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Paton C, Amarakoon P, Braa J, Kobayashi S, Marcelo A, Kane T, Fraser H, Hannan T. Open Source Software in Healthcare: International Case Series from the IMIA Open Source Working Group. Stud Health Technol Inform 2024; 310:1266-1270. [PMID: 38270018 DOI: 10.3233/shti231168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
In this case series, we demonstrate how open-source software has been widely adopted as the primary health information system in many low- and middle-income countries, and for government-developed applications in high-income settings. We discuss the concept of Digital Global Goods and how the general approach of releasing software developed through public funding under open-source licences could improve the delivery of healthcare in all settings through increased transparency and collaboration as well as financial efficiency.
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Amarakoon PM, Gundersen RB, Muhire A, Utvik VA, Braa J. Exploring health information system resilience during COVID-19 pandemic: case studies from Norway, Sri Lanka & Rwanda. BMC Health Serv Res 2023; 23:1433. [PMID: 38110892 PMCID: PMC10726492 DOI: 10.1186/s12913-023-10232-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/27/2023] [Indexed: 12/20/2023] Open
Abstract
The study aims at exploring health system resilience by defining the scope on health information systems, one of the six building blocks of the health system. The empirical evidence is derived using qualitative data collection and analysis in the context of Norway, Sri Lanka and Rwanda during the COVID-19 pandemic. The case studies elicit bounce back and bounce forward properties as well as the agility as major attributes of resilience present across the countries. Existing local capacity, networking and collaborations, flexible digital platforms and enabling antecedent conditions are identified as socio-technical determinants of information system resilience based on the case studies across the countries.
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Paton C, Braa J, Muhire A, Marco-Ruiz L, Kobayashi S, Fraser H, Falcón L, Marcelo A. Open Source Digital Health Software for Resilient, Accessible and Equitable Healthcare Systems. Yearb Med Inform 2022; 31:67-73. [PMID: 35654431 DOI: 10.1055/s-0042-1742508] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To assess the impact of open-source projects on making healthcare systems more resilient, accessible and equitable. METHODS In response to the International Medical Informatics Association (IMIA) call for working group contributions for the IMIA Yearbook, the Open Source Working Group (OSWG) conducted a rapid review of current open source digital health projects to illustrate how they can contribute to making healthcare systems more resilient, accessible and equitable. We sought case studies from the OSWG membership to illustrate these three concepts and how open source software (OSS) addresses these concepts in the real world. These case studies are discussed against the background of literature identified through the rapid review. RESULTS To illustrate the concept of resilience, we present case studies from the adoption of District Health Information Software version 2 (DHIS2) for managing the Covid pandemic in Rwanda, and the adoption of the OpenEHR open Health IT standard. To illustrate accessibility, we show how open source design systems for user interface design have been used by governments to ensure accessibility of digital health services for patients and healthy individuals, and by the OpenMRS community to standardise their user interface design. Finally, to illustrate the concept of equity, we describe the OpenWHO framework and two open source digital health projects, GNU Health and openIMIS, that both aim to reduce health inequities through the use of open source digital health software. CONCLUSION This review has demonstrated that open source software addresses many of the challenges involved in making healthcare more accessible, equitable and resilient in high and low income settings.
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Affiliation(s)
- Chris Paton
- University of Oxford, United Kingdom.,University of Otago, New Zealand
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Kobayashi S, Falcón L, Fraser H, Braa J, Amarakoon P, Marcelo A, Paton C. Using Open Source, Open Data, and Civic Technology to Address the COVID-19 Pandemic and Infodemic. Yearb Med Inform 2021; 30:38-43. [PMID: 33882602 PMCID: PMC8416191 DOI: 10.1055/s-0041-1726488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES The emerging COVID-19 pandemic has caused one of the world's worst health disasters compounded by social confusion with misinformation, the so-called "Infodemic". In this paper, we discuss how open technology approaches - including data sharing, visualization, and tooling - can address the COVID-19 pandemic and infodemic. METHODS In response to the call for participation in the 2020 International Medical Informatics Association (IMIA) Yearbook theme issue on Medical Informatics and the Pandemic, the IMIA Open Source Working Group surveyed recent works related to the use of Free/Libre/Open Source Software (FLOSS) for this pandemic. RESULTS FLOSS health care projects including GNU Health, OpenMRS, DHIS2, and others, have responded from the early phase of this pandemic. Data related to COVID-19 have been published from health organizations all over the world. Civic Technology, and the collaborative work of FLOSS and open data groups were considered to support collective intelligence on approaches to managing the pandemic. CONCLUSION FLOSS and open data have been effectively used to contribute to managing the COVID-19 pandemic, and open approaches to collaboration can improve trust in data.
