The open health information mediator : an architecture for enabling interoperability in low to middle income countries.
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Date
2015
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Abstract
Interoperability and system integration are central problems that limit the effective use of
health information systems to improve efficiency and effectiveness of health service delivery.
There is currently no proven technology that provides a general solution in low and middle
income countries where the challenges are especially acute. Engineering health information
systems in low resource environments have several challenges that include poor infrastructure,
skills shortages, fragmented and piecemeal applications deployed and managed by
multiple organisations as well as low levels of resourcing. An important element of modern
solutions to these problems is a health information exchange that enable disparate systems
to share health information.
It is a challenging task to develop systems as complex as health information exchanges that
will have wide applicability in low and middle income countries. This work takes a case
study approach and uses the development of a health information exchange in Rwanda as
the case study. This research reports on the design, implementation and analysis of an
architecture, the Health Information Mediator, that is a central component of a health
information exchange. While such architectures have been used successfully in high income
countries their efficacy has not been demonstrated in low and middle income countries. The
Rwandan case study was used to understand and identify the challenges and requirements
for health information exchange in low and middle income countries. These requirements
were used to derive a set of key concerns for the architecture that were then used to drive
its design. Novel features of the architecture include: the ability to mediate messages at
both the service provider and service consumer interfaces; support for multiple internal
representations of messages to facilitate the adoption of new and evolving standards; and
the provision of a general method for mediating health information exchange transactions
agnostic of the type of transactions.
The architecture is shown to satisfy the key concerns and was validated by implementing
and deploying a reference application, the OpenHIM, within the Rwandan health information
exchange. The architecture is also analysed using the Architecture Trade-off Analysis
Method. It has also been successfully implemented in other low and middle income countries
with relatively minor configuration changes which demonstrates the architectures generalizability.
Description
M. Sc. University of KwaZulu-Natal, Durban 2015.
Keywords
Internetworking (Telecommunication)--Rwanda., Software engineering--Rwanda., Computer architecture., Information resources management--Rwanda., Medical informatics--Rwanda., Theses--Computer science.