I-TECH provides technical assistance on the prevention and control of COVID-19 that ranges from training health care workers and facilities in infection prevention and control best practices to supporting the development of national policies and standard operating procedures. During the COVID-19 pandemic, I-TECH continues to work with ministries of health and other key stakeholders to ensure that laboratories, health facilities, and clinics are implementing and being trained in procedures to prevent and control the spread of COVID-19.
In addition to directly supporting COVID-19 prevention and control efforts, I-TECH has been working with governments and the ministries of health to ensure the continuity of HIV care and treatment by supporting clinicians via telephone consultations, developing messaging campaigns to connect people living with HIV (PLHIV) with pharmacies and clinics stocked with antiretroviral therapy (ART) medications, and helping PLHIV form community ART refill groups.
Google has selected OpenELIS Global, a laboratory information system stewarded by the Digital Initiatives Group at I-TECH (DIGI), as a participant in the first year of its Season of Docs, a unique program that pairs technical writers with real-world open source projects. DIGI implements OpenELIS Global in Côte d’Ivoire and Haiti and manages contributions to the software as a part of the global developer community.
“We rely on talented contributors from the global health software community to ensure that our tools have the biggest impact and are available to the widest audience possible,” explained Casey Iiams-Hauser, Senior Digital Health Specialist with DIGI and the OpenELIS Global Product Owner. “By being transparent about our challenges and triumphs, we benefit from peer-to-peer sharing to problem solve for the benefit of the whole community.”
Technical writer Areesha Tariq was paired with the OpenELIS Global project as a part of the initiative. Based in Islamabad, Pakistan, Areesha has a background in software engineering and her writing focuses predominantly on user guides. She will work to improve OpenELIS Global end-user documentation by turning the current user manual into more pragmatic and accessible job aids.
Areesha is excited to join the team, saying, “I feel great to be selected as the technical writer for OpenELIS Global. It will be a new learning experience to work in an open-source community. I hope that I will be able to complete the project and continue working with the team so that I can contribute to a global cause.”
By participating in Google’s Season of Docs initiative, DIGI will not only benefit from Areesha’s contributions, it will also have the opportunity to increase awareness of OpenELIS in the global community by having our projects posted to the initiatives website and reviewed by a large number of technical writers, open source organizations, and contributors. “We are excited to be a part of Season of Docs,” said DIGI Managing Director, Joanna Diallo. “During the application process we met a number of highly qualified technical writers and observed a lot of interest in ‘global goods’ like OpenELIS.”
The idea for DIGI’s technical documentation project grew out of a proposal to PATH’s Digital Square project, which like Google’s Season of Docs, invests in critical technology that can be accessed worldwide. DIGI’s proposal was only partially funded by Digital Square to develop practical designs and generalizable approaches to achieve interoperability among open-source, clinic-level data management systems via the OpenHIE framework. These systems include OpenELIS; OpenLMIS, a laboratory management information system; and OpenMRS, an electronic medical records (EMR) system. However, the OpenELIS documentation scope of work remained unfunded.
“Having focused our thinking already on OpenELIS documentation gaps for the Digital Square application allowed us to pull together our Season of Docs application quickly,” explained Diallo. “It was fortuitous timing – and it is inspiring to see both PATH and Google investing in open source organizations.”
In winter 2019, the International Training and Education Center for Health (I-TECH) launched a new unit: the Digital Initiatives Group at I-TECH (DIGI). The DIGI team builds upon 15 years of experience at I-TECH designing, developing, implementing, and evaluating health information systems (HIS) around the world.
The group — co-led by Dr. Nancy Puttkammer, Assistant Professor in the Department of Global Health, and Jan Flowers, Clinical Faculty and Director of Global Health Informatics in the Clinical Research Group (CRIG) — provides services to help programs scope and build technical solutions to manage program or clinical data.
“The shared faculty lead role helps the group leverage diverse resources from departments across the university,” said Joanna Diallo, DIGI Managing Director.
By promoting open-source “global goods” that are supported by implementer communities, DIGI helps partners such as Ministries of Health to be able to own and continue to develop long-term solutions.
In April, Flowers received a Digital Square award to lead an online community of practice on open-source lab information systems like OpenELIS, and Dr. Puttkammer received a Digital Square award to design and test practical and generalizable solutions for interoperability between OpenELIS and two other leading open source tools: OpenMRS and OpenLMIS.
DIGI partners with global communities to develop and enhance digital tools and provide technical assistance for effective implementation and sustainability. The team works closely with on-the-ground experts and stakeholders to guide and facilitate governance, capacity building, and continuous quality improvement using a maturity model lens.
DIGI works in the following technical areas:
Software Design & Development
Health Data Exchange Standards
Health Systems Architecture
Information Security
Evidence-Based Evaluation and Implementation
Digital Health Workforce Development
“With investment from the I-TECH center to launch DIGI, we have been able to approach the work in a new way that is flexible and responsive and promotes cross project sharing,” explained Dr. Puttkammer. “We hope this will continue to strengthen the department’s standing as a leader in digital health.”
