Toward a global framework for e-health information systems

Toward a global framework for e-health information systems by David Lubinski and Jan Grevendonk, PATH Improving health outcomes through strengthened platforms and systems has emerged as a guiding principle of donors and multilateral agencies. A key building block for this effort will be the development of integrated information systems to support a variety of products and programs. In the summer of 2008, the Rockefeller Foundation sponsored a conference series bringing together more than 200 leaders from developing countries, the global health care community, technology, finance, policy, and government. The Foundation called for the development of a global e-health architecture to ensure that these systems both comply with global standards and meet the needs of their users. In order to meet the needs of health workers across programs and countries, global and in-country stakeholders must identify common functional requirements that translate these needs into a language that can be used by developers to deliver appropriate information system solutions. In this context, the Rockefeller Foundation awarded PATH, a grant to develop a catalytic approach to health information system strengthening through the Collaborative Requirements Development Methodology (CRDM). The CRDM consists of three sets of activities: (1) a landscape analysis of best practices and research, (2) identification and validation of functional requirements, and (3) standardized documentation of the functional requirements and processes in non-technical language. Ensuring the continuous availability of vaccines, pharmaceuticals, and medical supplies is core to any health system strengthening effort. Improving logistics management also represents a common challenge for many countries and programs. For these reasons, CRDM was first applied to the development of requirements for Logistics Management Information Systems (LMIS). The goal of LMIS is to ensure that adequate quantity and quality of vaccines, essential medicines, and supplies are always available to meet patient demand. In order to do this, the LMIS must be capable of: 1. Capturing accurate routine administration, dispensing, and consumption data. 2. Real-time end-to-end logistics management from the point of origin to service-delivery point. 3. Demand forecasting, capacity planning, and modeling based on consumption. The application of CRDM requires rich collaboration from stakeholders, subject matter experts, and users to identify the core business processes relevant to logistics and describe their associated activities and workflow. Between October 2009 and April 2010, partners engaged in this collaborative effort and designed a model for LMIS, listing each business process and its information requirements. Four countries (Vietnam, Kenya, Senegal, and Rwanda) validated the model and provided feedback, which the working group used to refine and augment the original model. The resulting map of the business processes involved in LMIS is displayed in Figure 1. For each business process shown in Figure 1, there is a clear objective (e.g., the objective of receiving is to receive verified quantity and quality of goods into store and determine need for remedial action when necessary. There is also a set of statements that describe the functionality that an information system would need to provide in order to support each business process. To continue with our example of business process (receiving) there are several areas of functionality required. For example, the system needs to provide notification of arrival, it needs to provide the information necessary to prepare storage space, and it needs to show the results of an inspection upon arrival, among other things. Each of these functions, in turn, require inputs and outputs that are easy to understand and use on a regular basis. Together, the requirements for logistics management information systems provide the beginnings of an architectural framework that crosses national boundaries and provides a strong base for developing rational, easy-to-use systems for storing, retrieving, and using information for better decision-making within the health system. PATH and the Health Metrics Network (HMN) are now reviewing these processes and requirements with a broader group of stakeholders which will lead to additional feedback and refinement. Following this review phase, documents describing the common requirements for LMIS will be released to the global health community for LMIS-strengthening efforts in countries. These common requirements can be used to identify gaps in current systems, as terms of reference for the development or acquisition of new systems, or at a very basic level, to help document standard operating procedures or develop training materials. The methodology may also be applied to other domains in the health system. The results of this work will be published and made available through WHO and the HMN. Countries, donors, and software developers working on health care related information systems will then have a strong, validated base to build upon be it assessing if a preexisting information system is right for them or developing a customized system to meet their unique needs. We invite you to comment on or post a question relating to this article by clicking the post reply button on this page. 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