Electronic Health Information Systems in the Pacific: An Analysis of the current situation (progress and challenges) and recommendations for the Region

Purpose of the Consultancy

Working closely with the health information managers in the Ministry of Health and Medical Services across the Pacific and with support from the WHO Country Office, the consultant will assess the electronic health information system adoption level in the countries of the Region (22 countries and areas) based on the survey results collected by the World Health Organization and Pacific Health Information Network (PHIN) and specific case studies conducted in the selected countries. The main objective is to analyse information on electronic health information applications  and collect additional data though case studies in order to support the countries to plan better E-health strategies focusing particularly on policies for supporting Electronic health record (EHR) implementation. Understanding the implementation status and barriers to EHR system implementation is the first step to overcoming them and moving forward.

Specific objectives:

• Assist in finalizing the survey instrument and help with data analysis
• Develop case studies on the implementation and use of EHR and other health information systems, with particular focus on interoperability in Pacific countries.
• Provide recommendations to implement EHR and to achieve interoperability in eHealth in the region

Background

Although electronic health information systems  can bring numerous benefits to the countries, there is no regional level data available to know their level of adoption and usage by all the countries. Some information has been collected earlier from eight countries related to electronic health information systems. Pacific countries have implemented various electronic health systems over time, which have supported different functions such as management, medical records, medication prescribing, dispensing and procurement, surveillance of NCDs and infectious diseases and policy decision making. Many countries have already some type of electronic patient record system in place, and those who do not have, are also increasingly interested in implementing EHR because they offer several advantages over paper records.  However, there is variation in their use within the facilities with highest being in the main hospitals and the least in primary care facilities. Primary level facilities usually use paper-based system for HIS or they have adopted district level reporting tools. However, most of the countries seem to use different EHR systems; some of them are owned by its governments others use open-source software products that do not require any cost for using and some systems employ proprietary software products which are under commercial licenses. While funding is likely to be an ongoing issue regionally (and globally) that hinders implementation, also capacity, infrastructure and legal issues are causing challenges for the countries in their implementation.

Planned timelines (subject to confirmation)

Start date: 20/09/2017

End date: 15/11/2017

Work to be performed
 

Method(s) to carry out the activity

Desk work and telephone/Skype interviews

Output/s

Contractor should report the status of national electronic health information system implementation. It should consider the level adoption of different national electronic health information systems and their integration. Finally, barriers to implementation and recommendations for the future approaches should be discussed.

In collaboration with national counterparts and relevant key stakeholders, and under the guidance of the Ministry of Health(s) and supervision of WHO, to undertake the following tasks /functions:

• Report based on situation analysis on the current state of national electronic health information system adoption in the Region
  • WHO and PHIN collect data with a survey instrument on the current state of electronic health information national adoption in the Region from the all 22 countries and areas. Consultant is expected to help with finalizing the instrument and assist with data analysis and report writing. 
• Develop methodology for in-depth case studies based on different stages of national electronic health information system  development to identify best practices, challenges and give recommendations for the planning and implementation:
  • Country at early adaptation or no EHR in place: case study should focus on but not to be limited to readiness assessment including critical questions prior EHR implementation (e.g. Kiribati)
  • Country in process of building up EHR (limited adoption of EHR) where aid agencies and donors are main supporters of the system: case study should focus on but not be limited to assessing comprehensiveness  and relevance of the patient records and technical and financial sustainability of the current system (e.g. Tuvalu)
  • Country in scaling up and mainstreaming their EHR. For example countries where HIS are increasingly linked, but still have primary health care that is not using EHR or it is just been piloted. The focus of the case study should be on usability of the system and give recommendations how to integrate the EHR at the primary health care level and expand the system include the patients to view their own records (e.g. Fiji)
  • Country that will have their current HIS including EHR undergoing a reform as part of the larger scale development project (e.g. E-governance reforms or large scale funding to reform the HIS) (e.g. Tonga, Samoa)
  • Country that has implemented DHIS2: implementation status and lessons learned
  • Identify technical assistance needs in the case study countries: Short/ medium/long-term priorities for should be identified along with resource requirements and technological solutions.
• Assist collecting right information for the case studies in the field in selected countries
  • Much of the additionally necessary information can be obtained through phone/Skype contacts and through field level WHO staff/consultants that will collect necessary data for the case studies

• Identifying Opportunities and Developing Implementation Strategies
  • Setting directions and identifying the best strategies for the countries focusing  particularly on important key fundamental arrangements for future e-health and EHR (such as IT architecture and support, unified ID development and application and use of international standards on medical coding including strengthening linkages between hospitals and PHC facilities)
  • Recommendation on how HIS should response to climate change and adopt early warning systems
  • Recommendations on regional cooperation between countries in terms of EHR and electronic health information systems development and WHO’s and its partner’s role in assisting on this.
  • Support the PHIN Executive team for developing PHIN activities and strategies for the next three-five years on e-health.
  • Recommendations and strategies should be shared and discussed with the President of Pacific Health Information Network and Regional Advisor for E-health in Western Pacific including Pacific Health Systems and policy, Pacific Technical Support/WHO prior including them into the report.

The expected deliverables of the contract will be:

• Workplan, and methodology (timeline for work, suggested methodology for case studies) and outline for the report.
• Revised survey instrument
• Report and case study outlines
• Final report to include:
  • Outcomes of the EHR assessment including a summary and case studies
  • Recommendations for WHO and partner’s role in giving technical assistance and capacity building on EHR development at national and regional levels
• Create a template of HIS country profiles

Technical Supervision

The selected Consultant will work on the supervision of:

Responsible Officer:

Katri Kontio, Technical Officer, Pacific Health Systems and policy, Pacific Technical Support

Email: kkontio@who.int

Manager: Kunhee Park, A/Team Coordinator, Pacific Health Systems and policy, Pacific Technical Support

Email: parkku@who.int

Specific requirements

- Qualifications required: Postgraduate studies and/or training in public health and health information/health informatics

- Experience required: At least 7 years of working experience, including international work experience, with specialisation in developing and implementing electronic health records and district health information systems in low and middle-income countries, preferably in one or more Pacific islands. Experience working in user centred design or integrating climate data for health information systems would be an asset.

- Skills / Technical skills and knowledge: Knowledge of the specific or technical area of electronic patient records (system architecture/ICT applications/interoperability, legal frameworks for EHR, data standardization etc.)

- Language requirements: Written and spoken fluency in English is essential. Working knowledge of other UN languages is an advantage

Competencies

Communicating in a credible and effective way;

Producing results; and

Moving forward in a changing environment.

Place of assignment

The contractor would provide home-country based remote support during the contract period.

Timeline/Duration of assignment
The duration for of the assignment is from 20 September to 15 November 2017, with 23 working days.

• Technical revision and finalization of the survey instrument, 1 day
• Data collection for case studies: telephone interviews and literacy review, 3 days
• Data collection for case studies: telephone interviews and literacy review, 7 days
• Data analysis and write up: survey data analysis and case studies, 6 days
• Complete the final report, 4 days
• Regional webinar development and conducting the webinar of the results, 2 days

Detailed cost breakdown

Contractual fee = (expected working days, preferably 23 days) X (your expected daily rate) = ___________

Miscellaneous (if any, specify) = ______________                         

TOTAL = _____________________

Qualified and interested individuals or institutions should submit an application letter to wpfjidpsprocurement@who.int  by 3 September 2017. Please use Tender Notice No. 60915 as subject to all submissions.

Only short-listed applicants will be contacted