Summary IL

Palladium KeHMIS appreciates the efforts made by other Health information solution developers and is cognizant of the fact that some of these solutions are also funded by donors. In these regards, KeHMIS has developed an interoperability layer (IL) towards the provision of a standards-based interoperability solution that orchestrates data exchange between disparate systems within health care settings. Based on the OpenHIE framework, our interoperability solution promotes clinical data sharing for care coordination and automated reporting to national systems. This has been possible through PEPFAR funding under the cooperative agreement with CDC Kenya.

The KeHMIS interoperability layer (IL) has a total of 8 participating systems in the country, namely, Ushauri – an automated appointment diary with a defaulter tracing module that ensures patients are seen and followed up in the shortest time possible, Text for adherence (T4A)- which uses SMS/USSD for monitoring Adherence to ARVs and reporting problems, Web Antiretroviral Dispensing Tool (Web ADT), mobile Laboratory (mLab) which uses SMS for sending lab results from the national laboratories to a dedicated facility phone, Kenya’s DHIS2 (KHIS), Platform for Partner Progress Monitoring (3 PM) and KenyaEMR or IQCare.

Currently, the use cases implemented in the IL are based on Health Level Seven International (HL7) standard for care & coordination and the Aggregate Data Exchange (ADX) standard for aggregate data reporting. The existing use cases for IL are;

Client Registration – The goal was to avoid patient duplication by centralizing client registration in one system (EMR) to serve as a Client Registry. Through subscription, other systems (WebADT, T4A) receive the registration message.
Appointment management – The goal is to avoid double work where the appointment adherence team have to key inpatient details and appointment details already documented by the provider into the T4A system. The use case caters for scheduling, cancelling, and honouring appointments).
Prescription and Dispensing – Automates the Prescription and dispensing information data exchange between pharmacy systems and Care & Treatment systems;
Viral load Management – In this use case, the system exchanges data with EID/VL systems to achieve remote log-in of VL orders and automated transmission of lab results to the KenyaEMR system.
Clinical observations – In this use case, clinical observations such as weight, temperature, height, etc., documented mainly by the clinicians and nurse, are sent to other subscribers such as the Pharmacy information systems.
Automated Indicator Reporting (AIR) – Automates reporting of aggregate data from health facilities to National reporting system – DHIS2 and reporting Key population variables to 3 PM donor system.

The IL is enhanced with specific features to enhance the operation across systems. These features are:

Contract & Subscription Management:  IL implements a publisher-subscriber model where the sending system declares what type of message it will be publishing, and other systems can subscribe to receive such messages once published. In this model, the publisher and the subscriber do not have to “know” each other. In addition, a single published message can be sent to multiple subscribers. By subscribing to a message, the subscribing system is confirming that it has the capability to consume the said message.
Message Routing: The IL ensures that messages despatched from a source application are routed to the respective target system that has an explicit subscription for the dispatched message.
Message Queuing: If a target system is offline, The IL will continue to poll the target system and send any messages intended for the target system when it comes back online. The priority queuing algorithm has been enhanced for this.
Message Syntax and standards definitions: The IL is a standard based message broker. This means the sending and receiving systems must be able to process and generate messages as per a defined standard. It comes prepackaged with message templates for all the messages channels currently configured. These templates support participating system owners to configure their systems to produce and consume messages.
Message Logs: The IL provides a log that clearly indicates the Source systems, target systems, message payload and status of the message exchange. This information is used by the system implementer to detect any issues with Interoperability messages that they have sent or received.

Interoperability has been enhanced to achieve the following benefits to the health care systems:

Improved care coordination and patient experiences
Greater patient safety
Stronger privacy and security for patients
Higher productivity and reduced healthcare costs
More accurate public health data