The Story of Nakanda
Nakanda is a fictitious country with a challenging HIS landscape. To understand the value of global goods developed by the GIC available in the Sandbox let’s consider the fictional case study of Nakanda, Wakanda’s poorer neighbor. (Wendy was here and changed to “neighbor”).
Nakanda’s Goal
To control the HIV epidemic through robust case surveillance, evidence based targeted interventions, and systematic and timely monitoring and evaluation.
Ministry of Health Mandate
Make all electronic medical records (EMR) interoperable and standards-based.
Scenario - HIV Case Surveillance System
Current State
- Three different EMR systems, one of which is OpenMRS installed in 400 of 1000 sites
- OpenMRS system is three versions behind
- Each EMR system has a different concept dictionary
- Each EMR system is funded by a different donor
- Each EMR system is supported by a different implementing partner
- EMR systems in facilities are enabled to capture core data, including patient demographics, fingerprints, and clinical data
- HIV case surveillance system does not support reporting and analytics
Patient Care Scenarios
- Patients primarily return to a home health facility for care and medications
- Patients have lab test performed at a laboratory separate from the home facility
- Many patients do no return to the their home facility for follow up and medication pick up
- When visiting family on occasion patients may visit an different or away facility
Challenges
- Limited data use at health facilities
- Limited data use for clinical decision making
- Insecure data transmission via email
- Data lost via email transmission
- Delays result from the need to retransmit data
- Data from away facility visits are not transmitted to home facility limiting the continuum of care
- Clinicians at the away facility do not have access to the patient's medical history, limiting the care provided
- Patient data from varying facilities are not reconciled when reported to the national data repository (NDR)
- Data cleaning and deduplication are manual processes using R and Excel causing duplication resulting in inflated numbers
- Patients are being registered as new people at facilities and labs, so classified "lost patients"
Enhancement Opportunities
Leveraging global goods developed by the GIC, Nakanda can move to an HIV case surveillance system with higher quality, complete, and timely data that supports programmatic decision making.
This includes goods that will help to ensure a secure environment for data exchange across the complex EMR and lab systems landscape.
Further, to assist Nakanda in successfully achieving this, goods are also available to support budgeting for the enhancement work and evaluating the outcomes.
GIC Global Goods to Support Robust Case Surveillance in Nakanda
Implement a standards-based interoperable open-source EMR (OpenMRS)
Standards-Based, Governed Data Elements
- OpenMRS HIV Reference Implementation (OHRI) HIV Testing Services Concept Dictionary and Care and Treatment Concept Dictionary (Requires OpenMRS Open Concept Lab (OCL) Registration)
- OHRI Care and Treatment Concept Dictionary
- OHRI HIV Testing Services (HTS) Concept Dictionary
- Terminology Management Learning Series
Defined EMR Requirements
- Digital Systems Assessment Toolkit (DSAT)
- EMR Requirements
Migration to Single Standardized EMR
- Costing Toolkit
- OHRI
Establish Standards-Based Data Exchange
OpenHIE Based Architecture for Interoperability
- Requirements and Processes for Data Integration Use Cases
- Health Data Access, Sharing, and Use Generic Guidelines
- Policy and Standards for HIE
Patient Identity Management
- Client Registry Requirements
Ensure Data Privacy, Confidentiality, and Security
- Health Data Privacy, Confidentiality, and Security Generic Guidelines
- Health Information Security Toolkit
- Data Security and Confidentiality Requirements for DISI Architectural Approaches
- Procedures for Data Extraction, Transformation, Transmission, Loading, Storage and Use for DISI
- Guidance on Managing Data Groups for Data Integration to Ensure Data Privacy and Confidentiality
Strengthen Workforce
- Informatics for Leaders (I4L)
- HIS Project Management Toolkit Training
Ensure Effective Management and Monitoring
- HIS Project Management Toolkit
- DSAT
- ISO Assessment
On This Page
- The Story of Nakanda
- Nakanda’s Goal
- Ministry of Health Mandate
- Scenario - HIV Case Surveillance System
- Current State
- Patient Care Scenarios
- Challenges
- Enhancement Opportunities
- GIC Global Goods to Support Robust Case Surveillance in Nakanda
- Implement a standards-based interoperable open-source EMR (OpenMRS)
- Establish Standards-Based Data Exchange
- Ensure Data Privacy, Confidentiality, and Security
- Strengthen Workforce
- Ensure Effective Management and Monitoring
