Connecting Point of Care Applications to the Health Exchange in low connectivity settings

Hi all,

There have been a number of discussions around how to connect point of care systems (OpenMRS and other PHC or Hospital Systems), as well as pharmacy, lab and other applications that live ‘under’ the interoperability layer, to the health information exchange when there is limited and intermittent connectivity.

In environments like this (most of Africa!), an online transactional system is not possible. Even in South Africa we find that there are many many primary healthcare facilities with no internet connection. The use of 3G modems is possible, but there are operational issues that make this difficult (no structures in place to limit usage to health applications, no mechanisms for ensuring there is enough credit for data etc.).

A few years ago we developed a prototype application, called a LIM (local information mediator), that allowed one to write custom database queries against a number of different relational databases. This was specifically meant for extracting data from iDART installations (pharmacy) and posting this data to the exchange for stock management. It uses a simple file queue to queue up messages, and these are posted to the exchange when there is connectivity. I guess one could call this a kind of data trickle mechanism. Although we are not using HL7 messages for this application, the LIM could easily create and queue HL7 messages.

The advantages to this kind of mechanism as we see them are:

  1. Allows trickling of data when connectivity becomes available

  2. Allows a non-web enabled application to post data to an http(s) endpoint

  3. Provides access to data via direct queries to the database when it may not be possible to change code (for proprietary systems that vendors are not willing to change, or just old, unmaintainable systems)

There are of course some disadvantages, the main one being security - the service will need direct access to the database, and the database password in the config will need to be secured.

We have found though, in many situations, that many of these kind of standalone apps are used on unsecured computers in facilities and that a worryingly large number of the databases use default passwords that are widely known!

We would be very interested to hear any thoughts from the community around this kind of application, and if anyone out there has similar needs.



Pierre Dane

Jembi Health Systems

Software Development Manager

tel: +27 (0)21 701 0939

cel: +27 (0)83 680 8274