MALAWI TERMINOLOGY SERVICE: NEED FOR IMPLEMENTATION GUIDANCE

[Kondwani_Kuthyola]

Good day team,

My name is Kondwani Kuthyola, Product Manager under Baobab Health Trust, Malawi. We are in the early stages of developing a Terminology Service for the country. However, it is still fuzzy at this stage on how we should go about this. For starters, we are following the OPENHIE guide on developing Terminology Services and at this point in time, we have “Analysed the current environment” and “identified a few stakeholders”. However, before we go too deep into it, we though we’d get clarification on the below points from the team and any other information that is necessary for us:

1. In cases where healthcare providers don’t understand how to use existing terminologies, are there special bodies that provide training to ensure better clinical accuracy?
2. Looking at the documentation, implementing a centralised Terminology Service makes more sense but Malawi has a big issue with network reliability as well as frequent power cuts (especially in the remote and hard to reach areas). What would be the best approach to this taking into account similar implementations in other African countries?
3. There is lack of experience of internal human resources in terms of classification, mapping, coding and standards. How best can we deal with this constraint?
4. For determining the project scope, it might help us a lot if you could share sample user stories from successful implementations as basis for building user stories that fit the Malawi Use Case.
5. What data standards are common and in widespread use particularly in African countries knowing we have similar disease conditions?
6. Based off other literature, ICD 10 is listed as a Healthcare Billing Terminology, SNOMED CT is listed as a Clinical Terminology, LOINC is listed as a Clinical and Laboratory Terminology and then RxNorm is listed as a Pharmacy Terminology. Does this mean that one would have to implement each one of these if there are use cases for each or using SNOMED for instance would take care of all use cases? Is it possible to append to a reference terminology (i.e. SNOMED, LOINC), custom standard terminologies that are/were developed by a nation?
7. In terms of the implementation software, what are the best tools both open source and commercial that one would utilise?
8. What are some open source mapping tools that could be utilised?
9. Are there already existing data inventories from other implementers (preferably from African countries) that we could utilise as a basis.
10. What have been the common challenges faced during implementation and how have they been resolved?
11. What tools are recommended especially during requirements gathering phase?
12. Are their contacts we can talk to if we need a demo on some of the implementations that have been done?
    Looking forward to collaborating with you all.

Kind regards,

Kondwani

[Carol_Macumber]

Hello Kondwani -

My apologies for the delayed response. The OHIE Terminology Services Community would be happy to discuss the items below. Would it be possible for you and/or
your team to join the next Terminology Services call on Wednesday February 20^th (details are below)?

Kind Regards,

Carol

Terminology Services Community Call

Agenda & Notes:

https://wiki.ohie.org/display/resources/Terminology+Service+Community+Call

How to Join:

Access Code 20486132#

Toll Free Numbers:

US: 800-220-9875

Norway: 800-142-85

Ireland: 800-625-002

Canada: 800-221-8656

South Africa 0-800-982-555

International (Not Toll-free) 1-302-709-8332

A complete list of toll free country numbers can be found out on the terminology call page

https://wiki.ohie.org/display/resources/Terminology+Service+Community+Call

On Behalf Of Kondwani Kuthyola

···

Good day team,

My name is Kondwani Kuthyola, Product Manager under Baobab Health Trust, Malawi. We are in the early stages of developing a Terminology Service for the country. However,
it is still fuzzy at this stage on how we should go about this. For starters, we are following the OPENHIE guide on developing Terminology Services and at this point in time, we have “Analysed the current environment” and “identified a few stakeholders”. However,
before we go too deep into it, we though we’d get clarification on the below points from the team and any other information that is necessary for us:

In cases where healthcare providers don’t understand how to use existing terminologies, are there special bodies that provide training to ensure better clinical
accuracy?

Looking at the documentation, implementing a centralised Terminology Service makes more sense but Malawi has a big issue with network reliability as well
as frequent power cuts (especially in the remote and hard to reach areas). What would be the best approach to this taking into account similar implementations in other African countries?

There is lack of experience of internal human resources in terms of classification, mapping, coding and standards. How best can we deal with this constraint?

For determining the project scope, it might help us a lot if you could share sample user stories from successful implementations as basis for building user
stories that fit the Malawi Use Case.

