Health Innovation Note #1: Make health information travel, not patients

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This article is a contribution to Madiro's Health Innovation Notes, a collection of news that describe the progress and endeavors of Madiro and its partners toward advancing sustainable and scalable digital health solutions in low- and middle-income countries (LMICs).

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In the pursuit of global health equity, one of the most pressing challenges faced by low- and middle-income countries (LMICs) is the limited ability of health information to travel seamlessly across various healthcare providers. The current fragmented system often requires patients to physically visit different healthcare facilities, resulting in increased costs, inequities, inefficiencies, and delays in care – assuming that traveling is an option. However, envision a future where health information flows effortlessly, enabling healthcare providers to access vital patient data regardless of their location. This impactful shift has the potential to transform healthcare delivery and improve outcomes in the most remote areas. This note delves into the initial steps that Madiro Digital Health is taking in that direction. 

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The Benefits of Health Information Exchange

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Imagine that after being examined and referred by a community health worker, a patient visits the nearby last-mile health facility where contact and screening information is already available. With an interconnected health information system, the patient's medical history, allergies, and previous treatments can be readily accessed by the healthcare provider, allowing for personalized and informed care. This also eliminates the need for patients to carry paper-based records or rely on memory to provide crucial medical information while simultaneously increasing the visibility of health data for health partners and governments.

Furthermore, seamless health information exchange enables telemedicine consultations. Picture a scenario where a patient in a remote primary health care center receives a consultation with a specialist sitting in a district hospital a hundred kilometers away. By securely accessing all relevant clinical information, such as laboratory results, X-rays, and previous diagnoses, the specialist can provide accurate and timely recommendations. This virtual interaction saves time, reduces travel costs, and brings specialized care closer to those who need it most.

The Path To Transformative Healthcare Delivery

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Developing partnerships

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‍Bolstering collaboration among stakeholders is crucial for successful health information exchange regardless of the software or platform they use. Engaging government bodies, NGOs, healthcare providers, and technology experts in collaborative initiatives promotes knowledge sharing, resource pooling, and aligning efforts towards common priorities. 

Madiro constantly and actively engages with all actors from the digital health community. In particular with open-source communities that often thrive on collaborative development and can benefit from partnerships with organizations that have expertise in the implementation and scaling of digital health solutions. For example, Madiro is financing the secondment of resources for Médecins Sans Frontières (MSF) to assess and pilot OpenMRS, a well esteemed open-source electronic medical record (EMR) solution implemented in more than 8,000 sites, as a candidate for the digitalization of medical operations that is ready for interoperability and data exchange. 

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Understanding each other

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Language and terminology inconsistencies often hinder effective health information exchange. Madiro is focusing on ways to harmonize medical content by collaborating with frontline healthcare workers, terminology platforms such as OpenConceptLab (OCL), and medical terminology experts such as the Columbia International eHealth Laboratory (CIEL). Ensuring a common language for clinical forms, diagnoses, treatments, and indicators across organizations, levels of care, and platforms aims to facilitate seamless communication between healthcare providers globally as well as the reusability of already authored and refined content in multiple contexts. 

For example, Madiro and MSF collaborated with OpenFn, a Digital Public Good focusing on interoperability, on a proof of concept in May 2023 to showcase the automated synchronization of patient data between OpenMRS EMR and DHIS2 indicators, even though both systems might use different medical content definitions. Practically, it means that data captured once in the EMR can be consumed by multiple systems without entering it manually multiple times, which also reduces the chances of errors or gaps in data. That is key to Ministries of Health that are looking for accurate monitoring and evaluation (M&E) at all levels of care. That prototype could also be extended to the integration of a Master Patient Index (MPI) and distributed EMRs to support the vision of “one patient, one record” in the context of nationalizations. 

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Establishing governance and protocols

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Digital health is often driven by specific implementation requirements, regional considerations, or delivery deadlines. It results in siloed datasets, duplication of data, and fragmented efforts to develop similar tools. In that context, Madiro dedicates time to support the alignment of the vision, guidelines, and roadmap of the OpenMRS development and its implementers like MSF, the International Red Cross Committee (ICRC), and Partners In Health (PIH). The result shows a common interest in shared requirements and additional conventions are needed to encourage more sustainable contributions to the product, rather than implementer-based or health program-based development that are difficult and costly to maintain. Moreover, any new development is following the internationally agreed protocol Fast Healthcare Interoperability Resources (FHIR) to facilitate health information exchanges between systems.

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Together For A Greater Impact

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The vision of making health information travel, less the patients, holds immense potential for transforming healthcare delivery and achieving global health equity. The convergence of partnerships, harmonization of practices and content, shared conventions, and innovative prototypes are essentials. By ensuring seamless health information exchange, healthcare providers can offer personalized and timely care, regardless of geographical barriers. Embracing these initiatives will not only enhance patient outcomes but also foster more efficient and equitable healthcare systems. 

Connect with us to explore how we can pilot and scale innovation, empower communities, and leverage technology for more sustainable and inclusive healthcare. 

#Healthcare #DigitalHealth #Collaboration #Interoperability #OpenInnovation #Sustainability

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