National strategies, policies, and governance define the implementation environment for health information systems (HIS) and are recognized as a foundational building block for health system goals, including universal health coverage and control of HIV and other infectious diseases. I-TECH is supporting Cameroon’s Ministry of Health (MOH) to develop a national eHealth strategic plan by September 2019. A goal of the project will be to develop governance structures and processes, which can continue onward beyond the strategic planning process under MOH leadership, for on-going strategic direction, coordination, and oversight of investments in the national HIS.
I-TECH has worked with the Ministry of Health and Wellness, Centers for Disease Control and Prevention, and other implementing partners in Botswana to develop and implement robust national health information system that enable greater efficiency and accountability and strategic use of information. I-TECH’s work on the National Data Warehouse ensures the availability of strategic information to monitor progress toward reaching epidemic control, with particular focus on Treat All, linkages to care, and HIV clinical cascade for 90-90-90 care continuum.
The overall goal of the Enhancing Quality of Healthcare Activity (EQHA) program in Cambodia is to improve the quality of public and private health services in national and sub-national health systems by August 2023. The project, funded by the US Agency for International Development (USAID), is being implemented by Family Health International (FHI360) in collaboration with I-TECH and other partner organizations. I-TECH’s scope of work focuses on improvements to 1) the national health policy regulatory framework and 2) national pre-service health education and training institutions.
Casey-Iiams Hauser, Senior Informatics Implementation Specialist, presents on laboratory information systems at the Global Digital Health Forum in Washington, D.C.
The Fifth Annual Global Digital Health Forum was held from 10-11 December in Washington, D.C., attracting more than 300 participants to the FHI 360 Conference Center. At the forum, representatives from the new Digital Initiatives Group at I-TECH (DIGI) and its partner in Haiti, CHARESS, shared knowledge and lessons learned from 15 years of experience implementing digital health solutions worldwide.
The theme for this year’s forum was “A Shared Language for Digital Health,” and built on a foundation of the World Health Organization’s Classification of Digital Health Interventions.
“I welcome the messages from donors funding digital health work that they are shepherding a new era through the Digital Investment Principles,” said Joanna Diallo, DIGI Managing Director. “The conference provided DIGI an opportunity to present our contributions to global goods like OpenELIS, OpenMRS, and OpenHIE.”
Diallo moderated a panel titled “Different Labs Need Different Systems: An Exploration of Open Source Laboratory Information Systems Use in Global Health and the Community of Practice that Brings Them Together.” Jan Flowers, DIGI Faculty Co-Lead and Director of Global Health Informatics at the University of Washington Clinical Informatics Research Group, and Casey Iiams-Hauser, Senior Informatics Implementation Specialist with DIGI, were panelists, along with Steven Wanyee of IntelliSOFT, a former member of the I-TECH Kenya team.
The panel highlighted LIS as a critical component of national health information systems (HIS) architecture, exploring a complementary suite of open source LIS that are implemented across low- and middle-income countries, describing the laboratories and use cases each serves.
“The forum is a fantastic opportunity to meet with funders, on-the-ground implementers and technologists to discuss our work and learn about new initiatives and technologies,” said Iiams-Hauser. “We can leverage this knowledge for success both in our existing health information projects and in future partnerships.”
CHARESS HIS Lead Nathaelf Hyppolite participated in a session highlighting the development, implementation, and transition of EMR in developing countries, drawing on I-TECH and CHARESS’s work in Haiti. Participants heard about the benefits of an interoperable EMR: a unified data format, the ability to back up data, and that same data can be used to generate reports via DHIS2 from both the cloud servers and hardware EMR system. Hyppolite also shared the advantages and limitations of transitioning to an OpenMRS and OpenHIE platform, which bring experts together to share knowledge, standards, and best practices, as well as collaborate on technologies.
This focus on community and communication was noted by Diallo and the other participants. “DIGI really appreciated the opportunity to learn more about new standards and technologies, how to best approach digital health governance work, and how a shared language will help us collaborate and work together to ultimately improve health outcomes,” said Diallo.
Nancy Puttkammer of I-TECH and Rose Boulay of Haiti’s MSPP/PNLS standing next to I-TECH’s poster on MMS of ART at CROI 2018.
Nancy Puttkammer, PhD, MPH, presented a poster at the Conference on Retroviruses and Opportunistic Infections (CROI) in Boston on 4-7 March 2018. She was joined by Rose Boulay, a representative from the Haiti Ministry of Health (MSPP) National HIV Program (PNLS). Madame Boulay works on data quality assessment, training for clinical sites, and decision making using data from the iSanté electronic medical record (EMR) system.
