This document summarizes a presentation on health information system (HIS) interoperability and integration given by Manish Kumar and Sam Wambugu of MEASURE Evaluation. It describes issues with HIS in low and middle income countries like weak systems, lack of standards and data quality. It discusses the importance of interoperability, data standards, and collaboration. Country experiences from Liberia and Swaziland show efforts to develop HIS strategies, integrate systems, and use data for decision making. Key messages are promoting country ownership, stakeholder collaboration, agreed information architecture and standards, and institutional data use.

1. Health Information System
Interoperability and
Integration to Maximize
Effective Decision Making
Manish Kumar, MPH, MS
Sam Wambugu, MPH, PMP
MEASURE Evaluation
October 6, 2015
Brown Bag Presentation
USAID

2. Outline
• Describe ecology of HIS
• Discuss issues around interoperability and
integration
• Present country and global experiences
• Key messages
• Tools and resources

3. Adapted by MEASURE Evaluation from Common Road Map Steering Committee. Roadmap for Health Measurement and Accountability. June
2015. Washington, DC: World Bank Group, USAID, and the World Health Organization. Available from http://ma4health.org.

4. HIS situation in LMICs
• Weak health systems, leadership, and
governance
• Inadequate capacity
• Limited user engagement
• Lack of standards
• Redundant data
• Data quality issues
• Fragmented HIS

6. What can we do?
• Collaborate and conduct HIS landscape
assessment
• Agree on health information needs
• Develop standard measurement indicators
• Develop data and interoperability standards
• Build technical, institutional, and organizational
capacity
Develop country HIS architecture.

7. What is interoperability?
Ability of health information systems to work together
within and across organizational boundaries in
order to advance the effective delivery of
healthcare for individuals and communities.
Ability of different information technology systems
and software applications to communicate,
exchange data, and use the information that has
been exchanged.
Source: HMISS Interoperability and Standards Toolkit

8. What are data standards?
Broadly grouped under two categories:
• Data representation standards
 Data structure-XML
 Data semantics-ICD10, SNOWMED, LOINC
• Data interchange standards
 HL7
Context of standards is the information
architecture

10. Country and global experiences
• Liberia
• Swaziland
• DATIM

11. HIS situation in Liberia
• Progress in generating service delivery data through the
HMIS and using them for decision making
• Limited development of resource information systems
• Fragmented HIS components and data sources
 Example: weak link between HMIS and DHIS 2
• Lack of ‘co-operability’ among multiple partners
• Outdated HIS strategic plan (2009)
• Lack of adequate ICT infrastructure and capacity

12. HIS strengthening in Liberia
• Conducted overall HMIS and ICT infrastructure assessment
• Facilitated development of HIS Strategy 2015−2021
 Supported MOH to create a stakeholder coordination mechanism
 Facilitated stakeholder consultation to achieve consensus on the strategy and
operational plan
• Supporting development of HIS data architecture
• Provide technical assistance to accelerate the process of
integrating HIS systems and their sub-systems
• Facilitating collaboration between MOH and OpenHIE community
• Enhance MOH capacity to use data for decision making

13. HIS situation in Swaziland
Results of HIMS assessments in Swaziland:
• Parallel/ disease specific systems
• Too many data collection tools
• Lack of procedures for data collection
• Lack of a modern, patient-based information
system to capture, store, and retrieve a clean
dataset

14. 1. Developed an enterprise architecture plan
2. Established a Strategic Information Department for MOH
3. Developed a consolidated patient
file and a Unique Patient Identifier
4. Developed a modular client
management information system
(CMIS) / EMR
5. Developed clinical data servers
(distributed data servers)
6. Ongoing development of
clinical data warehouse
Swaziland
HMIS strengthening steps

17. Key messages
• Promote country ownership and build local
capacity
• Establish stakeholder collaboration and
coordination
• Agree on information needs and architecture for
health systems
• Develop/adapt standards-based health information
architecture
• Promote institutional mechanism for data use

18. Tools and resources
Common Road Map Steering Committee. Roadmap for Health Measurement and
Accountability. June 2015. Washington, DC: World Bank Group, USAID, and the World Health
Organization. Available from http://ma4health.org.
Gobee Group. Regional, Real-Time Data Infrastructure for Ebola Response: An Assessment
of On-The-Ground Data Systems and Realistic Opportunities for Transformation in Guinea,
Liberia & Sierra Leone. Gobeegroup.com. July 2015.
HIMSS. HIMSS Interoperability and Standards Toolkit. Available from
http://www.himss.org/library/interoperability-standards/toolkit
HMN WHO. Framework and Standards for Country Health Information Systems. Second
Edition ed. Geneva: World Health Organization: Geneva, 2008
Principles for Digital Development. Available from http://digitalprinciples.org/wp-
content/uploads/2015/05/Principles-Overview.pdf
Ritz D, Althauser C, Wilson K. Connecting Health Information Systems for Better Health:
Leveraging interoperability standards to link patient, provider, payor, and policymaker data.
Seattle, WA: PATH and Joint Learning Network for Universal Health Coverage, 2014

19. MEASURE Evaluation is funded by the U.S. Agency
for International Development (USAID) under terms
of Cooperative Agreement AID-OAA-L-14-00004 and
implemented by the Carolina Population Center, University
of North Carolina at Chapel Hill in partnership with ICF
International, John Snow, Inc., Management Sciences for
Health, Palladium Group, and Tulane University. The views
expressed in this presentation do not necessarily reflect
the views of USAID or the United States government.
www.measureevaluation.org

20. Question and answers