What data standards are common and in widespread use particularly in African countries knowing we have similar disease conditions?

Based off other literature, ICD 10 is listed as a Healthcare Billing Terminology, SNOMED CT is listed as a Clinical Terminology, LOINC is listed as a Clinical
and Laboratory Terminology and then RxNorm is listed as a Pharmacy Terminology. Does this mean that one would have to implement each one of these if there are use cases for each or using SNOMED for instance would take care of all use cases? Is it possible
to append to a reference terminology (i.e. SNOMED, LOINC), custom standard terminologies that are/were developed by a nation?

In terms of the implementation software, what are the best tools both open source and commercial that one would utilise?

What are some open source mapping tools that could be utilised?

Are there already existing data inventories from other implementers (preferably from African countries) that we could utilise as a basis.

What have been the common challenges faced during implementation and how have they been resolved?

What tools are recommended especially during requirements gathering phase?

Are their contacts we can talk to if we need a demo on some of the implementations that have been done?

Looking forward to collaborating with you all.

Kind regards,

Kondwani

–
You received this message because you are subscribed to the Google Groups “Terminology Services” group.
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[Carol_Macumber]

Corrected teleconference information below

···

From: Carol Macumber
Sent: Tuesday, February 5, 2019 3:29 PM
To: Terminology Services terminology-services@googlegroups.com
Subject: RE: MALAWI TERMINOLOGY SERVICE: NEED FOR IMPLEMENTATION GUIDANCE

Hello Kondwani -

My apologies for the delayed response. The OHIE Terminology Services Community would be happy to discuss the items below. Would it be possible for you and/or
your team to join the next Terminology Services call on Wednesday February 20^th (details are below)?

Kind Regards,

Carol

Terminology Services Community Call

Agenda & Notes:

https://wiki.ohie.org/display/resources/Terminology+Service+Community+Call

How to Join:
Join from PC, Mac, Linux, iOS or Android: https://iu.zoom.us/j/233948207

Or Telephone: Dial:
+1 669 900 6833 (US Toll) or +1 646 558 8656 (US Toll)

Meeting ID: 233
948 207

International numbers available:** **https://zoom.us/u/dlbzRk84T

From:
terminology-services@googlegroups.com [mailto:terminology-services@googlegroups.com]
On Behalf Of Kondwani Kuthyola
Sent: Tuesday, February 5, 2019 11:35 AM
To: Terminology Services terminology-services@googlegroups.com
Subject: MALAWI TERMINOLOGY SERVICE: NEED FOR IMPLEMENTATION GUIDANCE

Good day team,

My name is Kondwani Kuthyola, Product Manager under Baobab Health Trust, Malawi. We are in the early stages of developing a Terminology Service for the country. However,
it is still fuzzy at this stage on how we should go about this. For starters, we are following the OPENHIE guide on developing Terminology Services and at this point in time, we have “Analysed the current environment” and “identified a few stakeholders”. However,
before we go too deep into it, we though we’d get clarification on the below points from the team and any other information that is necessary for us:

In cases where healthcare providers don’t understand how to use existing terminologies, are there special bodies that provide training to ensure better clinical
accuracy?

Looking at the documentation, implementing a centralised Terminology Service makes more sense but Malawi has a big issue with network reliability as well
as frequent power cuts (especially in the remote and hard to reach areas). What would be the best approach to this taking into account similar implementations in other African countries?

There is lack of experience of internal human resources in terms of classification, mapping, coding and standards. How best can we deal with this constraint?

For determining the project scope, it might help us a lot if you could share sample user stories from successful implementations as basis for building user
stories that fit the Malawi Use Case.

What data standards are common and in widespread use particularly in African countries knowing we have similar disease conditions?

Based off other literature, ICD 10 is listed as a Healthcare Billing Terminology, SNOMED CT is listed as a Clinical Terminology, LOINC is listed as a Clinical
and Laboratory Terminology and then RxNorm is listed as a Pharmacy Terminology. Does this mean that one would have to implement each one of these if there are use cases for each or using SNOMED for instance would take care of all use cases? Is it possible
to append to a reference terminology (i.e. SNOMED, LOINC), custom standard terminologies that are/were developed by a nation?

