David Lubinski, Group Leader September 15, 2010

1. Creating Stronger Health Systems Through Stronger Health Information Systems“Understanding how things work, how you want them to work and how to get there.” David Lubinski, Group Leader September 15, 2010

2. Topics for This Session • The Challenges Countries Face in Strengthening Their Health Information Systems • Towards a Systematic Architected and Rational Approach to HIS Strengthening • Results of a Demonstration of this Approach Applied in LMIS • Discussion, Feedback, Next Steps

3. Global CEO & Leaders Study Results • Escalation of complexity: The world’s private- and public-sector leaders believe that a rapid escalation of “complexity” is the biggest challenge confronting them. They expect it to continue—indeed, to accelerate—in the coming years. • Not Equipped to Respond: They are equally clear that their enterprises today are not equipped to cope effectively with this complexity in the global environment. • Creativity is Key: Finally, they identify “creativity” as the single most important leadership competency for enterprises seeking a path through this complexity. This study is based on face-to-face conversations with more than 1,500 chief executive officers worldwide. Released May 2010

4. A National Government A National Health System is Complex Health Trade & Industry Agriculture Energy and Power Finance Foreign Affairs Internal Affairs Information & Media Justice Labor Lands Local Government Marine Resources Natural Resources Public Affairs Public Works-Housing Social Welfare Tourism and Culture Transportation Governorate North Governorate East Governorate South Governorate West Disease Control & Prevention Drug & Medical Supplies Financial Resources Hospital & Lab Services Human Resources for Health Internal Audit Management Services Medical Services Nursing Services Planning & Information Primary Health Care Support Services District N1 District W1 District S1 District E1 District N2 District W2 District S2 District E2 District N3 District W3 District S3 District E3 District N4 District W4 District S4 District E4

5. Core Functional Domains of a Health System

6. The Supply Chain for Health Products is Complex Procurement systems for pharmaceutical products – Senegal, Apr 2008

7. Architecture Helps With Complexity Architecture is a unifying or coherent structure: to be logically or aesthetically consistent so that all the separate parts fit together and add up to a harmonious or credible whole. “The fundamental organization of a system embodied in its components, their relationships to each other, and to the environment, and the principles guiding its design and evolution.” Leads to common understanding and direction for strengthening systems. Made up of well described and designed building blocks that are reusable to save time, save money and reduce risk of project failure.

8. Enterprise Architecture Defined • An Architecture driven by specific requirements of an organization: • A ministry of education for example is an enterprise comprised of a collection of programs and administrative functions, that share a common set of goals. • An enterprise might include external partners and providers of services or financing that operate within a country or system.

9. The Goal: Organizations that Perform Enterprise Architecture How everything fits together across the organization Functional Architecture Principles, Objectives, Policy How the organization is structured & works to meet its objectives Functional Requirements Information Architecture Technical Architecture Data How information systems support the objectives of the organization Applications Infrastructure Architecture How the technology fits together and supports the organization Phones & Computers Networks & Communications

10. People that would benefit from technology have a difficult time talking to the people that create it, Scott Adams captured it brilliantly…

11. Topics for This Session • The Challenges Countries Face in Strengthening Their Health Information Systems • Towards a Systematic Architected and Rational Approach to HIS Strengthening • Results of a Demonstration of this Approach Applied in LMIS • Discussion, Feedback, Next Steps

12. Systematic Architected Rational Approach for Solution Development Need more attention here Most funding is focused here 1 2 3 4 Design Develop Deploy Analysis Context Problems Users Processes Requirements TCO*/budget Specifications Data Model User Interface Device types Interfaces Standards SDLC* Dev Tools Data base OS* Network Road map User Training Migration plan Infrastructure Support staff Maintenance TCO*/budget *”SDLC” software development life cycle, “OS” operating systems, “TCO” total cost of ownership.

