This is page is a work in progress. This info bubble will be removed once the TWG feels it is complete.
This page captures interoperability workflows that add value to Community Health Worker organizations.
User Personas
(Michael will fill this in)
Interoperability Patterns from Experience
Anonymous Events from CHIS to DHIS2
Goal: Track individual events from the CHIS so that it can be tracked against a programme in DHIS2.
Steps:
Each form from the CHIS gets anonymized
Each anonymized form pushes to DHIS2 Tracker
Monthly Reports from CHIS to DHIS2
Goal: Ensure monthly trends in the CHIS are captured and reported in the central reporting system by programme
Each DHIS2 data element is broken down to category options
Steps:
On a regular schedule the CHIS compiles a large report based on the data in the system
The large report gets converted to the DHIS2 format
The report gets sent over to DHIS2 which populates the aggregate information in the system
Pull data to CHIS from EMR for follow-up
Goal: Get a list of people who need to be followed-up in the community and follow up in the CHIS. Any changes in the CHIS go back to the EMR
One CHIS to many EMRs that are specific to a region
Steps:
EMR generates a report on a regular schedule
CHIS queries the report and creates the "cases" for follow-up in the CHIS
CHWs work through the list
Updates for each "case" is pushed to the EMR
Bidirectional duplication of programmatic patient data between CHIS and EMR
Goal: Ensure that both systems have a copy of the appropriate information so it is locally available for the defined interoperability workflows
Steps CHIS to EMR:
User collects a form in the mobile app
Mobile app syncs to the central system
CHIS Central system identifies that there is a form that needs to go to the EMR
Each different type of CHIS form has a different action.
Additionally, the state of the case vs the EMR patient is considered at each integration point
CHIS Central system queries EMR to verify state
Does the patient exist
What's the latest record
CHIS Central system compares the EMR state against the current state
If no difference, then they stop the workflow here
CHIS Central system orchestrates the multistep process of creating entities in EMR
Create a patient if it doesn't exist (this also creates a person)
Start a visit
Create an encounter
Create observations
End the visit (within a 24 hour period)
Store appropriate duplicate information in CHIS case for that patient
CHIS Central system closes out the connection and marks it as done.
Steps EMR to CHIS:
CHIS queries the OpenMRS atom feed for each entity type (patient, encounter, observation) on a regular schedule
CHIS loops through each item in the atom feed and queries the EMR system
CHIS identifies the changes, runs through logic and applies the changes locally
Create cases for new patients
Create form submissions for new encounters
Update case properties in the event EMR has the latest information
CHIS marks the atom feed item as processed and saves state on each entry
CHIS to EMR Referral Workflow
Goal: Referrals are when a patient is referred from a community to a central health facility or visa versa so that they can receive care that that team can provide. Referrals are a package of information sent from the CHIS to the EMR in this instance.
Steps:
User collects a form in the mobile app
Mobile app syncs to the CHIS central system
CHIS Central system identifies that there is a referral that needs to go to the EMR
CHIS Central system creates the referral package by mapping incoming form submission fields to the output(s)
Central system sends the package(s) to the EMR
Note: This may require creating multiple entities in the EMR and the CHIS is responsible for orchestrating that. For example, you first need to create the patient, then the encounter, then the observations with the ability to roll back changes.
EMR receives the package and confirms that it was received
EMR parses each package and stores them in the system
EMR may trigger internal events based on this changing information
CHW Supervision Workflow
Goal: Provide the appropriate information for supervisors so they can understand the inputs and outputs of the CHWs. Interoperability in this case supports identifying the original source of truth.
Mapping between these systems is critical to ensure that each patient or case is assigned to the right team in the CHIS. There needs to be a clear path to the community health worker.
Steps:
The case is created in the CHIS based on whatever input
Mapping is done so that we appropriately map the case to the right health worker in the CHIS
This mapping is often done by geographic information or identifier patterns. For example, we know that ids from this EMR need to go to this CHW team in the CHIS
We duplicate case properties in the CHIS to be able to represent
Integration Setup and Maintenance
Every integration requires setting up the system the first time and then maintaining the metadata over time.