Developing a Regional Health Enterprise Architecture Framework and Principles to Enhance Interoperability of Health Information Systems in Asia

Concept Note as of July 27, 2018

Background

Countries need guidance in planning, designing, implementing, and scaling digital health as an established intervention or strategy for universal health care. Based on numerous meetings indicated within this section, an enterprise architecture (EA) workshop referred to as health enterprise architecture framework or ‘HEAF’ is being planned for August 2018 with the goal of generating a guidance publication for countries.

After training 26 members on HL7 in 2012, AeHIN discovered that simply having standards (eg, building blocks) is not sufficient without a blueprint (eg, enterprise architecture). Recognizing this, AeHIN conducted two TOGAF certification trainings for 28 members (Ulanbaatar Nov 2013 and Kuala Lumpur April 2014). From these 28, 12 eventually became certified.

At the Global Health Forum in Manila August 2015, an Interoperability roundtable was convened by AeHIN and it was agreed that a Regional Enterprise Architecture Council for Health (REACH) be formed from the AeHIN members who were TOGAF certified. REACH would be a shared resource for the region to provide architectural advice. Subsequently, REACH recommended OpenHIE as a draft Interoperability framework and encouraged members to study its features and share experiences. At the 5th AeHIN GM in Myanmar, OpenHIE and IHE proponents met for the first time.

Starting in January 2018, a series of workshops was planned by ADB and SIL-Asia to support various activities focused on health information exchange standards, interoperability, and EA leading up to the 2018 AeHIN General Meeting in Colombo, Sri Lanka where the outputs will be presented for potential regional implementation. The workshops address the need for capacity building to achieve interoperability, as well as developing web enabled resource technical capacity for health enterprise architecture principles and framework for regional adoption. The EA will take into account health information systems maturity cycle and the use of new and existing technologies for health such as HL7 FHIR[1], blockchain and DHIS2[2].  The HEAF workshop will utilize existing artifact resources[3], include outputs from workshops previously held, and will leverage expert knowledge and best practices.

Meetings of relevance thus far include:

• During the February 2018 PMAC[4] held in Bangkok, Thailand, a side meeting was convened to finalize the co-creation of the digital health investment guidance jointly developed by ADB and AeHIN[5] member country experts. The purpose of the investment guidance publication is to help governments, the private sector and the public identify investments in knowledge, people, policies and equipment that will maximize the impact of digital health. [6]  During the digital health investment meeting, it was identified countries require additional guidance in which digital health components to invest in with consideration to prioritizing foundational structures, data standards, interoperability and data use. A subsequent meeting was proposed to develop principles for an elaborated Enterprise Architecture (EA) and include representation from the public and private sectors.
• The concept for the Enterprise Architecture workshop was further elaborated on 26-28 March 2018 when the National Taipei University of Nursing Health Science (NTUNHS) hosted the 2^nd Taiwan-AeHIN Health I.T. Collaboration workshop in Taipei, Taiwan. The Health I.T Collaboration workshop, was organized by the Asia eHealth Information Network (AeHIN), Taiwan Electronic Health Association, and NTUNHS with support from the Asian Development Bank (ADB). During the workshop, AeHIN members reiterated the need to continue and build on the work that has been started during the 2017 AeHIN General Meeting in Nay Pyi Taw, Myanmar by building capacity and helping each other to develop robust components of each of the identified four main building blocks for the successful interoperability of various health information systems, namely, governance, enterprise architecture, program management, and standards.
• In May 2018, SIL-Asia organized and hosted, with support from ADB, a workshop with Integrating the Healthcare Enterprise (IHE[7] a non-profit initiative by healthcare professionals, sponsored in part by HIMMS[8]) on how to improve health information exchange through coordinated use of established health information technology standards to help address specific clinical needs in support of optimal patient care. During the four-day workshop, an introduction to IHE, including insights, strategies, common blueprints, how to write use cases, profiles and as well as how to test profiles, were discussed. The workshop included sessions on the health information system needs of member-countries, specifically Vietnam, as well as ADB learnings from other countries such as Tonga, Armenia and Uzbekistan. It also included a session on strategy planning for the AeHIN blockchain demo as well as how SIL-Asia can be established as an IHE Center for Excellence in the future.
• Also of importance, this workshop will serve to answer a call by the May 2018 World Health Assembly held at WHO in Geneva Switzerland, specifically Digital Health Resolution[9] WHA 71.7 agenda item 12.4. Items 4 – 6 call on member States to disseminate, as appropriate, best practices and successful examples of digital health architecture, programmes, and services, in particular effective policy design and practical implementation, with the international community, including through WHO, bilateral, regional, cross-regional and global networks, digital platforms and hubs.
• In June 2018, SIL-Asia organized a HL7 FHIR workshop held at ADB in Manila that focused on building further health information exchange technical capacity of the SIL-Asia and the Vietnam Ministry of Health eHealth Administration. During that workshop, it was acknowledged that countries need guidance in developing health information exchange specific architecture (e.g. interoperability layer) that includes data standards and services such as HL7 (FHIR) and integrates with existing architectural components in use in Asia and the Pacific such as DHIS2 and EMRs.To continue this work, the HEAF workshop will further progress in regional health information technology priorities with a focus on health enterprise business architecture for health information exchange, data, specifically for primary point of service/health facility, insurance support, national and/or regional infrastructure support, secondary/tertiary health support, analytics, data use, and public health reporting.

