Website: http://aehin.org
2
AeHIN now an NGO
In the photo are Dr. Fazilah Allaudin from Malaysia, Dr. Alvin Marcelo from the Philippines, Ms. Winnie Tang from Hong Kong, Dr. Boonchai Kijsanayotin from Thailand, and Mr. Mark Landry from WHO were present for the launch.
Hong Kong--Four years since AeHIN was launched as a community of like-minded eHealth advocates, it has grown into a network of over 700 members coming from 45 countries around the world. This December, AeHIN has been formalized as a Non-Governmental Organization (NGO) incorporated in Hong Kong, independent of but remaining a critical collaborator with WHO and other development partners.
AeHIN WC meets in BKK
The AeHIN Working Council concluded the year with a meeting in Bangkok on December 1, 2015. After a review of the past four years marked by rapid growth in membership, AeHIN aims to consolidate its trained members into a shared resource for the region, These are: 1. The Regional Enterprise Architecture Council for Health (REACH) 2. The Community of Interoperability Labs (COIL) 3. The Geographic Information Systems Labs 4. The DHIS2 Implementing Countries The Working Council resolved to ensure that countries still without certified personnel be scehduled for their own training and supported with their national eHealth program development through resource sharing and knowledge exchange. The rapid network effect among peers which has been effective will be harnessed to loop in more countries into the networked learning process.
HMIS Development in Afghanistan (2003-2015) In 2002, the newly formed Ministry of Public Health (MOPH) inherited a health system that was in shambles: individual health facilities were offering services, but there was no health system to speak off. The few national guidelines that existed were on paper. The most updated listing of active health facilities was maintained out of country. While definitely offering a possible starting point for planning, much of the data had not been updated for more than 6 months, and the list mixed facilities and services offered at the facilities indiscriminately , thus making it impossible to estimate the existing number of active service delivery points. Several vertical programs (EPI, TB, malaria) maintained routine service delivery data, but the repository databases were maintained by the respective donor/UN agencies. The data contained in these databases was often incomplete, of questionable reliability and generally only available to the MoPH under the form of summary reports. Most of the health services were delivered by NGOs, who were apprehensive of close relationships with the central government, quite understandable given the nature of the recently ousted Taliban regime. A routine general service statistics database existed in the MOPH, it was newly implemented and contained little information, reflecting the reluctance of NGOs to regularly report to the central MOPH. There was no modern IT infrastructure in the MOPH, neither were there reliable utilities like electricity, heating, water. Decision making in the MoPH was influenced by all kinds of considerations, but not by using existing data. Several factors represented a good opportunity for development of a functioning HMIS. A sustained influx of donor funding for health systems improvement was likely to exist for several years to come, and likewise sustained technical
In the picture (from left to right) are Ms. Aliyah Evangelista from the Philippines, Ms. Win Min Thit and Dr. Boonchai Kijsanayotin from Thailand, Dr. Fazilah Allaudin and Ms. Dirayana Kamarudin from Malaysia, Dr. Jakir Hossain Bhuiyan Masud from Bangladesh, and Dr. Alvin Marcelo from the Philippines. Other WC members not in the picture joined the meeting via WebEx.
AeHIN REACH meets in BKK
The AeHIN Regional Enterprise Architecture Council for Health (REACH) met last December 1, 2015 in Bangkok to discuss possible activities for 2016-2017. After various members of AeHIN received certification trainings on IT governance, enterprise
architecture, and standards, the REACH intends to build and maintain a repository of shared architectural artifacts for the region. These artifacts will inform countries on appropriate solutions tht they can adopt to maximize reuse of IT infrastructure for healthcare
Sri Lanka-Army Hospital to use EHR
A team led by Dr. (Col.) Nishantha Pathirana , in-charge of Army Hospital of Sri Lanka, visited eHospital-Dompe in November. The officials of the IT division also participated in this field visit. With the capabilities and positive attitudes, they will start using EHR to improve quality and efficiency of health care and patient safety in their hospital.
assistance for improving critical health systems performance. The newly formed MOPH set clear health policies and strategies, targeting conditions that contributed most to the high child and maternal mortality. The recommended interventions were formulated in the
Basic Package of Health Services and the Essential Package of Hospital Service. After a quick assessment, the newly formed MOPH realized that most of the service delivery was implemented by NGOs, and that the MOPH would be incapable of taking over this task in the near future. (Continued on page 4)
Not an AeHIN member yet? Visit our website http://aehin.org to register and email us a copy of your CV at secretariat@aehin.org!
