Collecting and using health information is an important part of health workers’ jobs. While we have made great strides in moving from paper-based records to digital health information systems, data that both health workers and policy makers need is often scattered across multiple information systems that cannot “talk” to each other. This means that health workers have to spend more time entering and finding data in multiple places and results in an incomplete view of both patient and community health.
How can we address this issue? Enabling interoperability across different information systems is one promising strategy. Interoperability allows different health information systems to exchange and use data coordinated through shared application interfaces and standards to provide timely and seamless information portability—and ultimately strengthen health systems to optimize health outcomes.
The process of achieving interoperability is complex and looks different across diverse country contexts, but there are some common elements in every interoperability journey that can lead to success. We hosted a webinar as part of USAID’s Health System Strengthening Learning Series on March 27, 2024, to share lessons learned from health information system interoperability implementation across four CHISU countries.
Panelists from Indonesia, Burkina Faso, Ghana, and Madagascar shared strategies, successes, and challenges from diverse HIS interoperability implementation. CHISU Deputy Project Director Dr. Stephanie Watson-Grant moderated the discussion, which included the following government representatives:
- Pak Setiaji, Senior Advisor to the Minister of Health for Health Technology; Chief of Digital Transformation Office, Ministry of Health, Indonesia
- Dr. Wisdom Atiwoto, Director of Research, Statistics, and Information Management (Digital Health), Ministry of Health, Ghana
- Dr. Jean Serge Dimitri Ouattara, Director of the Information System, Ministry of Health, Burkina Faso
- Daniel Elysé Rakotoarison, Head of Service for the Exploitation, Maintenance, and Development of the Information System (SEMDSI), Ministry of Health, Madagascar
- Sherri Haas, Senior Digital Health Systems Advisor, Office of Health Systems, USAID Bureau for Global Health
Haas kicked off the webinar by discussing the intention behind the Health System Strengthening Learning Series and how interoperable health information systems fit into learning for stronger health systems. She also shared USAID’s digital health strategy and vision that guides investments in digital health.
Digital transformation is a top priority for Indonesia. To that end, the country’s Ministry of Health (MOH) developed a digital transformation blueprint in 2021, and they launched the SATUSEHAT data exchange platform six months later. The MOH mandates that all health facilities be integrated into the system or risk losing their accreditation. Indonesia also released a mobile app version of SATUSEHAT that provides patients with easy access to their health data to improve continuity of care.
Setiaji noted that in Indonesia, there are more than 60,000 health facilities—so that means there are a lot of different applications and systems already in use. “Because of that, it’s a very important thing that we engaged more participants and more stakeholders (including CHISU) to support us in not only building the integration, but also building the capacity,” he said.
Ghana’s digital health journey started in 2005, and the country first attempted interoperability between systems when the National Health Insurance Authority defined a standard for exchanging health insurance claim data electronically. Subsequently, there were many situations in which different systems were required to exchange data. This led to a great deal of one-to-one (also known as peer-to-peer) interoperability between two information systems, which became complicated and has led to the government looking at moving to a health information exchange—which allows health care providers to access and share a patient’s medical information electronically across multiple systems.
“The government’s ownership and leadership is very critical, even if the private sector is going to be involved, or partners are going to be involved,” said Atiwoto. “It must be government-owned and then government-driven.”
In Burkina Faso, one of the main priorities has been creating an integrated surveillance platform in the District Health Information System 2 (DHIS2) to support the country’s One Health approach. As Ouattara explained, stakeholders started with databases from each ministry involved and then defined the indicators they wanted to monitor—along with the calculation methods and data sources they wanted to use. With these pieces in place, they created a new One Health-specific database using ZATO as an extract, transform, and load (ETL) layer, which allows decision makers to visualize indicators and make evidence-based decisions. CHISU has also supported the country's maintenance of this layer.
“This approach has been an enriching experience in terms of both results and governance,” Ouattara said. “In terms of results, the platform is up and running, and there are plans to extend it vertically and horizontally. In terms of governance, the issue of interoperability has been taken seriously by the hierarchy, and every effort is being made to ensure that all platforms are interoperable.”
Meanwhile, Madagascar has established a national interoperability standard that all public institutions must comply with—but the country lacks developer interoperability guidelines, which guide data exchange. Rakotoarison noted that Madagascar is developing these guidelines with the support of technical and financial partners, including CHISU.
“In the short term, our vision is to put in place an interoperability layer enabling the seamless sharing of information between health information subsystems, and then to develop a mediator for external communication with the government’s X-Road,” he said, and explained that the country used X-Road (which is an open-source software) to establish their national interoperability framework in 2022.
Despite their different journeys, we saw a common thread that systems may vary from country to country, but government leadership and HIS governance are critical steps in the interoperability journey.
Watch the webinar recording to hear more about these countries’ interoperability journeys.