13. From Architecture to Impact Local Global Health No health impact until you get into the green box. Path #1 leverages global standards & architecture. Path #2 leverages global standards, architecture and others’ R&D. Country solutions need to work as part of a national health information system. General Architectures 1 2 General Solutions

14. Example of What a Common Architecture Building Block Looks Like

15. Example of what a Common Solution Building Block Looks Like

16. From Architecture to Impact Local Global Health No health impact until you get into the green box. Path #1 leverages global standards & architecture. Path #2 leverages global standards, architecture and others’ R&D. Country solutions need to work as part of a national health information system. General Architectures 1 2 General Solutions

17. Requirements Foundation: The Collaborative Requirements Development Methodology (CRDM) Partnership with the Public Health Informatics Institute to adapt a proven methodology evolved over 10 years of domestic U.S. public health practice Collaborative approach to determine and document common requirements is the core of the methodology As applied to global health supply chain the CRDM was designed to be: Collaborative across communities of global subject matter experts, global stake holders, country subject matter experts, country stakeholders & users Collaborative across vertical disease programs including vaccines, reproductive health, essential medicines Collaborative across four countries Viet Nam, Kenya, Rwanda & Senegal

18. Topics for This Session • The Challenges Countries Face in Strengthening Their Health Information Systems • Towards a Systematic Architected and Rational Approach to HIS Strengthening • Results of a Demonstration of this Approach Applied in LMIS • Discussion, Feedback, Next Steps

19. Facilitated Process Analysis to Produce Draft Processes and Requirements

20. Collaboratively Determining Logical Workflow

21. Critical clarification or annotation Capture logic and requirements through nontechnical modeling Discrete work activity or task Sub-process that contains a set of tasks Logical flow of work and/or data Where the work takes place Process links to next page Person who does the work Decision point in the work flow Beginning of the process Capture comments and feedback

22. Language of Health Users and Experts That is Easy to Understand & Share 52 12 168

23. Country Validation with LMIS Users EPI Store Keeper Pharmacist Logistician Stock Picker

24. The Language of the Software Architect Business Class Unified Modeling Language (UML) Model GoodsOrder Unique Identifier Department SetPrice( ) SetPriceInCurrency( ) Cancel( ) GoodsEntry StockItem Quantity GoodsList 1 1* Requisition FileDate IssueDate LoadFinancials( ) Submit( ) <<Interface>> IApprover ARDecision( ) RequestConcurrence( ) IssueHold( ) LogToAudit( ) FinancialInfo BudgetCode Account CostCenter

25. The Language of the Software Engineer in C# namespace PathLMIS { public class GoodsOrder { … // Requisitions for placement of orders // Status of requestion updated by IApprover interface // Last update, 2010-03-20 by RJA, Approved by JL public class Requisition : GoodsOrder, IApprover { public Requisition() { this.fileDate = new Date(System.GetDate()); this.issueDate = new Date(-1); // Date will be set when approved } private Date fileDate; Date FileDate { get { return this.fileDate; } } /// <summary> /// LoadFinancials - set financial information on requisition after authorization /// </summary> /// <returns>Returns true if values are set</returns> public bool LoadFinancials(int departmentCode, int authorizationCode){ bool flag = true; if (CheckUserAuthorization(this.submitter, authorizationCode, departmentCode) == false) { this.financials = new FinancialInfo(); flag = false; // Failure to authorize } else { FinancialInfo fi = CompanyFinancials.Lookup(deparmentCode); this.financials = fi; } return flag; } }

26. How are these requirements being used? • Used to develop RFPs to evaluate software in the market • Used by developers to develop technical specifications and write software • Used to evaluate what is already installed to compare how well it meets requirements and develop plans to enhance existing applications • Used by commercial off-the-shelf product companies to build products more in line with user needs

27. Topics for This Session • The Challenges Countries Face in Strengthening Their Health Information Systems • Towards a Systematic Architected and Rational Approach to HIS Strengthening • Results of a Demonstration of this Approach Applied in LMIS • Discussion, Feedback, Next Steps

28. Thank you ขอบคุณ Merci شكرا لك 謝謝您 Cảm ơn bạn Thank You Asante Shukran Danke Grazie Dank je Gracias