In terms of the implementation software, what are the best tools both open source and commercial that one would utilise?

What are some open source mapping tools that could be utilised?

Are there already existing data inventories from other implementers (preferably from African countries) that we could utilise as a basis.

What have been the common challenges faced during implementation and how have they been resolved?

What tools are recommended especially during requirements gathering phase?

Are their contacts we can talk to if we need a demo on some of the implementations that have been done?

Looking forward to collaborating with you all.

Kind regards,

Kondwani

–
You received this message because you are subscribed to the Google Groups “Terminology Services” group.
To unsubscribe from this group and stop receiving emails from it, send an email to
terminology-services+unsubscribe@googlegroups.com.
For more options, visit https://groups.google.com/d/optout.

[Andrew_Kanter1]

Dear Kondwani,

Very nice to see the progress you have made since the Malawi OMRS meeting! I think you probably know that I manage the CIEL concept dictionary, and so I tend to be biased toward a more curated solution. The OpenHIE terminology service model can support either a real-time translation service, or a more curated model where the server is mostly used to produce a curated dictionary which is loaded and standardized in the applications. The latter solution is not as robust as an on-the-fly translation service, but I think it is likely to be more applicable in poor connectivity settings. I hope that you have been tracking the discussion about Open Concept Lab (OCL) and how that can serve as a cloud-based curated dictionary server (loaded with CIEL in particular). I might defer to others more active in OpenHIE than I, but I will make some comments below. AK>

Andy

···

On Tuesday, February 5, 2019 at 10:35:27 AM UTC-6, Kondwani Kuthyola wrote:

Good day team,

My name is Kondwani Kuthyola, Product Manager under Baobab Health Trust, Malawi. We are in the early stages of developing a Terminology Service for the country. However, it is still fuzzy at this stage on how we should go about this. For starters, we are following the OPENHIE guide on developing Terminology Services and at this point in time, we have “Analysed the current environment” and “identified a few stakeholders”. However, before we go too deep into it, we though we’d get clarification on the below points from the team and any other information that is necessary for us:

1. In cases where healthcare providers don’t understand how to use existing terminologies, are there special bodies that provide training to ensure better clinical accuracy?

Providers should not be expected to understand terminology. If your system requires that, you are bound to have trouble. I would focus on clinical documentation and teaching good searching skills (if that is appropriate to your application). I know that there are folks to help train developers and designers, however, including work I have done for the open source community.

1. Looking at the documentation, implementing a centralised Terminology Service makes more sense but Malawi has a big issue with network reliability as well as frequent power cuts (especially in the remote and hard to reach areas). What would be the best approach to this taking into account similar implementations in other African countries?

See above.

1. There is lack of experience of internal human resources in terms of classification, mapping, coding and standards. How best can we deal with this constraint?

Most OMRS implementations of size have people who are terminology subject matter experts. CIEL has been working with many of them to assist in the overall design or curation of their dictionaries. The goal should be to reduce the burden on local implementations by deferring a lot of the work to a centralized authority like CIEL.

1. For determining the project scope, it might help us a lot if you could share sample user stories from successful implementations as basis for building user stories that fit the Malawi Use Case.

I think you could refer to PIH, ONA (OpenSRP), ITECH and WHO who have used CIEL services to help. Kenya EMR and Uganda EMR started with CIEL, but not sure how far they got with building up local resources.

1. What data standards are common and in widespread use particularly in African countries knowing we have similar disease conditions?

There aren’t many. See below in regards to domain standards, but specific subsets are hard to find. The CIEL dictionary has an LMIC focus and so generally is applicable.

1. Based off other literature, ICD 10 is listed as a Healthcare Billing Terminology, SNOMED CT is listed as a Clinical Terminology, LOINC is listed as a Clinical and Laboratory Terminology and then RxNorm is listed as a Pharmacy Terminology. Does this mean that one would have to implement each one of these if there are use cases for each or using SNOMED for instance would take care of all use cases? Is it possible to append to a reference terminology (i.e. SNOMED, LOINC), custom standard terminologies that are/were developed by a nation?

