An Architecture and Reference Implementation of an Open Health Information Mediator: Enabling Interoperability in the Rwandan Health Information Exchange

Architectural frameworks for developing national health information systems in low and middle income countries

“…Success stories include the District Health Information System (DHIS) [45,46] and Open Medical Record System (OpenMRS) [9,10,28,47], both of which are reaching enterprise scale in several LMICs. An open health information exchange (OpenHIE) has also recently been implemented in Rwanda [7] . Some countries are attempting to consolidate and expand their current health information systems into coherent and integrated NHIS.…”

“…Based on our experiences working in LMICs [7][8][9][10], we observe the following general evolution of NHIS in LMICs through three different stages of maturity.…”

“…An example of a Stage 3 NHIS is the Rwanda Health Information Exchange (RHIE) [7] that is implementing a national standards-based HIE to improve interoperability between health applications, initially for maternal and child health with plans for other domains.…”

“…Drawing from our own experiences in designing and deploying NHIS in developing African countries [7,8], and previous experiences of others in LMICs [46,62] and HIC [11,63] we highlight the following key considerations for engineering effective NHIS in LMICs.…”

“…However NHIS in LMICs have several characteristics that set them apart from traditional enterprise information systems. Based on our experiences working in LMICs [7][8][9][10] we aim in this paper to identify these characteristics and elaborate why novel approaches to their engineering are required. In Section II of this paper, we review approaches to NHIS engineering in various settings.…”