Building an eHealth Architecture to Streamline Exchange and Investment in Ethiopia’s Health Information System

Achieving the Sustainable Development Goals for health requires well-managed systems supported by dynamic digital health solutions that have proper governance and adequate investment. Ethiopia’s first and second health sector strategic plans, Health Sector Transformation Plans (HSTP I and II) identified the Information Revolution (IR), a strategic document for digital health systems investments, as a key priority area. Both HSTP I and II stressed the need for a strategy that promotes coordinated digital health investments and data management through exchange and interoperability among the systems.

The Ministry of Health (MOH) developed a variety of national electronic health (eHealth) applications to meet the country’s priority health needs. While making significant progress, the country’s eHealth initiatives could also be characterized as fragmented with poor coordination and haphazard investment. There was no framework or set of standards to normalize health data and govern standard-based health information exchange among existing eHealth systems. Moreover, there were no mechanisms to institutionalize or assess existing eHealth system maturity level. These challenges limited the MOH’s ability to govern eHealth investments and implement interoperable systems that are critical to improve the quality of health care.

Recognizing these challenges, the Ethiopia Data Use Partnership (DUP), a joint initiative between JSI Research & Training Institute, Inc. and the MOH developed a national eHealth architecture (eHA) framework that outlines and governs existing and planned business processes, data management systems, and technologies. The eHA also provides an overview of the terminology and messaging standards and interoperability profiles that can be optimized among current and incoming applications in the sector. Figure 1 depicts how the eHA aligns with other national eHealth strategic documents.

Developing and ensuring the success of the eHA, including interoperability, is a large national undertaking. DUP collaborated with global entities, including OpenHIE, a community of practice supporting architecture and standards-based interoperability in the health sector, and Regenstrief Institute to align the country’s eHA development with global trends and best practices. DUP employed a three-phased approach based on the Principles of Digital Development Guide (Figure 2).

The team started the eHA development process in 2017 and finished the first working version in 2019. The eHA was revised and updated in 2021 in response to new demands and real-world implementation. Because the eHA lays the foundation for scaling up and sustaining eHealth applications that are standardized and interoperable, it will facilitate stakeholder’s access to higher-quality health data and more complete information. This, in turn, will improve decision-making and health outcomes. The following are key contributions of the national eHA:

• Implementation of foundational eHealth applications: Based on the eHA guidelines, the MOH has invested in the implementation of foundational and shared service systems, including a master facility registry (MFR)—a software program that manages a complete, authoritative list of health facilities at a national level—and the National Health Data Dictionary.
• Linkage of new eHealth interventions and investments with the eHA: The MOH is using the eHA process framework to guide development of new eHealth applications and future investments.
• Reference for national-level strategic and standard documents: The eHA document is a key reference for the preparation and development of Ethiopia’s digital health blueprint and electronic health record standards document. In addition, the eHA laid the foundation for the development of the national interoperability and messaging standard documents.
• Guide initial interoperability solutions among multiple eHealth applications: Based on the country’s data exchange priorities and needs that were identified in the eHA document, the implementation of national-level health data exchange solutions has started for the MFR and District Health Information System 2.

Written by Nebyou Azanaw