SNOMED is not really a clinical terminology for point of care use (interface terminology). It is better than other reference terminologies, but CIEL recommends a user interface terminology model where concepts are managed independently from the various reference terminologies you reference above. You will need all of them for different use cases and interoperability, but you don’t need all of them all the time in the UI.

1. In terms of the implementation software, what are the best tools both open source and commercial that one would utilise?

Recommend OCL and CIEL

1. What are some open source mapping tools that could be utilised?

OCL, Apelon

1. Are there already existing data inventories from other implementers (preferably from African countries) that we could utilise as a basis.

CIEL supports over 50 countries and many throughout Africa.

1. What have been the common challenges faced during implementation and how have they been resolved?

Too big a discussion for this brief email

1. What tools are recommended especially during requirements gathering phase?

Hope others can help here.

1. Are their contacts we can talk to if we need a demo on some of the implementations that have been done?

Happy to arrange demos of CIEL and OCL along with Jonathan Payne.

Looking forward to collaborating with you all.

Kind regards,

Kondwani

[Kondwani_Kuthyola]

Dear Andy,

Thank you for responding to my email and providing a starting point. It really does make a difference and it’d be nice to have an in-depth chat on this. I have included the larger team in the email who will greatly benefit from these discussions. Perhaps we can use the February 20 Community Call meeting as a starting point.

Kind regards,

···

Kondwani Kuthyola

Kuunika Products Manager
Baobab Health Trust,
P.O. Box 31797,
Lilongwe 3,
Malawi.

Cell: +265993741034

Website: www.baobabhealth.org

[Kondwani_Kuthyola]

Dear Carol,

Thanks for coming back to me. I think February 20 is just fine. Let’s have a chat then. I have included the larger team that might be interested in these discussions.

Kind regards,

···

Kondwani Kuthyola

Kuunika Products Manager
Baobab Health Trust,
P.O. Box 31797,
Lilongwe 3,
Malawi.

Cell: +265993741034

Website: www.baobabhealth.org

[jthomas]

Andy,

Are you able to make the call on Wednesday, February 20 @10am EST?

···

**Jamie Thomas **|****Health Information Project Manager/Communications

Center for Biomedical Informatics

1101 West Tenth Street

Indianapolis, IN 46202

Tel 317-274-9218 | Fax 317-274-9305

Email: jt48@regenstrief.org | Skype: jamie.thomas5670 | Twitter: @Regenstrief

www.regenstrief.org

Confidentiality Notice: The contents of this message and any files transmitted with it may contain confidential and/or privileged information and are intended solely for the use of the named addressee(s).
Additionally, the information contained herein may have been disclosed to you from medical records with confidentiality protected by federal and state laws. Federal regulations and State laws prohibit you from making further disclosure of such information
without the specific written consent of the person to whom the information pertains or as otherwise permitted by such regulations. A general authorization for the release of medical or other information is not sufficient for this purpose.

If you have received this message in error, please notify the sender by return e-mail and delete the original message. Any retention, disclosure, copying, distribution or use of this information
by anyone other than the intended recipient is strictly prohibited.

From: “terminology-services@googlegroups.com” terminology-services@googlegroups.com on behalf of Kondwani Kuthyola k.kuthyola@gmail.com
Reply-To: “terminology-services@googlegroups.com” terminology-services@googlegroups.com
Date: Wednesday, February 6, 2019 at 5:46 AM
To: “terminology-services@googlegroups.com” terminology-services@googlegroups.com
Cc: Jeremiah Chienda jeremiahchienda@gmail.com, kanthungo christopher kanthungo@gmail.com, Bwighane Mwalwanda bsmwalwanda@gmail.com, Mwatha Bwanali mwathabwanali@gmail.com, Soyapi Mumba soyapi.mumba@gmail.com, Maganizo Monawe mmonawe@gmail.com
Subject: Re: MALAWI TERMINOLOGY SERVICE: NEED FOR IMPLEMENTATION GUIDANCE

Dear Andy,

Thank you for responding to my email and providing a starting point. It really does make a difference and it’d be nice to have an in-depth chat on this. I have included the larger team in the email who will greatly benefit from these discussions.
Perhaps we can use the February 20 Community Call meeting as a starting point.

