Digital Health CW Toolkit v1.2

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Country Experience Documentation on Digital Health Convergence Workshops

Digital Health Convergence Workshop in Lao PDR 2021

Revitalizing the Digital Health Roadmap: From Multi-stakeholder Planning to Endorsement of the Lao PDR National Digital Health Strategy

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Background of Digital Health in the Country

2013

Adoption of DHIS2

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2014

Pilot of Supply (Currently the national health logistics management system)

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2018-2020

Multiple integration efforts in DHIS2

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2021

First digital health convergence workshop in Lao PDR (Hybrid)

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Note: Report included in this section is only valid until the time the digital health convergence workshop was conducted in March 2021.

Workshop Implementation

Objectives

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Creation of an overseeing governance structure

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Plan the development of standards and registries

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Find an agreement for the adoption of a unique Patient ID

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Improve the cooperation with other ministries

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Involve the Ministry of Technology and Communications

Methodology

1

Request

Requested technical advice from AeHIN to conduct the digital health convergence workshop

2

Coordination

Formation of core team:

  • Ministry of Health (MoH)
  • World Health Organization (WHO)
  • Asian Development Bank (ADB)
  • Asia eHealth Information Network (AeHIN)

3

Planning and Preparation

  • Pre-convergence workshop
  • Program planning
  • Invitation to stakeholders
  • Event logistics

4

Implementation

Discussion points: Digital Health Vision in the Country, AeHIN’s Mind the GAPS Framework, Special Topics on Digital Solutions for Health, Experience-sharing from Neighboring Countries, Translation of Work Group Conclusions into Action Plans

5

Follow-up

  • Stakeholder Engagement Workshop (December 2021)
  • Digital Health Strategy 2023-2027 Dissemination Workshop (January 2023)

Output

Itemized Digital Health Action Plan
Leadership and Governance Action Items
  • Identify the digital health champion.
  • Identify the department to lead the creation of the digital health governance structure.
  • Create a digital health steering committee composed of the MoH and other ministries.
  • Create a digital health technical working group composed of the MoH and other ministries.
  • Create experts groups working on specific digital health subjects.
  • Create a program management office to support the Committees.
  • Set the digital health steering committee to convene once every quarter.
  • Identify the enterprise architect.
  • Identify the department to lead the definition of the digital health enterprise architecture.
  • Identify the program management leader.
  • Create a program management office to lead digital health project management.
  • Identify the future project managers to lead health system developments.
  • Identify the standard leader.
  • Identify the departments to be the custodian of Health ID and lead its development and implementation.
  • Identify the departments to be the custodian of client
    registry in the exchanged architecture and lead its
    development and implementation.
  • Identify the department to be the custodian of EMR
    standard and lead its development and implementation.
  • Identify the department to be the custodian of the shared
    health record registry in the exchanged architecture.
  • Identify the responsible department to promote the usage
    of eGovernment tools and lead the development of new
    eGovernment applications and infrastructures for health.
  • Identify the responsible department to promote usage of
    ICT and improve ICT capacities within the MoH.
Standards and Interoperability Action Items
  • Define the digital health enterprise architecture that responds to all stakeholders for all activities. Adopt an exchanged architecture such as Open Health Information Exchange (OpenHIE) as information systems architecture.
  • Define each component of the exchanged architecture and assign ownership.
  • Document the current enterprise architecture (baseline), the desired enterprise architecture (target).
  • Plan the migration from the baseline to the target enterprise architecture.
  • Integrate the digital health enterprise architecture with the enterprise architecture of the eGovernment center of the Ministry of Posts and Telecommunications (MTC).
  • Document a program management handbook to be shared to all project managers.
  • Create a standard and interoperability lab to develop health standards and experiment interoperability.
  • Identify the list of standards to develop and identify the owners.
  • Develop in priority national health ID, morbidity and mortality list, and medical terminologies standards.
  • Document a standard and guidelines handbook.
  • Construct the Health ID standard datasets and formats.
  • Develop the interoperability between the health client registry and other health information systems.
  • Link the health client registry with the eGovernment Lao KYC database.
  • Define EMR standard minimum functions, minimum datasets, data formats, and link with other health standards and coding.
  • Document an EMR standard and guideline handbook.
  • Promote and support the usage of the standard EMR in health facilities hospital information systems.
  • Develop the interoperability of hospital information systems with shared registries and services within the exchanged architecture.
  • Integrate the digital health enterprise architecture with the eGovernment enterprise architecture.
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Strategy and Investment Action Items
  • Develop a digital health strategy plan for the next five years.
  • Identify the development partners supporting the
    implementation of the digital health governance structure.
  • Identify the development partners supporting the
    construction of enterprise architecture foundations.
  • Identify the development partners supporting the projects led by the program management office.
  • Identify health projects to be supported in priority by the program management office.
  • Identify the development partners to support the
    improvement of project management capacities in the
    health sector.
  • Identify the development partners supporting the development of health standards.
  • Identify the development partners to support the creation
    of the Health ID standard and create the client registry.
  • Identify the development partners to support the
    development of EMR standards and its implementation in
    the hospital information systems.
  • Create a partnership between MoH and MTC to cooperate
    for the development and promotion of eGovernment for
    health.
  • Identify the development partners to support the
    improvement of eGovernment infrastructures,
    applications, and services within the health sector.
  • Identify the development partners to support the
    improvement of ICT capacities in the health sector.
  • Document the current level of ICT capacity within the
    health sector and define objectives and strategies f
    improvement.
Systems and Applications Action Items
  • Develop shared registries, shared services, and
    interoperability layer inside the exchanged architecture.
  • Identify which system is the most suitable to manage ID
    services: biometrics, registration, authentication, ID
    management, etc.
  • Construct the health client registry based on the family folder exercise.
  • Improve new family folder exercise data quality and consistency.
  • Streamline birth and death notifications of health facility with the health client registry.
  • Assessment of conditions to implement EMR systems within health facilities.
  • Identify or develop a pilot system implementing EMR standards.
  • Development of Government-to-Government (G2G) applications and services: e-Office, corporate email online storage, document management systems, intranet, etc.
  • Development of Government-to-Business (G2B) applications and services: licensing systems for private facilities, information platform, etc.
  • Development of Government-to-Citizen (G2C) applications and services: Information platform, vaccination passport, death and birth notification/certification, etc.
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Infrastructure Action Items
  • Development of ICT infrastructures in all health facilities throughout the country.                                                                     
  • Development of ICT infrastructures within the administration of the Ministry of Health throughout the country.                                                                                                      
  • Development of ICT infrastructure and applications for the digital health exchanged architecture: interoperability layer, shared services, shared registry, data centers, and technologies.                                                                                                                                                                                                                                                                                  
Policy and Legislation Action Items
  • Document the current digital health legal framework, existing strategies, and existing committees.
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Workforce Action Items
  • Training and certification on governance frameworks such as Control Objectives for Information and Related Technologies (COBIT) 2019. 
  • Training and certification on enterprise architecture frameworks such as The Open Group Architecture Framework (TOGAF), OpenHIE, and others.
  • Increase enterprise architecture capacities through training of trainer format.
  • Training and certifications on project management such as Projects in Controlled Environments (PRINCE2) and others.
  • Increase project management capacities inside the MoH through the training of trainer format.
  • Training and certifications on health standards such as Health Level Seven International Fast Healthcare Interoperaility Resources (HL7 FHIR) and others.
  • Train health workers on the usage of eGovernment applications through the training of trainers format.
  • Create incentives for inclusion of ICT in medical career pathways for health workers and the administration (ex: monitoring and evaluation, data analyst, health informatics, etc.)
  • Create or develop partnerships with medical universities in country or abroad to include ICT in the medical curriculum.
  • Increase health workers ICT capacities through training of trainer format.