[1] http://www.hl7.org/index.cfm?ref=nav

[2] https://www.dhis2.org

[3] https://www.measureevaluation.org/resources/publications/tl-17-03c?searchterm=maturity+model

[4] http://pmac2018.com/site

[5] http://www.aehin.org

[6] https://www.adb.org/publications/guidance-investing-digital-health

[7] https://www.ihe.net

8] https://www.himss.org

[9] http://apps.who.int/gb/ebwha/pdf_files/WHA71/A71_R7-en.pdf

OBJECTIVES

At the end of the workshop, the participants should be able to:

1. Identify their country priorities and use cases for health information exchange;
2. Consolidate best practices, challenges, status from select identified countries, and other architecture models;
3. Describe the importance of national ID systems;
4. Describe the importance of using standards, such as HL7 FHIR and terminology;
5. Describe the use and importance of IHE and standards profiles;
6. Describe the value/benefits of health information exchange mechanisms necessary for effective interoperability;
7. Describe the value of looking into the uses of innovative technologies, including blockchain in the health sector;
8. Describe the value of having a health enterprise architecture for health information exchange –one that is data and data-use driven;
9. Identify the national-level HEAF needs that would be needed to develop a regional HEAF;
10. Identify various health priority use cases for the initial set of HEAF principles;
11. Develop a HEAF for health insurance purposes and HIE involving personal health records;
12. Discuss necessary functional and non-functional requirements of an enterprise architecture that includes security; and
13. Discuss the next steps for HEAF development and pilot testing.

WORKSHOP OUTPUTS

Workshop outputs are as follows:

1. Development of regional health enterprise architecture principles and draft of v1 framework guidance document;
2. Elaboration of health information exchange (HIE) mechanisms (eg layer) necessary for interoperability that is inclusive of data integration and terminology services;
3. Development and submission of regional health enterprise architecture infographics for wider group distribution and review;
4. Submission of paper that takes into account the case studies and lessons learned from various countries, including Malaysia, on new, integrated regional health enterprise architecture principles and framework for interoperability. This will be based on a maturity model approach (low/middle/high income countries with reference to countries health priorities and strategies). The paper will provide key principles for health enterprise architecture framework development for health systems of developing member countries (DMCs) in Asia.

PROGRAM

Day 1 (August 7): Why’s and How’s of HEAF

Day 2 (August 8): HEAF Country Experiences and Current Technologies

Day 3 (August 9): Future of HEAF