OSCHA 2007 Conference Presentations

Session #08 – Open Source-based District Health Management Information Systems (Case in Wonosobo District, Central Java Province, Indonesia)
Background: Since the enactment of health decentralization policy, many argued that Indonesian health information system became more fragmented. While there’s no comprehensive national policy on district health information systems (DHIS) integration and interoperability, some districts have initiated different approach and innovations influenced by internal and external factors. Wonosobo is a district with 735.000 population, located in the Central Java province which has started a wireless wide area network DHIS by the end of 2006. Objective: This article aims to (1)describe factors determining Wonosobo district to adopt Open Source platform, (2)present preliminary results of the developmental phase and (3)discuss upcoming agenda. Results: Previous failure e-Gov implementation has strongly influenced the District Health Office (DHO) to adopt Open Source approach for DHIS development. According to the RFP document, one of the objectives of this project is to develop an open source DHIS software as well as open source community for Indonesian public health domain. The selected vendor has been implementing the software in the DHO and 21 primary health centers. Before the implementation, 60% of the operators were using computer mostly for writing letter and report. Each primary health centers (PHC) provided with 2 workstations running a web-based application to support clinic activities and community health programs as well. At the DHO, we-based application has been developed to integrate reports from the PHCs, transforming the data into map, graphic and tables and aggregating selected health indicators for vertical report. Application was developed with PHP 5.1 with AJAX and supported by mySQL 5.0.23 database. However, there’s no organizational structure dedicated for maintaining DHIS. Conclusion: Wonosobo district has started an open source approach for DHIS development in Indonesia. Initial phase showed that while technical aspect is relatively fast developed, organizational and human resource aspect should be the main agenda to resolve. – Anis Fuad – Indonesia

Session #25 – BuddyWorks Telehealth Project
The BuddyWorks Telehealth Project (http://telehealth.upm.edu.ph/bw/) is an e-government funded project that aims to reduce the inequities in the Philippine health care system and help curb the impact of the exodus of health care providers through telehealth. The project uses electronic information and communications technologies to provide and support health care for underserved communities and geographically remote areas where health care expertise is largely unavailable. This presentation focuses on the benefits of developing using free/open source software but also the challenges of implementing telehealth initiatives in a devolved health care system. In summary, the use of free/open source platforms allowed for substantial savings and greater flexibility for program managers as they maneuvered through the difficult organizational aspects of the project. – Alvin Marcelo – Philippines

Session #04 – Community Health Information Tracking System (CHITS)
The *Community Health Information Tracking System* or CHITS (www.chits.info) is an extensible, modular, open source information system for rural health units in the Philippines. It collects existing routine health data from vertical programs using the Department of Health’s Field Health Service Information System (FHSIS) and integrates them into a unified, comprehensive computerized information system. Through CHITS, community-based health information is made available not only to public health agencies requiring community level information but also to the community itself which generates the information. It enables the community to use this information for local decision-making and health planning. In addition to software, CHITS also includes structured capability-building programs designed to improve the health information systems within local health centers, manual or otherwise. CHITS began in Pasay and is now in seven municipalities around the country with requests for installation from many more. It was a finalist at the Stockholm Challenge 2006 and was named one of the top 3 e-government projects by the APEC Digitial Opportunity Center (July 2006). – Alvin Maecelo – Phillipines

Session #14 – The openEHR Overview
This session will be an introduction to the technical aspects of the openEHR infrastructure as well as archetypes. I will also present the openEHR Foundation’s open principles, how the process works and how to become involved in developing openEHR products. I will also present some of the implementation projects that are underway. – Timothy W. Cook – USA

Session #19 – Implications of FOSS in improving physician acceptance of health care IT.
This report looks at the reasons why the uptake of clinical information technology systems is so slow to take hold. There is a culture of blame being passed from the physicians to the vendors and also from the vendors to the physicians. This session examines the facts and fallacies surrounding this environment. While this report focuses on primary care physicians in the United States; it also contrasts that environment with other health care settings. In this session we will look at underlying issues such as the culture of medical training and the subsequent thought processes (short term thinking vs. long term planning) of primary care physicians. In conclusion this report points out how open source and open content business models can overcome many of the issues causing the disconnect between physicians and technologists. – Timothy W. Cook – USA