Kind regards,

On Tue, Feb 5, 2019 at 11:26 PM ‘andy_kanter’ via Terminology Services terminology-services@googlegroups.com wrote:

Dear Kondwani,

Very nice to see the progress you have made since the Malawi OMRS meeting! I think you probably know that I manage the CIEL concept dictionary, and so I tend to be biased toward a more curated solution. The OpenHIE terminology service model
can support either a real-time translation service, or a more curated model where the server is mostly used to produce a curated dictionary which is loaded and standardized in the applications. The latter solution is not as robust as an on-the-fly translation
service, but I think it is likely to be more applicable in poor connectivity settings. I hope that you have been tracking the discussion about Open Concept Lab (OCL) and how that can serve as a cloud-based curated dictionary server (loaded with CIEL in particular).
I might defer to others more active in OpenHIE than I, but I will make some comments below. AK>

Andy

On Tuesday, February 5, 2019 at 10:35:27 AM UTC-6, Kondwani Kuthyola wrote:

Good day team,

My name is Kondwani Kuthyola, Product Manager under Baobab Health Trust, Malawi. We are in the early stages of developing a Terminology Service for the country. However,
it is still fuzzy at this stage on how we should go about this. For starters, we are following the OPENHIE guide on developing Terminology Services and at this point in time, we have “Analysed the current environment” and “identified a few stakeholders”. However,
before we go too deep into it, we though we’d get clarification on the below points from the team and any other information that is necessary for us:

1. In cases where healthcare providers don’t understand how to use existing terminologies, are there special bodies that provide training to ensure better clinical accuracy?

AK> Providers should not be expected to understand terminology. If your system requires that, you are bound to have trouble. I would focus on clinical documentation and teaching good searching skills (if that is appropriate to your application).
I know that there are folks to help train developers and designers, however, including work I have done for the open source community.

1. Looking at the documentation, implementing a centralised Terminology Service makes more sense but Malawi has a big issue with network reliability as well as frequent power cuts (especially in the remote
   and hard to reach areas). What would be the best approach to this taking into account similar implementations in other African countries?

AK> See above.

1. There is lack of experience of internal human resources in terms of classification, mapping, coding and standards. How best can we deal with this constraint?

AK> Most OMRS implementations of size have people who are terminology subject matter experts. CIEL has been working with many of them to assist in the overall design or curation of their dictionaries. The goal should be to reduce the burden
on local implementations by deferring a lot of the work to a centralized authority like CIEL.

1. For determining the project scope, it might help us a lot if you could share sample user stories from successful implementations as basis for building user stories that fit the Malawi Use Case.

AK> I think you could refer to PIH, ONA (OpenSRP), ITECH and WHO who have used CIEL services to help. Kenya EMR and Uganda EMR started with CIEL, but not sure how far they got with building up local resources.

1. What data standards are common and in widespread use particularly in African countries knowing we have similar disease conditions?

AK> There aren’t many. See below in regards to domain standards, but specific subsets are hard to find. The CIEL dictionary has an LMIC focus and so generally is applicable.

1. Based off other literature, ICD 10 is listed as a Healthcare Billing Terminology, SNOMED CT is listed as a Clinical Terminology, LOINC is listed as a Clinical and Laboratory Terminology and then RxNorm
   is listed as a Pharmacy Terminology. Does this mean that one would have to implement each one of these if there are use cases for each or using SNOMED for instance would take care of all use cases? Is it possible to append to a reference terminology (i.e.
   SNOMED, LOINC), custom standard terminologies that are/were developed by a nation?

AK> SNOMED is not really a clinical terminology for point of care use (interface terminology). It is better than other reference terminologies, but CIEL recommends a user interface terminology model where concepts are managed independently
from the various reference terminologies you reference above. You will need all of them for different use cases and interoperability, but you don’t need all of them all the time in the UI.

1. In terms of the implementation software, what are the best tools both open source and commercial that one would utilise?

AK> Recommend OCL and CIEL

1. What are some open source mapping tools that could be utilised?

AK> OCL, Apelon

1. Are there already existing data inventories from other implementers (preferably from African countries) that we could utilise as a basis.

AK> CIEL supports over 50 countries and many throughout Africa.

