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mHealth4Afrika: Supporting Standards Based Integration of Medical Sensor Data

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mHealth4Afrika has introduced the use of CE approved medical sensors at the point of care in primary healthcare facilities in Africa as part of an integrated platform supporting primary health care services. This paper shares insights into the standards-based architecture and HL7 FHIR service developed to support data transfer from sensors with proprietary standards to populate the mHealth4Afrika electronic patient record via custom Android and Windows applications. The current iteration is being validated in healthcare facilities in Ethiopia, Kenya, Malawi and South Africa.
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Baskaya, M., Yuksel, M., Laceli Erturkmen, G. B., Cunningham, M., Cunningham, P.
(2019), mHealth4Afrika - Supporting Standards based Integration of Medical Sensor
Data, Short Paper, Series Studies in Health Technology and Informatics, Volume 258,
ICT for Health Science Research, Proceedings of EFMI STC 2019, IOS Press, ISBN:
978-1-61499-959-1, DOI: 10.3233/978-1-61499-959-1-259
mHealth4Afrika - Supporting Standards
based Integration of Medical Sensor Data
Mert BASKAYAa,c, Mustafa YUKSELa, Gokce Banu LALECI ERTURKMENa,
Miriam CUNNINGHAMb and Paul CUNNINGHAMb
a SRDC Software Research Development & Consultancy Corp, Turkey,
Email: baskaya@srdc.com.tr, mustafa@srdc.com.tr, gokce@srdc.com.tr
b IIMC / IST-Africa Institute, Ireland, Email: miriam@iimg.com, paul@iimg.com
c Department of Computer Engineering, Middle East Technical University, Turkey
Abstract. mHealth4Afrika has introduced the use of CE approved medical sensors
at the point of care in primary healthcare facilities in Africa as part of an integrated
platform supporting primary health care services. This paper shares insights into
the standards-based architecture and HL7 FHIR service developed to support data
transfer from sensors with proprietary standards to populate the mHealth4Afrika
electronic patient record via custom Android and Windows applications. The
current iteration is being validated in healthcare facilities in Ethiopia, Kenya,
Malawi and South Africa.
Keywords. Africa, Ethiopia, Kenya, Malawi, South Africa, Wireless medical
sensors, Sensor gateway, Continua Design Guidelines, HL7 FHIR, EMR
1. Introduction
mHealth4Afrika is co-designing an integrated platform to facilitate holistic monitoring
of a patient's well being in resource constrained primary healthcare facilities in urban,
rural and deep rural environments in Southern Africa (Malawi, South Africa), East
Africa (Kenya) and Horn of Africa (Ethiopia) in close collaboration with Ministries of
Health, district health officers, clinic managers and health workers [1, 2]. It integrates
Electronic Medical Records (EMR) and Electronic Health Record functionality with
medical sensors and data visualisation tools to facilitate interpretation and monitoring
of the patient results. One of the research objectives was to identify CE approved
medical sensors to be integrated with the mHealth4Afrika platform and implement a
vendor neutral integration layer to capture sensor readings for a specific patient and
transfer them via Health Level Seven (HL7) Fast Healthcare Interoperability Resources
(FHIR) to the EMR. As part of the integrated platform, mHealth4frika has introduced
the use of medical sensors at the point of care to capture blood pressure, pulse, oxygen
in blood (SpO2), glucose, temperature, weight and haemoglobin [1, 2]. This paper
provides an overview of the design of a standards-based approach to support the
transfer of medical sensor readings from CE approved devices using proprietary
standards to populate the mHealth4Afrika EMR that is built upon DHIS2.
This research is co-funded by the European Commission under the Horizon 2020
Research and Innovation Framework Programme (mHealth4Afrika, Grant Agreement
No. 688015).
Baskaya, M., Yuksel, M., Laceli Erturkmen, G. B., Cunningham, M., Cunningham, P.
(2019), mHealth4Afrika - Supporting Standards based Integration of Medical Sensor
Data, Short Paper, Series Studies in Health Technology and Informatics, Volume 258,
ICT for Health Science Research, Proceedings of EFMI STC 2019, IOS Press, ISBN:
978-1-61499-959-1, DOI: 10.3233/978-1-61499-959-1-259
2. Design
The architecture of the mHealth4Afrika medical device integration includes:
1. Tablet Application: A native Android tablet application to gather various
medical measurements from Bluetooth compliant BewellConnect medical
devices and transmit them to automatically update the mHealth4Afrika EMR.
2. Windows Application: A Windows application to gather haemoglobin
readings from HemoCue HB201+ device via USB and transmit to the EMR.
