Manfredt Kavetu
4 April 2008
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Windhoek — Namibia's health system aims to improve and maintain the well-being of its citizens by providing services to prevent and cure diseases, to rehabilitate those that have suffered illness, and to generally promote good health.
Some of the most serious challenges facing healthcare today-medical errors, inconsistent quality, and rising costs-can be addressed through effective application of readily available information technology that links providers and health information throughout a community and throughout the country.
Such networks enable decision support anywhere at any time, improving public and individual health and reducing cost. In this article, we propose a grand vision to integrate and connect all the public hospitals, health centers and clinics through an IP/MPLS network infrastructure, and further, integrate all the processes, applications and documents through the web portal.
Why We Need the Integrated National Health Information Infrastructure
Our healthcare system is facing significant challenges from medical errors, inconsistent quality, neglect, and rising costs, and these factors are already contributing to preventable deaths in our hospitals each year. Recent cases of neglect and errors have made headlines in local newspapers. The recent outbreak of cholera highlighted the significant new challenges to our public health system.
The current paper-based healthcare system is unable to consistently deliver recommended care, particularly for chronic diseases, and therefore substantial improvement in healthcare is only attainable with the ubiquitous availability of complete healthcare information and decision support at any point of care through our proposed integrated national health connected infrastructure.
There is abundant evidence from international practices that effective use of information technology can improve patient safety, quality of care, efficiency, and reduce costs. Preventive service reminders, for example, have been shown to significantly improve the delivery of preventive healthcare.
Continuity and Quality in Medical Care
The health framework supports four major domains - personal health, clinical care (medication, allergies, immunization, surgical, trauma, alerts, family medical history, physician note), public health, research and policy.
As such, it will provide an improved link between healthcare and public health, facilitating disease surveillance and response and eliminates the need for redundant tests and X-rays because prior results will be readily available.
It will facilitate the use of decision support, allowing clinicians to apply the latest treatment recommendations and research advances without the need for superhuman memory. It will automate billing and quality reports from the record of care, minimizing additional work.
The medical record must "tell the story" of the patient as determined by the physician in the circumstances in which he or she saw the patient. The record is not just a personal memory aid for the individual physician who creates it, it must allow other health care providers to read quickly and understand the patient's past and current health concerns.
It is not expected, however, that all patients will always be able to read and understand their medical records. Medical records may contain abbreviations and terminology unique to the health care professions.
The Integrated Connected Health Framework Model
The integrated connected health framework is a central data warehouse of health information that collects information from all the hospitals, health centers, clinics, laboratories, as needed for patient care.
The key to the successful integration of state-of-the-art IT services, applications, and business processes is the combination of the IP/MPLS network infrastructure, wireless-based network infrastructure from Telecom, and the GPRS/3G/HSDP mobile connectivity from the cellular companies. An embedded, mini .net framework in mobile handheld devices like cell phones and PDAs enable these devices seamless access to the web portal.
We believe the proposed integrated health framework is the most technologically advanced in the whole of Africa for the public health system. It will form the basis for entirely new treatment methods, increased efficiencies, and better patient care.
The wireless network (SWITCH from telecom) and GPRS/3G/HSDP from the mobile phone operators (MTC, Cell One) will deliver patient information any time, and from any location, along with communication systems, alarms, and calls. Already the mobile phone operators are covering more than 90% of Namibia.
For mobility of use and access to the Internet, 3G/HSDPA is becoming faster and very reliable. HSDPA (High-Speed Downlink Packet Access) enables a user to access the Internet and transfer data wirelessly through mobile telephone technology at up to 1.8 Mbps.
The technology enabled by the 3G (third generation) standard deliver sufficient bandwidth over cellular networks, making it feasible to use mobile phones to send and receive data-hungry applications like live broadcasts, video clips, and e-mails. And with the embedded .net framework in cellphones and PDAs, the possibility for communication and sharing of patient information becomes realistic and affordable.
Manfredt Kavetu
A web portal is a web page that provides quick access to the data, applications and services (hosted on the data warehouse) via an ordinary Web browser. The portal is designed to make it as easy as possible to aggregate and integrate information, and to collaborate with external business partner applications or the emerging world of Web services.
The portal offers a cost-efficient way to connect remote health facilities via a single access point to the centralized data warehouse. Temporary users like partners, consultants and project teams can also be quickly plugged in for as long as necessary.
The web portal is a dashboard into which application assemblies (small applets having a small footprint of no more than 50 KB) display themselves. The business rules and logic are contained in the application assemblies, and these are hosted in the middle layer on the application server.
The application server is not a standalone executable, but is a combination of the operating system (Windows Server 2008) and the ASP.NET runtime. The framework is based on the emerging service oriented architecture (SOA), web services, and composite applications.
Service Oriented Architecture and Composite Applications
The Service Oriented Architecture (SOA) ultimately enables the delivery of a new generation of dynamic applications (sometimes called composite applications). A SOA is one in which the functions of an IT resource, whether an application, system, or trading partner are made available as Web services, large-scale software components that communicate by exchanging messages as described in published message interfaces or contracts.
A composite application implements a specific process on top of a SOA, integrating multiple Web services while keeping the logic of the business process (its workflow) separate from the constituent Web services.
Service Oriented Architectures turn existing applications into libraries of components (web services) that other developers can discover and integrate into new, composite applications. A comprehensive national health framework for the Ministry of Health and Social Services, which integrates islands of applications and upon which future applications (fleet management, registration of birth, etc.) can be developed, would accelerate our country's economic and social progress.
One of the applications which must be integrated into the web portal is the District Health Information System and the older HIS, which are desktop applications. The business rules and logic must be decoupled from the DHIS (and HIS) user interfaces and re-implemented as .net assemblies.
The HIS Office should only have access through high-speed fiber optic, and access the application through the web portal. HIS data must be hosted on the central data warehouse, and regional health facilities must have access only through the integrated web portal.
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