The poster, titled “Multi-Month Scripting (MMS) and Retention on HIV Antiretroviral Therapy (ART) in Haiti,” reflected the collaboration between I-TECH and MSPP to analyze national policies using iSanté data from 85 ART clinics. They examined the MSPP-led MMS initiative to prescribe longer intervals of ART for stable patients. The goal of the MMS approach is to improve patient retention on ART by reducing the burden to patients of coming into the clinic monthly to pick up their ART prescription.
“Our analysis showed impressive uptake of MMS across all health facilities, suggesting that longer intervals are welcomed by providers and patients,” explained Dr. Puttkammer. “Patients prescribed ART for two months or more were 18% more likely to be retained, after adjusting for various patient and facility factors, compared to patients on monthly ART regimens. This is a promising result in terms of the goals of the MMS approach.”
Haiti’s national EMR system allows for the MSPP to conduct data analysis to evaluate the success of health interventions across the entire network of clinics and hospitals in a timely manner. “We are very pleased that we have been able use the iSanté data system to measure the progress of our national HIV and AIDS response, and to share our results with an international audience at CROI. It has been a great experience,” stated Madame Boulay.
Logo courtesy of the Consortium of Universities for Global Health (CUGH): https://www.cugh.org/.
Representatives from the International Training and Education Center for Health (I-TECH) are headed to New York for the 9th Annual Consortium of Universities for Global Health (CUGH) Conference. The conference—held on March 16-18, with satellite sessions on March 15—will be co-hosted by Columbia University, Stellenbosch University, and the University of Peradeniya.
Featured speakers include Richard Horton, Editor of The Lancet, and Natalie Kanem, Deputy Executive Director of the United Nations Population Fund.
Building on the theme of “Health Disparities: A Time for Action,” staff and faculty from I-TECH will be presenting on the following topics:
King Holmes, MD, PhD, founding chair of the Department of Global Health and a co-Principal Investigator of I-TECH’s IAETC award, will join a morning plenary session and discussion about global health disparities. The discussion will be moderated by Director of the Fogarty International Center Roger Glass. Dr. Holmes will be joined for the discussion by Rose Leke, Gairdner Foundation Global Health Committee member and Emeritus Professor at Universite de Yaounde, and K. Srinath Reddy, President of the Public Health Foundation of India.
Kate Wilson, PhD, Clinical Assistant Professor, is presenting a poster titled “Evaluation of a New Field Epidemiology Training Program (FETP) Intermediate Course to Strengthen Public Health Preparedness in Tanzania.” The locally adapted course significantly improved trainee knowledge and skills in field epidemiology, and the evaluation also showed evidence of improvement in data quality and performance at trainees’ workplaces and districts.
Lindsay Mumm, MPA, Program Manager, is presenting a poster titled “Creating Relevant Change towards Reaching the UNAIDS 90-90-90 Target with High-Impact Leadership Training – Afya Bora Fellowship in Global Health Leadership.”
In addition to the research being shared at CUGH, I-TECH was represented earlier this month at the Conference on Retroviruses and Opportunistic Infections (CROI) in Boston. Nancy Puttkammer, PhD, MPH, presented a poster titled “Multi-Month Scripting (MMS) and Retention on HIV Antiretroviral Therapy (ART) in Haiti.” The retrospective study used data from the iSanté electronic medical record system in Haiti and found promising results that MMS for ART in virally suppressed patients improved retention and engagement in treatment.
About CUGH
The mission of CUGH is to build interdisciplinary collaborations and facilitates the sharing of knowledge to address global health challenges while promoting mutually beneficial, long-term partnerships between universities in resource-rich and resource-poor countries, developing human capital and strengthening institutions’ capabilities to address these challenges. Read more about CUGH: https://www.cugh.org/.
About CROI
Established in 1993, The Conference on Retroviruses and Opportunistic Infections (CROI) was provides a forum for scientists and clinical investigators to present, discuss, and critique their research. The goal of the conference is to provide a forum for researchers to translate their laboratory and clinical findings into tangible progress against the HIV pandemic. Read more about CROI: http://www.croiconference.org/.
Cambodia
I-TECH’s work in Cambodia began in 2013 on a laboratory program focused on refining operations and building capacity through improved quality assurance and management practices. The program continues to deliver intensive mentoring and support for laboratory workers, support for national laboratory system policy development, and job-specific training programs.
In 2018, I-TECH expanded its work in Cambodia with the Enhancing Quality of Care Activity (EQHA) program. The EQHA program aims to improve the quality of public and private health services in national and sub-national health systems by August 2023 by improving the national health policy regulatory framework and pre-service health education and training institutions.
In all efforts, I-TECH works closely with the Ministry of Health and local partners to support and strengthen laboratory systems and improve the quality of public and private health services in Cambodia.
Google has selected 
In winter 2019, the International Training and Education Center for Health (I-TECH) launched a new unit: the 