3
HMIS Development... (Continued from page 3) It therefore went for contracting out mechanisms for the service delivery whereby NGOs would receive donor funding through the MOPH to implement the BPHS and EPHS throughout the country. This allowed the MOPH to focus its efforts on assuming the stewardship role for the health system: making policy and strategy, putting regulatory mechanisms in place. For the donors and the broader Afghan government to buy in to this mechanism, ongoing performance monitoring of the contracted entities was required, and hence also improved Health Information Systems. At the same time, the contracting mechanism allowed for enforcing contractual compliance with standard MOPH reporting systems. While some were pushing for different assessments to define health priorities, the MoPH in 2002 had a clear idea of what the priority public health interventions should be and what the most vulnerable portions of the population were. In a country, starting out as one of the poorest three decades ago, having known decades of foreign occupation and prolonged civil war, with large parts of the country out of the control of a central government most of the time and no organized delivery of the most basic health services, one knows that the groups suffering most are younger children
and women of child bearing age. Very early on, the MoPH focused most of the donor funding for health on a Basic Package of Health Services, addressing the common childhood killer diseases, conditions related to poorly assisted pregnancy and childbirth for women, and major infectious diseases for the general population. For most of these conditions, low-cost interventions of proven efficacy existed. Profiting from the quasi non-existence of open opposition to the Transitional Authority early 2002, the MoPH mobilized different donors to support a massive inventory taking of facilities, staff and services, covering all but 2 of the then 329 Afghan districts. Having the most updated information at readily hand helped put the MoPH firmly in the driver’s seat for planning the implementation of the BPHS. Immediately after the initial assessment, the MoPH started registering health facilities, assigning a unique MoPH code to each registered facility. Application for inclusion in the contracting-out mechanism, i.e. qualification for donor funding for implementing the BPHS was made dependent on official registration with the MoPH of the facilities included in the contract. Late 2002 the rather primitive ANHRA (Afghanistan National Health Resource Assessment) database was
adapted to become the base of the HMIS database which was Facility Master List/database opening a room for integration of all health sector databases, and later on all other databases developed by the MoPH. Determined to ensure that the ANHRA would not become yet another assessment whose data would lose accurateness with time as the BPHS would increase in coverage, the MoPH quickly assessed the capacity of the existing HIS for providing routine data on the progress of BPSH implementation. The existing HIS database contained updated reports of about 5% of the active health facilities, and it did not address all priority interventions of the BPHS. A main stumble block was the centralized data entry, which created backlogs even for the small amount of data it contained. Early 2003, the MoPH created an HMIS Task Force to revise and update the existing HMIS. The Task Force defined working principles that are still guiding the present revisions of the HMIS. The resulting dataflow is a hybrid system of paper and electronic data transmission, the degree of computerization depending on the capacity at provincial level for replicating and synchronizing copies of the database. For those provinces where replication and synchronization is available, NGOs
Ministry of Public Health Information Architecture
provide monthly electronic copies of the database to the Provincial Public Health Office (PPHO), which then forwards quarterly copies to the MoPH. When that capacity is not available at the PPHO, NGOs send their replica (Soft copy of data set) to the MoPH, where it gets synchronized into the master file. All PPHO send their own replica, which in some cases contains the synchronized data of the NGOs, to the MoPH. Anybody contributing data to the system receives quarterly analysis copies of the complete HMIS data base. NGOs report to MoPH monthly on BPHS implementation for each component. In addition, MOPH reports to cabinet and parliament – helped keep health as a priority within the government. Also HMIS data feeds into annual results conference and strategic planning for MoPH and keep provincial public health offices updated and focused on BPHS. Beside of that HMIS data allows NGOs to monitor activities of each facility. It is important that the design of a HMIS gives consideration to what can be realistically achieved with available resources and capabilities. That the Afghanistan HMIS reflects the main priorities of the health sector and their supporting implementation strategies and documents including the BPHS and EPHS and the National Core Health Indicators.
After successful implementation of HMIS in 2010, the MoPH Executive Board has determined that the HMIS department will have oversight of the MoPH all databases and provide technical expertise to establish standards and procedures to ensure better consultation, coordination, development and supervision of the MoPH databases as well compatibility and integrity of those databases to HMIS database. This lays the foundation for the development and coordination of a data warehouse. This is one of the critical activities identified in the MoPH Strategic Plan for the MoPH HMIS Department. There are no private providers that have the essential health experience and technical skill to continue the development and maintenance function of the MoPH databases. The MoPH HMIS database is the “common” database for which many critical departmental databases interact relationally with the core system. See diagram below. Changes or additions to any databases affect the main core system. The MoPH HMIS Department is to take the technical lead in facilitating and coordinating database development. This HMIS system has three main databases which include: A “common” database containing data related to the organizational hierarchy, and related data (e.g. GPS co-ordinates, grant data, and organizational
hierarchy data); A “backend” database; and A “frontend” database or user interface. At present the MoPH databases are at the level of a datamart, which allows each department to easily extract data from their own databases or other queries using a common link. Integrating at a minimum the HMIS, the HRMIS and the EMIS and the Surveillance system will provide decision makers with easy to access dashboard indicator information. To date the TBIS, Expanded Program for Immunization, HIV/ AIDS, Blood Bank have been successfully integrated. Further integration efforts are needed to develop a database warehouse. This will also assist in the streamlining of Health Information System functions. Currently there are multiple departments responsible for HIS functions with limited coordination. A data warehouse allows easier access to pre-determined and well-coordinated information without the need to structurally reorganize the MoPH Organogram. In addition, the HMIS Department will, on behalf of the MoPH, lead an initiative with the World Bank to develop public access to data and reports to improve governance and accountability. This intervention is a multi-sectorial initiative and implies a publicly available website and or data repository or portal that includes data on the core indicators, metadata and survey, and analytical/statistical reports.
We have held more than 50 webinars already! Webinar recordings are available at http://aehin.org/aehinhour Never miss a webinar again by checking our public calendar at http://bit.ly/aehinhourcalendar
4