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Affiliation(s)
| | - Luis Falcón
- GNU Solidario, GNU Health, Las Palmas de Gran Canaria, Spain
| | - Hamish Fraser
- Brown Center for Biomedical Informatics, Brown University, Providence, USA
| | | | | | - Alvin Marcelo
- Asia eHealth Information Network, Manilla, Philippines
| | - Chris Paton
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Abstract
Abstract:The health system in South Africa has to date been fragmented and centralised. The priority of the new government is to establish an integrated and decentralised district health system of which a key element is the development of district health and management information systems (H & MIS). This paper presents experiences from two projects in the Western Cape in which a process to establish a district-based H & MIS was initiated and a situation analysis of the information systems was done. The two projects applied different research methods but the results show with remarkable consistency that much time is used on data collection, but information is not used at local level. The projects have applied different approaches towards developing a district H & MIS but in both important pre-requisites for a successful, action-led H & MIS include local ownership and motivation, a process based around existing local management structures and the active involvement of the community
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Braa J, Heywood A, Sahay S. Improving quality and use of data through data-use workshops: Zanzibar, United Republic of Tanzania. Bull World Health Organ 2012; 90:379-84. [PMID: 22589572 DOI: 10.2471/blt.11.099580] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 01/29/2012] [Accepted: 01/31/2012] [Indexed: 10/23/2022] Open
Abstract
PROBLEM In Zanzibar, United Republic of Tanzania, as in many developing countries, health managers lack faith in the national Health Management Information System (HMIS). The establishment of parallel data collection systems generates a vicious cycle: national health data are used little because they are of poor quality, and their relative lack of use, in turn, makes their quality remain poor. APPROACH An action research approach was applied to strengthen the use of information and improve data quality in Zanzibar. The underlying premise was that encouraging use in small incremental steps could help to break the vicious cycle and improve the HMIS. LOCAL SETTING To test the hypothesis at the national and district levels a project to strengthen the HMIS was established in Zanzibar. The project included quarterly data-use workshops during which district staff assessed their own routine data and critiqued their colleagues' data. RELEVANT CHANGES The data-use workshops generated inputs that were used by District Health Information Software developers to improve the tool. The HMIS, which initially covered only primary care outpatients and antenatal care, eventually grew to encompass all major health programmes and district and referral hospitals. The workshops directly contributed to improvements in data coverage, data set quality and rationalization, and local use of target indicators. LESSONS LEARNT Data-use workshops with active engagement of data users themselves can improve health information systems overall and enhance staff capacity for information use, presentation and analysis for decision-making.
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Affiliation(s)
- Jørn Braa
- Department of Informatics, University of Oslo, Norway.
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Braa J, Kanter AS, Lesh N, Crichton R, Jolliffe B, Sæbø J, Kossi E, Seebregts CJ. Comprehensive yet scalable health information systems for low resource settings: a collaborative effort in sierra leone. AMIA Annu Symp Proc 2010; 2010:372-376. [PMID: 21347003 PMCID: PMC3041283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We address the problem of how to integrate health information systems in low-income African countries in which technical infrastructure and human resources vary wildly within countries. We describe a set of tools to meet the needs of different service areas including managing aggregate indicators, patient level record systems, and mobile tools for community outreach. We present the case of Sierra Leone and use this case to motivate and illustrate an architecture that allows us to provide services at each level of the health system (national, regional, facility and community) and provide different configurations of the tools as appropriate for the individual area. Finally, we present a, collaborative implementation of this approach in Sierra Leone.
