By the end of 2015, PEPFAR through the Ministry of Health Kenya was supporting implementation of 7 health information systems (HIS)- KenyaEMR, IQCare (2 distinct versions), Ampath MRS, Faces OMRS, CPAD and E-CARE. With an increase in data demand and adoption of new HIV standards and guidelines, there was a need to ensure that all systems being implemented adhered to the set guidelines and adoption of standards based electronic health systems. Additionally, there was need to reduce duplication of efforts in system development and support.
In 2017, CDC gave the guidance to transition CPAD to IQCare, one of the two adopted EMR solutions by KeHMIS II. To achieve this, a CPAD-IQCare migration tool was developed by both Palladium and CPAD developers. This aided in the migration of over 100 sites distributed in 8 counties (Siaya, Muranga, Nyeri, Laikipia, Nyandarua, Makueni, Kitui and Machakos) between the years 2017- 2018.
With the success of CPAD migration, a further need to migrate the SI version of IQCare to KenyaHMIS version was established in 2018. The Palladium team in collaboration with developers for IQCare SI version developed a toolkit targeted on the successful migration of over 100 sites supporting facilities implemented by faith-based organizations.
In 2019, the National AIDS & STI Control Programme (NASCOP) a division of MoH, resolved to migrate all IQCare implementations to KenyaEMR in order to align with the government’s agenda of promoting and adopting a single open source software solution. KenyaEMR is based on OpenMRS which has an active global and local community of practice. This move was also strategically informed by the need to consolidate resources to support one major EMR platform that aligns well with the Government of Kenya digitization priorities and to further improve collaboration amongst partners supporting HIV program in the country. In this regard, NASCOP set up a committee of experts (CoE) to the put in place the necessary structures, processes, and procedures to guarantee successful migration of all 764 IQCare sites. This was earmarked as the grandest of all migrations and raised global attention based on the tight timelines for being achieve and the differences in implementation for the two EMRs.
To achieve this, several strategies and roles were recommended and have been key towards realizing this dream. The roles are as distributed below;
- MOH and PEPFAR
- Project governance, oversight, sensitization & communication to all stakeholders including CHMTS.
- Resources allocation.
- Project monitoring.
- Palladium and Community of Practice
- Develop the Migration Tool Kit.
- ToT Technical training to partners on migration.
- ToT training to partners on KenyaEMR.
- Conduct migration at demonstration sites.
- Develop SoPs and guides on migration.
- Service Delivery Partners
- Cascade end user training at facility level on how to use and support KenyaEMR as well as use the migration toolkit.
- Sensitize providers and end users on the migration.
- Validation of the migration toolkit.
- Prioritizing enhancements.
- Execute actual site level system migration.
The design and development of the Electronic migration toolkit commenced in October 2019. The ETL (Export, Transform and Load) procedures were adopted for this migration process. The project settled on the Pentaho Data Integration (PDI) tool for Exporting and Transforming data from the source system (IQCare) and for the Load process into the target system (KenyaEMR) the OpenMRS spreadsheet module was adopted. These tools are built on opensource platforms, are highly customizable to fit and aligned with principles of digital solutions to handle huge amounts of data. Over and above the technology, KeHMIS developed an assumptions and decision log containing key highlights on how some of the data will be handled and its implications after migration.
As at the end of November 2020, a total of 476 (62%) of the total 764 facilities had been migrated. This, after completion, will be one of the biggest migration undertakings in Africa.
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