Workshop #07 – Key Signing
A key-signing event is a get together with GnuPG/PGP users for the purpose of meeting other GnuPG/PGP users and signing each other’s keys. This extends the Web of Trust that GnuPG/PGP relies upon. At the OSHCA2007 conference there will be an official key-signing event for all who send their info in advance. If you show up at OSHCA2007 with your key information and ID, but did not send in the information beforehand, we will have a separate, one on one, key verification session. Anyone and everyone is invited. We sign keys because GnuPG/PGP is based upon a Web of Trust. This web of trust is what ensures that no one can pretend to be you and that you can really believe that a message you receive from Dr. Jones is really from Dr. Jones. The more deep and tightly inter-linked the web of trust is, the more difficult it is to defeat. For more information please see the Key-signing document on the OSHCA website or at http://home.comcast.net/~tw_cook/keysigningevent.html – Timothy W. Cook – USA

Plenary #2 – FOSS and Open Standards
The term “open standards” has been mis-used and abused by both vendors and users and it is sometimes confused with open source. In this presentation we will look at what constitutes an open standard and how the definition can vary with different organisations and environment. The benefits of open standards are highlighted and examples are given to show that FOSS and open standards, although different, can affect and complement each another. The need for a truly open standard for office documents is discussed next and the presentation will close with a look at some important IT standards pertaining to the healthcare industry. – Nah Soo Hoe – Maylasia

Session #06 – Open Source Projects in Public Health for Developing Countries
Public health is a promising field for development of Open Source (OS) solutions, mainly in developing countries, where there is a great demand for access to public information and computational resources in a safe, pervasive, and transparent way. Development of OS solutions focused on public health for developing (and non-English speaking) countries is incipient, despite of the intensive advance that could be achieved for the area. In Brazil, Medicine Assisted by Scientific Computing Network is playing a protagonist role by supporting development of OS projects in public health. Three projects are under development: (1) e-PID (Public Information and Development in Epidemiology) is an OS and Open Access e-learning environment aimed to Health Education Target Pentagon: students, professionals, managers, users and teachers; (2) EpiSSS (Epidemiologic Surveillance Support System) e PHISS (Pre-Hospital Information Support System) projects are aimed to provide decision support to management of acute events with low coverage of specialists such as epidemics, endemics and pre-hospital care; (3) Epidemics and Rescue! projects are games whose objective is simulate situations required for the training of public health and pre-hospital professionals, but difficult to be replicated in reality (like bioterrorist attack or a natural catastrophe). The use of OS for development of these projects not only makes them feasible to developing countries, but in addition can make solution of some technical obstacles, health informatics specific, easier. – Luciana Tricai Cavalini – Brazil

Workshops 11 & 12 – HISP
The HISP network was borne out of the collaboration between NORAD and the South African Government in the development of the DHIS. The network now covers most of the African Countries and a few countries outside the continent.The District Health Information Software is the flagship software of the organisation with DHIS 1.3, 1.4 and DHIS 2.0. The software is open source and the aim is to have it database and platform independent which has been achieved in DHIS 2.0. The implementation and rollout of the DHIS in 8 Nigerian states has been a steep learning curve for the organisation which included the setting up of HISP Nigeria. The rollout to all 36 states in this vast country with a population of more that 100 million inhabitants may be on the cards in the near future.Some of the key challenges in the development of the DHIS will be dealt with also.Aim of presentation:The presentation is aimed at sharing information on the building of the International HISP network (South-South-North collaboration) and discussing key learn in the development of an open source solution in Africa (DHIS). – Anders Gjendem – Vietnam

Session #05 – Challenges towards Adoption of FOSS Medical and Health Information Systems in Pakistan
Free and Open Source Software (FOSS) has been widely accepted as an enabler of Information Communication Technologies (ICTs) establishing its foundation as a parallel Open ICT Ecosystem opposing proprietary or closed source development economics and usage. Adding to its popularity is adoption by Governments, International Development Organizations, Private and Civil Sectors of society as well as individuals that are inclined towards benefiting from this system of open, collaborative and inclusive software and hardware technology development. Within the scale of activities in a FOSS Ecosystem, stakeholders benefit from development methodologies that encapsulate local skill development, collaboration, innovation and local resources for technical support meaning, countries can develop FOSS tools and platforms within specialized areas of humanitarian social and economic development assistance including Health and Medical Services which in turn is a viable support towards the achievement of the UN Millennium Development Goals. FOSS can facilitate the creation of networks based on open content to enable easier discussion and exchange of clinical and medical data, electronic transmission of medical files and radiological pictures for small and medium enterprise as well as large scale hospitals employing FOSS based Medical and Clinical Hospital Information Management Systems. Amidst the fact that there are many such FOSS tools available for free usage within the developing world, many countries including Pakistan still lack the benefits that come with such technologies. This paper/presentation looks at the challenges faced by Pakistan towards the successful adoption of FOSS based Medical and Health Information Systems. – Fouad Riaz Bajwa – Pakistan

