A community of software developers and organizations from around the world are working together to create a vibrant ecosystem of 'digital public goods' to support the health, finance, and education sectors, among others.
The term digital public goods refers to "open source software, open data, open AI models, open standards and open content that adhere to privacy and other applicable laws and best practices, do no harm, and help attain the SDGs," according to the definition endorsed by the UN Secretary-General (Roadmap for Digital Cooperation, Report of the Secretary-General, 2020).
In the healthcare sector, a growing suite of open-source software packages has been developed with support from GIZ, World Bank, USAID, and others, to strengthen and improve healthcare services around the world. These distinct and autonomous digital technologies can be linked together and configured to rapidly exchange data between platforms, helping to streamline critical processes and avoid errors in data management. This ability for different applications to communicate and exchange information with one another is known as 'interoperability'.
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The component parts of any healthcare system rely on the exchange of information such as patient medical records, test results and immunization statuses. The manual transfer of information — printing records and typing the data into another system — is very time-consuming and creates numerous opportunities for human error to corrupt the dataset. A simple mistake in the data-entry process can break the link between a patient identifier and their records, leading to delays in providing healthcare or settling insurance claims. The manual transfer of data is inherently less reliable, cost ineffective, and error-prone. By contrast, transferring data between interoperable systems is fast, reliable, and cost-effective. Digital technologies that share common standards (rules governing language and data structure) can instantly transfer critical information between one another, ensuring records remain accurate and up-to-data across all parts of the healthcare system.
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There are several digital public goods operating across the healthcare sector that are interoperable with openIMIS, including DHIS2 (the world's largest health information management system, founded in post-Apartheid South Africa) and OpenMRS (an open-source electronic medical record technology created by a global community of developers). For example, OpenMRS can send a hospital bill directly to openIMIS for an insurance claim to be processed and the results can then be returned directly to the hospital. Such direct links between different parts of the system helps to streamline the claims management process, thereby saving hospitals and administrators time and money.
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The mediation of data flows between different software packages is critically important to achieving interoperability. The Health Information Exchange Initiative (OpenHIE) defines a blueprint for national digital health information systems built from the growing ecosystem of free and open-source healthcare technologies. It specifies how software components communicate through common standards to establish shared workflows, data structures, and vocabularies.
The standardized framework used by open-source healthcare technologies is the HL7 standard for Fast Healthcare Interoperability Resources. The FHIR standards gained significant momentum as a result of the Affordable Care Act in the USA, which requires hospitals to exchange data with the health financing authorities.
Information mediators (based on software such as OpenHIM) sit within this interoperability layer, processing the data exchanges between systems to avoid software packages having to directly connect, which would introduce unnecessary complexity into the process.
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Establishing any new implementation of openIMIS will require the transfer of data (for example, migrating patient records from a hospital database to openIMIS) whether or not the system takes advantage of the software's potential interoperability with other platforms.
Some users of openIMIS have adopted an 'integration' approach to data transfer that involves downloading information in a particular format (e.g. Excel spreadsheet) and importing this directly. This approach can work, however, it requires the development of bespoke adaptors (to manage the import and data-sorting) to ensure each report is generated in the correct format and discrepancies (e.g. US vs European date formats) are managed.
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Interoperability brings significant economic and time-saving opportunities to organizations and institutions working across healthcare, in particular those serving developing countries. The economic advantages of adopting an open-source and interoperable system include:
The speed and accuracy of exchanging data avoids costs of manual data-entry and dramatically minimizes the potential for introducing errors into datasets.
Interoperable systems avoid the need for hybrid data-transfer solutions on a case-by-case basis (integration), with potentially expensive and time-consuming workflows.
Open-source software is totally free to use and adapt.
The global community of developers and users is highly supportive and responsive to the challenges that may arise, avoiding the need for expensive technical support arrangements.
For countries in the global south, there really isn't a viable alternative to open-source software given the costs involved with licensing and managing commercial software. Nevertheless, interoperability is never an off-the-shelf option.
Every implementation of openIMIS that interconnects with other software platforms will require investment and significant work to ensure the frameworks and standards are adapted for each specific scenario. Implementers can hit the ground running, however, by profiting from the pre-built adapters that come with openIMIS.