Key Insights

Emerging Good Practices

Systems review and stakeholder mapping for each identified need

  • Review of existing digital health systems, identification of support needed, and mapping of funding agencies and stakeholders

Development, endorsement, and dissemination of a Digital Health Strategy

  • Most impactful progress from the convergence workshop
  • Tackles overview of the strategy, strategic objectives and projects, and strategy implementation
     

Establishment of the Health Statistics and Information Center

  • Established to unify the roles of previous divisions, concentrate resources, and strengthen available capacity to better manage and implement the digital health strategy
  • Tasked with digital health-rated work
     

Formation of priority-based Digital Health Technical Working Groups

  • Digital Technical Working Groups (TWGs) formed based on identified priority activities:
    • University Hospital Information System (UHIS)
    • Electronic Immunization Record (EIR)
    • Laboratory Information Management System (LIMS)
    • Electronic Medical Record (EMR)

Membership to the National Digital Governance Transformation Committee

  • The Minister of Health is a member of the newly formed National Digital Governance Transformation Committee
  • In charge of the implementation of the National Digital Governance Framework
     

Multi-stakeholder approach in information sharing

  • Signed Memorandum of Understanding (MOU) with the Ministry of Home Affairs (MoHA) to exchange birth and death information

Agreement towards exchanged architecture

  • The MoH moved from an integrated to an exchanged architecture in alignment with the launched digital health strategy

Building the digital health capacity of prospect digital health program managers

  • Some core program management staff undergoing master’s and doctoral-level studies in medical informatics and data science to better support the current digital health governance structure

Standards development and implementation

  • Health ID, ICD10, EMR minimum data elements
  • Building capacity towards formation of a standards and interoperability lab through AeHIN COIL

Development of services and applications

  • Interoperability between client health registry and eCRVS (being developed)
  • Interoperability between GeoPrism and DHIS2
  • Piloting EMR and DHI2 interoperable projects

Emerging Needs

Support towards the transition of digital health function at the MOH

  • Transition from the Department of Planning and Finance to the new Health Statistics and Information Center

Alignment with the National Digital Government Framework

  • Establish a roadmap for digital health transformation through its digital health steering committee
  • Hold regular meetings among  digital health technical working groups to ensure harmonization of efforts and avoid duplication of work

Resources for implementation of data-related policies

  • Recruit a workforce for the digital health program management office at the Department of Planning and Finance and provide continuous training

Landscape analysis of the digital health situation

  • Landscape analysis on government enterprise architecture, infrastructure, data governance, policy and regulation, healthcare systems, standard and terminology, human resources
  • Needs workforce, capacity, and budget support

Awareness-building on digital health

  • Familiarize MoH employees with digital health concept, especially with the ongoing implementation of the digital health strategy

Implementation guidance for the rollout of standards and terminology

  • Develop implementation guidance for rollout of standards and terminologies, including guidance for customization or localization of global standards (e.g., SNOMED CT, LOINC) in the country
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