1. What have been the common challenges faced during implementation and how have they been resolved?

AK> Too big a discussion for this brief email

1. What tools are recommended especially during requirements gathering phase?

AK> Hope others can help here.

1. Are their contacts we can talk to if we need a demo on some of the implementations that have been done?

AK> Happy to arrange demos of CIEL and OCL along with Jonathan Payne.

Looking forward to collaborating with you all.

Kind regards,

Kondwani

–
You received this message because you are subscribed to the Google Groups “Terminology Services” group.
To unsubscribe from this group and stop receiving emails from it, send an email to

terminology-services+unsubscribe@googlegroups.com.
For more options, visit
https://groups.google.com/d/optout.

–

Kondwani Kuthyola

Kuunika Products Manager

Baobab Health Trust,
P.O. Box 31797,
Lilongwe 3,
Malawi.

Cell: +265993741034

Website:
www.baobabhealth.org

–
You received this message because you are subscribed to the Google Groups “Terminology Services” group.
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[Andrew_Kanter1]

Yes

Andrew S. Kanter, MD MPH FACMI
Akanter@e-imo.com
+1.646.469.2421

···

On Feb 6, 2019, at 7:31 AM, Thomas, Jamie jt48@regenstrief.org wrote:

Andy,

Are you able to make the call on Wednesday, February 20 @10am EST?

**Jamie Thomas **|****Health Information Project Manager/Communications

Center for Biomedical Informatics

<image001.png>

1101 West Tenth Street

Indianapolis, IN 46202

Tel 317-274-9218 | Fax 317-274-9305

Email: jt48@regenstrief.org | Skype: jamie.thomas5670 | Twitter: @Regenstrief

www.regenstrief.org

Confidentiality Notice: The contents of this message and any files transmitted with it may contain confidential and/or privileged information and are intended solely for the use of the named addressee(s).
Additionally, the information contained herein may have been disclosed to you from medical records with confidentiality protected by federal and state laws. Federal regulations and State laws prohibit you from making further disclosure of such information
without the specific written consent of the person to whom the information pertains or as otherwise permitted by such regulations. A general authorization for the release of medical or other information is not sufficient for this purpose.

If you have received this message in error, please notify the sender by return e-mail and delete the original message. Any retention, disclosure, copying, distribution or use of this information
by anyone other than the intended recipient is strictly prohibited.

From: “terminology-services@googlegroups.com” terminology-services@googlegroups.com on behalf of Kondwani Kuthyola k.kuthyola@gmail.com
Reply-To: “terminology-services@googlegroups.com” terminology-services@googlegroups.com
Date: Wednesday, February 6, 2019 at 5:46 AM
To: “terminology-services@googlegroups.com” terminology-services@googlegroups.com
Cc: Jeremiah Chienda jeremiahchienda@gmail.com, kanthungo christopher kanthungo@gmail.com, Bwighane Mwalwanda bsmwalwanda@gmail.com, Mwatha Bwanali mwathabwanali@gmail.com, Soyapi Mumba soyapi.mumba@gmail.com, Maganizo Monawe mmonawe@gmail.com
Subject: Re: MALAWI TERMINOLOGY SERVICE: NEED FOR IMPLEMENTATION GUIDANCE

Dear Andy,

Thank you for responding to my email and providing a starting point. It really does make a difference and it’d be nice to have an in-depth chat on this. I have included the larger team in the email who will greatly benefit from these discussions.
Perhaps we can use the February 20 Community Call meeting as a starting point.

Kind regards,

On Tue, Feb 5, 2019 at 11:26 PM ‘andy_kanter’ via Terminology Services terminology-services@googlegroups.com wrote:

Dear Kondwani,

Very nice to see the progress you have made since the Malawi OMRS meeting! I think you probably know that I manage the CIEL concept dictionary, and so I tend to be biased toward a more curated solution. The OpenHIE terminology service model
can support either a real-time translation service, or a more curated model where the server is mostly used to produce a curated dictionary which is loaded and standardized in the applications. The latter solution is not as robust as an on-the-fly translation
service, but I think it is likely to be more applicable in poor connectivity settings. I hope that you have been tracking the discussion about Open Concept Lab (OCL) and how that can serve as a cloud-based curated dictionary server (loaded with CIEL in particular).
I might defer to others more active in OpenHIE than I, but I will make some comments below. AK>