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Affiliation(s)
- Jørn Braa
- Department of Informatics, University of Oslo, Norway
| | - Andrew S. Kanter
- Department of Biomedical Informatics/Millennium Villages Project, Earth Institute, Columbia University, New York, NY, USA
| | - Neal Lesh
- D-Tree International, Boston, MA, USA
| | | | - Bob Jolliffe
- Department of Informatics, University of Oslo, Norway
| | - Johan Sæbø
- Health Metrics Network, WHO, Geneva, Switzerland
| | - Edem Kossi
- Department of Informatics, University of Oslo, Norway
| | - Christopher J. Seebregts
- Jembi Health Systems (NGO), Cape Town, South Africa
- Department of Computer Science, University of KwaZulu-Natal, Durban, South Africa
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de Timóteo Mavimbe JC, Muquingue HN, Braa J, Bjune G. Immunization coverage in Mozambique: from concepts to decision-making. Health Policy 2006; 79:92-100. [PMID: 16406132 DOI: 10.1016/j.healthpol.2005.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Accepted: 12/01/2005] [Indexed: 11/28/2022]
Abstract
Immunization is an effective strategy to reduce morbidity and mortality among children. This recognition has led many countries to concentrate efforts in establishing desirable achievements in the form of immunization coverage figures. However, less focus has been placed on effort made by different countries to attain high immunization coverage. During August 2002, 14 district health directors in a remote province of Mozambique (Niassa) were interviewed. The objective was to ascertain the construction of immunization coverage and how they implement the desired program strategies in order to improve the health status of the region. We found that most managers regarded the immunization coverage as data and thus high coverage as an end in itself, rather than as a reflection of the reality. We also found that there are uncertainties in population data which makes it difficult to plan activities bellow the level of a district. We argue further that the innovative distinction between the views proposed on the immunization coverage, provided us with an insight of the different challenges that district health directors face as leaders of the district health management team in Niassa. Clues on the implications of certain views of immunization coverage for policy and local decision-making in the national and global pursuit of immunization targets are provided.
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Abstract
Background Worldwide immunization coverage shows an increase in the past years but the validity of the official reports for measuring change over time has been questioned. Facing this problem, donor supported initiatives like the Global Alliance for Vaccine and Immunizations, have been putting a lot of effort into assessing the quality of data used, since accurate immunization information is essential for the Expanded Program on Immunization managers to track and improve program performance. The present article, discusses the practices on record keeping, reporting and the support mechanism to ensure data quality in Mozambique. Methods A process evaluation study was carried out in Mozambique in one district (Cuamba) in Niassa Province, between January and March 2003. The study was based on semi-structured interviews, participant observation and review of the data collection materials. Results Differences were found for all vaccine types when comparing facility reports with the tally sheets. The same applies when comparing facility reports with district reports. The study also showed that a routine practice during supervision visits was data quality assessment for the outpatient services but none related to data consistency between the tally sheets and the facility report. For the Expanded Program on Immunization, supervisors concentrated more on the consistency checks between data in the facility reports and the number of vaccines received during the same period. Meetings were based on criticism, for example, why health workers did not reach the target. Nothing in terms of data quality was addressed nor validation rules. Conclusion In this paper we have argued that the quality of data, and consequently of the information system, must be seen in a broader perspective not focusing only on technicalities (data collection tools and the reporting system) but also on support mechanisms. Implications of a poor data quality system will be reflected in the efficiency of health services facing increased demands, with stagnant or decreasing resources.
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Affiliation(s)
- João C Mavimbe
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Faculty of Mathematics and Natural Sciences, Department of Informatics, University of Oslo, Norway
- Faculty of Medicine, Department of General Practice and Community Medicine, Section of International Health, University of Oslo, Norway
| | - Jørn Braa
- Faculty of Mathematics and Natural Sciences, Department of Informatics, University of Oslo, Norway
| | - Gunnar Bjune
- Faculty of Medicine, Department of General Practice and Community Medicine, Section of International Health, University of Oslo, Norway
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Braa J. A data warehouse approach can manage multiple data sets. Bull World Health Organ 2005; 83:638-639. [PMID: 16184286 PMCID: PMC2626320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Affiliation(s)
- Jørn Braa
- Department of Informatics, University of Oslo, Norway.
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Braa J, Heywood A, King MS. District level information systems: two cases from South Africa. Methods Inf Med 1997; 36:115-21. [PMID: 9242007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The health system in South Africa has to date been fragmented and centralised. The priority of the new government is to establish an integrated and decentralised district health system of which a key element is the development of district health and management information systems (H & MIS). This paper presents experiences from two projects in the Western Cape in which a process to establish a district-based H & MIS was initiated and a situation analysis of the information systems was done. The two projects applied different research methods but the results show with remarkable consistency that much time is used on data collection, but information is not used at local level. The projects have applied different approaches towards developing a district H & MIS but in both important pre-requisites for a successful, action-led H & MIS include local ownership and motivation, a process based around existing local management structures and the active involvement of the community.
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Affiliation(s)
- J Braa
- Norwegian Computing Centre/Department of Community Health, University of Cape Town, South Africa
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