Kenya Health Informaion Systems
Interoperability Framework
Kenya Health Informaion Systems Interoperability Framework | 2
Table of Contents
Abbreviaions and Acronyms..................................................................................................................4
Foreward.......................................................................................................................................................5
Acknowledgements....................................................................................................................................6
Execuive Summary...................................................................................................................................8
Scope and structure of KHISIF document.....................................................................................9
Introducion..................................................................................................................................................10
CHAPTER 1: Overview of the Kenya Health Informaion Systems Interoperability
Framework and Interoperability Principles.......................................................................................11
1.1 Interoperability.................................................................................................................................12
1.2 Scope of the KHISIF.......................................................................................................................13
1.3 KHISIF Objecives..........................................................................................................................14
1.4 Underlying Principles...................................................................................................................14
1.4.1 Core interoperability principles........................................................................................15
1.4.2 Principles related to generic user needs and expectaions......................................16
1.4.3 Foundaion principles........................................................................................................16
CHAPTER 2: KHISIF Governance, Management, and Compliance..............................................19
2.1 Interoperability Governance Framework.................................................................................20
2.2 Leadership and Governance......................................................................................................20
2.3 Legal and Regulatory Interoperability.....................................................................................21
2.4 HIS Interoperability Compliance...............................................................................................21
2.5 Data Ethics.....................................................................................................................................22
2.6 Oversight and Accountability....................................................................................................22
2.6.1 KHISIF management process...........................................................................................22
2.6.2 KHISIF change management..........................................................................................25
2.7 Complying with the KHISIF........................................................................................................26
2.8 HIS Governance............................................................................................................................ 26
2.9 Human Resource Health Governance......................................................................................27
CHAPTER 3: Interoperability Architectural Technical Speciicaions......................................28
3.1 Interoperability Architectural Framework...............................................................................29
3.2 Common Services.........................................................................................................................31
3.2.1 Facility registry.....................................................................................................................31
Kenya Health Informaion Systems Interoperability Framework | 3
3.2.2 Client registry......................................................................................................................31
3.2.3 Terminology service..........................................................................................................32
3.2.4 Health worker registry......................................................................................................32
3.3 Interoperability Layer...................................................................................................................33
3.4 Business Services.........................................................................................................................36
3.4.1 Data services layer..............................................................................................................36
3.4.2 Kenya Health Informaion System for aggregate reporing....................................36
3.4.3 Logisics management informaion systems.............................................................36
3.5 Advanced Analyics and Business Intelligence and Support Services...........................38
3.6 Point-of-Service Applicaions...................................................................................................39
3.7 External Systems..........................................................................................................................39
CHAPTER 4: HIS Ceriicaion and Procedure..................................................................................41
4.1 Interoperability Ceriicaion.......................................................................................................42
4.2 Interoperability Maturity Model................................................................................................42
ANNEXES.....................................................................................................................................................44
Annex I: Interoperability Implementaion Roadmap...................................................................45
Annex II: Development of Interoperability Layer Sotware Requirements Speciicaion..46
Annex III: Development of Terminology Service Sotware Requirements Speciicaion..47
Annex IV: Terms of Reference and Ministry of Health Templates..........................................49
Key health-sector funcions......................................................................................................49
Annex V: Naional Integrated Data Analyics Framework........................................................50
Aspects of data and analyics framework..............................................................................50
Annex VI: Interoperability Suite of Tools.......................................................................................52
Annex VII: References........................................................................................................................53
Annex VIII: Stakeholders’ Engagement Reference List..............................................................55
Endnotes.......................................................................................................................................................58
List of Figures
Figure 1 Kenya Health Interoperability Architecture..........................................................................29
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Abbreviaions and Acronyms
API applicaion programming interface
eHealth use of informaion and communicaion technologies for health
EMR/EHR electronic medical records/electronic health records
HIE health informaion exchange
HIS health informaion system
HIS ICC Health Informaion System Interagency Coordinaion Commitees
ICT informaion and communicaions technology
IFMIS Integrated Financial Management Informaion System
IL interoperability layer
KHISIF Kenya Health Informaion Systems Interoperability Framework
MOH Ministry of Health
OHIE open health informaion exchange
SDGs Sustainable Development Goals
UHC universal health coverage
Kenya Health Informaion Systems Interoperability Framework | 5
The Government of Kenya is determined to improve access to and equity of quality essenial
health care services and to ensure that the health sector plays its role in the realizaion of Vision
2030
1
and atainment of the Sustainable Development Goals (SDGs) through implementaion
of universal health coverage (UHC). To fulill this mandate, the Ministry of Health developed
the Kenya Health Policy (2014–2030). One of the revised policy objecives is to plan, design,
and install informaion and communicaions technology (ICT) infrastructure, and health
informaion systems (HIS) for the management and delivery of essenial health care.