Andy

On Tuesday, February 5, 2019 at 10:35:27 AM UTC-6, Kondwani Kuthyola wrote:

Good day team,

My name is Kondwani Kuthyola, Product Manager under Baobab Health Trust, Malawi. We are in the early stages of developing a Terminology Service for the country. However,
it is still fuzzy at this stage on how we should go about this. For starters, we are following the OPENHIE guide on developing Terminology Services and at this point in time, we have “Analysed the current environment” and “identified a few stakeholders”. However,
before we go too deep into it, we though we’d get clarification on the below points from the team and any other information that is necessary for us:

1. In cases where healthcare providers don’t understand how to use existing terminologies, are there special bodies that provide training to ensure better clinical accuracy?

AK> Providers should not be expected to understand terminology. If your system requires that, you are bound to have trouble. I would focus on clinical documentation and teaching good searching skills (if that is appropriate to your application).
I know that there are folks to help train developers and designers, however, including work I have done for the open source community.

1. Looking at the documentation, implementing a centralised Terminology Service makes more sense but Malawi has a big issue with network reliability as well as frequent power cuts (especially in the remote
   and hard to reach areas). What would be the best approach to this taking into account similar implementations in other African countries?

AK> See above.

1. There is lack of experience of internal human resources in terms of classification, mapping, coding and standards. How best can we deal with this constraint?

AK> Most OMRS implementations of size have people who are terminology subject matter experts. CIEL has been working with many of them to assist in the overall design or curation of their dictionaries. The goal should be to reduce the burden
on local implementations by deferring a lot of the work to a centralized authority like CIEL.

1. For determining the project scope, it might help us a lot if you could share sample user stories from successful implementations as basis for building user stories that fit the Malawi Use Case.

AK> I think you could refer to PIH, ONA (OpenSRP), ITECH and WHO who have used CIEL services to help. Kenya EMR and Uganda EMR started with CIEL, but not sure how far they got with building up local resources.

1. What data standards are common and in widespread use particularly in African countries knowing we have similar disease conditions?

AK> There aren’t many. See below in regards to domain standards, but specific subsets are hard to find. The CIEL dictionary has an LMIC focus and so generally is applicable.

1. Based off other literature, ICD 10 is listed as a Healthcare Billing Terminology, SNOMED CT is listed as a Clinical Terminology, LOINC is listed as a Clinical and Laboratory Terminology and then RxNorm
   is listed as a Pharmacy Terminology. Does this mean that one would have to implement each one of these if there are use cases for each or using SNOMED for instance would take care of all use cases? Is it possible to append to a reference terminology (i.e.
   SNOMED, LOINC), custom standard terminologies that are/were developed by a nation?

AK> SNOMED is not really a clinical terminology for point of care use (interface terminology). It is better than other reference terminologies, but CIEL recommends a user interface terminology model where concepts are managed independently
from the various reference terminologies you reference above. You will need all of them for different use cases and interoperability, but you don’t need all of them all the time in the UI.

1. In terms of the implementation software, what are the best tools both open source and commercial that one would utilise?

AK> Recommend OCL and CIEL

1. What are some open source mapping tools that could be utilised?

AK> OCL, Apelon

1. Are there already existing data inventories from other implementers (preferably from African countries) that we could utilise as a basis.

AK> CIEL supports over 50 countries and many throughout Africa.

1. What have been the common challenges faced during implementation and how have they been resolved?

AK> Too big a discussion for this brief email

1. What tools are recommended especially during requirements gathering phase?

AK> Hope others can help here.

1. Are their contacts we can talk to if we need a demo on some of the implementations that have been done?

AK> Happy to arrange demos of CIEL and OCL along with Jonathan Payne.

Looking forward to collaborating with you all.

Kind regards,

Kondwani

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Kondwani Kuthyola

Kuunika Products Manager

Baobab Health Trust,
P.O. Box 31797,
Lilongwe 3,
Malawi.

Cell: +265993741034

Website:
www.baobabhealth.org

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