Session #36 – Zope/Plone/OIO – a software environment for clinical researchers and clinicians
FOSS provides the clinical researcher many tools that can be used and developed in collaboration. The Zope/Plone/OIO combination is a great platform for hospitals and for clinicians. It is simple to install and maintain, allowing clinicians to both administer and use the software themselves. – Nandalal Gunaratne – Sri Lanka

Plenary #1 – Opening Plenary – Overview of FOSS and it’s role in the Health care arena
Open source is a disruptive paradigm which has the power to radically improve health care delivery and outcomes on a global scale. This presentation will help set the stage for conference by providing an overview of the FOSS process and explain why this open, collaborative, evidence based improvement model is such a natural fit for health care. Examples of the power of FOSS to make high quality, effective health information technology both universally affordable and adaptable will be cited. The significant implications and opportunities of the open source model to health ICT strategy in both the developing and developed world will be summarized. – Joseph DalMolin – Canada

Session #34 – Touchscreen Patient Management on Rails
Malawi has 1 million people who are HIV positive and just 150 doctors in the entire country. The Baobab Health Partnership has developed a patient management system that allows poorly qualified health care workers to provide top quality HIV treatment, and thus fill this human resource gap. To accomplish this, Baobab has crafted a unique touchscreen user interface that captures data in real time at the point of patient contact. Custom built touchscreen clinical workstations along with software developed in Ruby on Rails and client side javascript provide an interface with finger sized buttons and a workflow that is intuitive even for health care workers with no previous computer experience. The system has been developed entirely from open source tools, including usage of the OpenMRS data model and tools like ruby on rails, svn, firebug, and selenium for development. Furthermore, Baobab has released the javascript based touchscreen toolkit as open source software, which converts any web application into a touchscreen user interface. Baobab is currently piloting the system at three sites, and is working with the Malawi ministry of health to plan a national rollout to 60 high burden sites within the next year. The presentation will focus on the philosophy, benefits and challenges of real time patient management, along with a demonstration of the system and a 1 minute video showing the system in use in Malawi. – Mike McKay – Malawi

Workshop #01 – Sahana: FOSS Disaster Management System
Sahana [http://sahana.lk/] is a Free and Open Source Disaster Management System. It was built in the aftermath of the Tsunami in December 2004, and has evolved into a fully fledged generic disaster management system. The system aims to be a comprehensive solution for information management in relief operations, recovery and rehabilitation. It is a web based collaboration tool that addresses the common coordination problems during a disaster from finding missing people, managing aid, managing volunteers, tracking camps effectively between Government groups, the civil society (NGOs) and the victims themselves. Sahana achieves these by providing specific modules to handle various aspects during the aftermath of disasters. Winner of many notable awards and recognition, Sahana has been deployed and used to manage disasters in many countries, including Indonesia, Pakistan and the Philippines. This session gives an overview of Sahana and describes the reasons behind the success of Sahana, especially the FOSS influence. It also looks at the practical applications/deployments of Sahana, as well as its relationship to healthcare. – Ravindra DeSilva – Sri Lanka

Xtra Presentation #1 – Opportunities: Alternative Health Technology Low-Cost Health Management Information Systems
What is Alternative Healthcare Technology and Access? AHT Introduction to the low-cost Alternative Hardware Access Examples of Alternative Hardware One Laptop Per Child Intel Classmate PC INK mPC – Affordable Computer Fouad Riaz Bajwa – Pakistan

Session #18 – Matching and Disclosure Choices of Person’s Health Records Across Institutional and Political Boundaries
For a person’s health care information to be readily available electronically (or conversely secured from access) across multiple health care systems, a number of technical and policy issues must be addressed. Beside the usual issues of defining a common standard for the representation of a computationally complex health care record, there is the even more complex issue of managing person identity and rules and choices regarding information disclosure across institutional and political boundaries. The United States Department of Veterans Affairs (VA) and Department of Defense (DOD) have evolved several solutions and policies that address many of the issues involved for such identity management (GCPR – Government Computer Patient Record; FHIE – Federal Health Information Exchange; BHIE – Bi-directional Health Information Exchange; CHDR – Clinical Data Repository/Health Data Repository). The departments use a “federated model” for Master Person Indexes (MPIs) with pre-established policies and rules for exchanging and matching identity information. Persons’ records can be automatically matched across the departments based on predefined traits or can be selected individually for matching or exclusion from sharing identity information. Details of the policies, processes and political issues will be described and discussed. – Cameron Schlehuber – USA