3. FHIR Service: An interoperability service that establishes HL7 FHIR STU3
based communication with the tablet and Windows applications, and via
native DHIS2 API to the mHealth4Afrika data model set up in DHIS2 server.
Applications implement a workflow including; authorization of a user, gathering
patient information based on user access rights, selecting a patient with related program
stage visit, gathering medical sensor readings and transferring them to FHIR Service as
FHIR STU3 bundles. FHIR Service interprets incoming bundles and populates data
fields in the mHealth4Afrika DHIS2 data model using the native DHIS2 REST API.
Figure 1. mHealth4Afrika Compliance with Continua Design Guidelines
Continua Design Guidelines (CDG) by Personal Connected Health Alliance
(PCHA) is implemented in the architecture. Figure 1 above briefly summarizes
mHealth4Afrika compliance with the Continua stack.
3. Conclusion
This paper provides an overview of the architecture and FHIR service developed as a
standards-based approach to populate mHealth4Afrika EMR with medical sensor
readings in resource constrained environments. The application has been used in
African healthcare facilities since 2017 and has undergone a number of iterations.
References
[1] Cunningham, M., Cunningham, P., van Greunen, D., Kanjo, C., Kweyu, E. and Tilahun, B . (2018)
mHealth4Afrika Beta v1 Validation in Rural and Deep Rural Clinics in Ethiopia, Kenya, Malawi and
South Africa, Proc. of IEEE Global Humanitarian Technology Conference (GHTC) 2018, IEEE Xplore
[2] Cunningham, M., Cunningham, P., van Greunen, D. (2018), mHealth4Afrika - Co-designing an
Integrated Solution for Resource Constrained Environments, Journal of Health Informatics in Africa,
Volume 5 (2018) Issue 2, ISBN: 978-3-9816261-8-6, DOI: 10.12856/JHIA-2018-v5-i2-198
... mHealth4Afrika incorporates an extensive set of programs (Medical History for adults and children, Obstetric History, Maternal Program, Family Planning, Cervical Cancer Screening, Child Under 5, Tuberculosis, Antiretroviral therapy, Diabetes, General and some specialist Outpatient Department) and functionality prioritised by participating key stakeholders. It supports realisation of SDG3 [1], by supporting effective technology adoption at the point of care and providing evidence of how adoption of appropriate technological innovation can support people-centered health services [2,6,7,20]. ...
Conference Paper
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Supported by the European Commission under Horizon 2020, mHealth4Afrika is co-designing and validating a modular, multilingual, state-of-the-art primary healthcare platform for use in resource constrained environments. Based on active consultation and collaboration with Ministries of Health (MoH), district health officers, clinic managers and primary healthcare workers from urban, rural and deep rural health centres in Ethiopia, Kenya, Malawi and South Africa, mHealth4Afrika has co-designed a comprehensive range of health programs and associated functionality. This paper provides insights into how mHealth4Afrika is supporting a holistic, patient-centric, standards-based "cradle to grave" approach to replacing paper-based registries and program-specific (or siloed) electronic solutions installed in many cases by donors targeting specific diseases. mHealth4Afrika is a HL7 FHIR-based platform integrating Electronic Medical Record (EMR) and Electronic Health Record (EHR) functionality, leveraging medical sensors and decision support at the point of care, saving time associated with monthly aggregate data reporting and encouraging attendance through SMS communications with clients and community health workers.
Article
Full-text available
Background: mHealth4Afrika is a collaborative research and innovation project, co-funded under Horizon 2020. It is focused on supporting Sustainable Development Goal 3 and Horizon 2020 Societal challenges by researching and evaluating the potential impact of co-designing and developing an open source, multilingual enabled mHealth platform to support quality community-based primary maternal healthcare delivery at semi-urban, rural and deep rural clinics, based on end-user requirements in Southern Africa (Malawi, South Africa), East Africa (Kenya) & Horn of Africa (Ethiopia). Methods: A mixed methods strategy is applied. For technical development of the platform, design science research techniques are applied. The various platform iterations are implemented using an agile development process. Qualitative data collection and ethnographic observation was used during the needs requirements and base line study and validation of system iterations. These methods support regular interaction with policy makers, district and clinic managers and healthcare workers as part of the co-design process. Results: This paper aims to share insights into the co-design process to develop a platform that integrates Electronic Medical Records, Electronic Health Records, medical sensors and visualisation tools, and automatically generates monthly program indicators. Conclusions: mHealth4Afrika has developed a custom application to strengthen primary healthcare delivery in resource-constrained environments. It supports a range of interdependent programs defined in consultation with key stakeholders. This is achieved by interacting with a data model set up in DHIS2 via a WebAPI to facilitate holistic monitoring of a patient's wellbeing.