1. Action Plan of Piloting
Shared Health Record in Bangladesh

2. Shared Health Record
Shared Health Record (hereinafter referred to as “SHR”) is a
system that stores a patient’s lifelong medical history in
electronic format.
• It is an endeavor to create a Health Information Exchange
(hereinafter referred to as “HIE”), in mode of OpenHIE,
targeting low resource settings.
• It intends to make exchange of health information across
systems possible.
• Shared health record will be the repository of health record
in Bangladesh.

3. - Due to operational, geographical or economic reasons. For
example: power shortage, no or infrequent and/or
inconsistent internet connectivity, hardware limitation, etc.
- Synchronization of data happens based on catchment
allowing for
- only download information for patients in your
catchment
- can happen in scheduled manner, and at off-peak-load
time
- resumption of sync from last processed
- automatic circuit breaker in case of consistent failures
- Also allows on-demand manual download
Designed for low resource settings

4. Primary objectives of a Health Information Exchange (HIE)
is the consistent integration, aggregation and
communication of diverse healthcare information.
The goals of this integration are varied for different profiles
of users:
- Clinical history
- Portable health record
- Public health reporting
- Utilization review and analysis
- Clinical decision support
Health Information Exchange (HIE)

5. Putting it all together - The Bangladesh HIE

6. - So what we are dealing with is a “Health Information Exchange” (HIE)
facilitating patient care information exchange.
- SHR is one of the systems in HIE storing patient care information.
- SHR identifies patients through another system called “Master Client
Index” (MCI)
- Manages patient information. Provides a unique Health ID to each
patient
- which can identify a patient by other identifiers like NID, BRN, UID,
location etc
- There are other systems in the HIE
- Terminologies Registry - manages all terms against coding systems.
e.g. Diagnosis, complaints, symptoms, tests, drugs etc
- Provider Registry - manages all providers in the country.
- Facility Registry - manages all facilities registered.
- Location Registry - assigns a geo location code in hierarchical manner
for all regions in Bangladesh
Health Information Exchange” (HIE)

7. Technologies and standards
Standards
- Facility Registry - FRED API (supported by PEPFAR and USAID)
- Location Registry - BBS location codes
- Provider Registry - HL7 FHIR based provider spec
- Patient Data structure - Bangladesh CCDS
- Encounters and clinical information - HL7 FHIR
- Terminologies: Coding - ICD10, ICD10 PCS, LOINC, WHO ATC.
(configurable)
Architecture
- Microservices Architecture. RESTful Services
- Communication: Atom based feed protocol (simplefeed)
Technology Stack
SHR, MCI - Java Spring REST Service
SHR, MCI Database - Apache Cassandra
Patient Record Viewer - Java Spring
MCI Admin UI - PHP
Terminology Server - OpenMRS Concept Management (java, spring, mysql)
DGHS HRM - PHP with mysql
DataSense - Java Spring Service with Quartz scheduler

8. 1st Phase Activity Plan
Stream Start date End date Outcome Post-check
Bahmni
implementation
24th August
2015
24th Jan 2016
(20 weeks)
1 upazila hospital
1 district level hospital
Post implementation
support (DGHS)
DGHS staff readiness
Learning’s from
implementation
Identifying need for a
tertiary hospital
CHW app –
pilot
24th August
2015
17th Jan 2016
(20 weeks)
3 community clinics
1 union health centre
DGHS staff readiness
Learning’s from pilot
CHW app
development
3rd August
2015
31st Jan 2016
(26 weeks)
Prioritised UAT feedback
Rollout ready features
Offline
Support for
SHR, CHW app
and Bahmni
20th July
2015
26th April
2016
(41 weeks)
Level 1 support (DGHS)
Level 2 support (DGHS)
Level 3 support (TW)
SHR
development
20th July
2015
3rd December
2015
(20 weeks)
Sharing patient and health
information across
hospitals

9. 2nd Phase Activity Plan
Stream Duration Outcome Post-check
Bahmni
implementation
5 months Tertiary hospital
Upazila hospital
District hospital
Reducing duration of
implementations
scaling options
CHW app – Clinic
pilot
5 months 10 Clinics including some
Union health centres
Reducing overhead of
implementations
CHW app
development
5 months Managing schedule &
appointments
Scaling & long terms features
Options to scale
Support for SHR,
CHW app and
Bahmni
Level 1 support (DGHS)
Level 2 support (DGHS)
Level 3 support (TW)
Options to handover and scale
support
SHR development Other features like Allergies
etc. based on priority

10. Information about Piloting
Sl No Topic Description Remarks
1 Pilot area
Gazipur District Hospital
Kaliganj Upazila Health Complex, Gazipur
Kaliganj Union Sub Center, Kaliganj, Gazipur
03 Community Clinics
Infrastructure will
be ready by 16th
August
General Hospital, Chittagong
Sitakundu Upazila Health Complex, Chittagong
Kumira Union Sub Center
03 Community Clinics
Infrastructure Ready
General Hospital, Commilla
Daudkandi Upazila Health Complex, Commilla
Gouripur Union Sub Center, Daudkandi,
Commilla
03 Community Clinics
Infrastructure will
be ready by 16th
August

11. Thank You