The Ministry of Health (MOH) and county health departments have made considerable
investments to strengthen health informaion systems across the spectrum of data
collecion, informaion generaion, analysis, and uilizaion. This commitment is intended to
support efecive decision-making among producers and consumers of health informaion.
Nonetheless, vast amounts of available medical informaion are oten stored in many diferent
formats across various systems and locaions, making access, sharing, and analyics diicult
or impossible to achieve. Ongoing eforts by the MOH are geared towards digiizing health
records and making diferent HIS interoperable to improve data sharing and access.
This document deines a collecion of speciicaions aimed at facilitaing the interoperability
of health informaion systems across its ecosystem. By using interoperability speciicaions
in this framework, health systems owners can ensure interoperability between health
informaion systems while leveraging exising or new digital health infrastructure.
I am happy to note that this framework has been developed and realized through an elaborate,
inclusive, paricipatory, and consultaive process. This efort has involved a wide range of
stakeholders drawn from the Ministry of Health, county governments, development partners,
civil society, research insituions, academics from universiies, and the internaional
community. It is my sincere hope that this well-informed document will foster sanity in the
applicaion of eHealth to support health informaion management while underscoring the
importance of adhering to the core principles, values, the right to informaion, and the bill of
rights as enshrined in the consituion.
Lastly, I’m posiive that all the stakeholders will embrace this framework in order to realize
the shared beneits that the guidance in this document will bring to the health sector as we
embrace the automaion agenda. It is envisaged that this framework will spur the uptake
and adopion of informaion technology in the sector and thus improve service delivery and
quality of care with resultant improvement in health outcomes.
Hon. Mutahi Kagwe, EGH
Cabinet Secretary, Health
Government of Kenya
Foreword
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This iniial publicaion, the Kenya Health Informaion Systems Interoperability Framework
(KHISIF), has been developed with reference to global standards on data interoperability
2
and
extensive consultaion with the relevant wide range of stakeholders drawn from the Ministry
of Health, county governments, development partners, civil society, research insituions,
academics from universiies, and the internaional community. The Ministry of Health
sincerely acknowledges departmental heads, divisional heads, and technical staf for providing
lead in their areas of experise towards realizaion of the KHISIF. We also owe graitude to
the MOH’s System Management Team technical working group, which spearheaded this
project and made it a valuable reference document. Speciically, we acknowledge the Ministry
of Health leadership led by Cabinet Secretary Hon. Mutahi Kagwe, EGH, and Principal
Secretary Ms. Susan Mochache for their stewardship, leadership, and support. Special thanks
goes to the Ag. Director General for Health, Dr. Patrick Amoth, and Dr. Charles Nzioka, Ag.
Director, Directorate of Health Policy, Research, Monitoring & Evaluaion, whose enormous
support and guidance ensured the full paricipaion of MOH staf and stakeholders in the
enire process.
Our appreciaion goes to Dr. Joseph Siienei, Head of Department of Health Sector
Monitoring & Evaluaion and Informaics, and the Head of Health Informaics Division, Mr.
Onesmus Kamau for technical guidance and support. We would also like to acknowledge the
contribuions and support received from Health Informaics Unit staf, Dr. Martha Muthami,
Mr. Samuel Cheburet, Mr. Abdullahi Kimogol, Mr. Francis Nyamari, Mr. Oscar Odiwuor, Ms.
Peris Mary Wanjiru, Ms. Judy Kabathi, Ms. Sophia Karanja, Ms. Nancy Amayo, Ms. Dorothy
Mibei, Mr. Ali Hassan, Mr. Patrick Warutere, Mr. Jeremiah Mumo, Mr. Gilbert N. Mboro, Mr.
Julius Muiso, Ms. Diana Kamar, and Ms. Dorcas Nguyo Administraion eHealth Unit for the
ime and energy they dedicated to developing the KHISIF.
Collaboraion with other health stakeholders in the Ministry of Health greatly contributed to
inalizaion of the KHISIF. We appreciate the contribuions of the following personnel: Ms.
Janete Karimi, Ms. Judy Kabathi, Ms. Margaret Muiso, and Dr. Wesley Ooga Oghera from the
Health Informaion System unit; Ms. Faith Ngari, Ms. Rose Agweny, Dr. Violet Oramisi, and
Dr. Catherine N. Ngugi from NASCOP. As well as Mr. Joshua Gitonga, Mr. George Onyango,
Ms. Mercy Omoke, and Dr. Nduku Kilonzo from NACC. Mr. Eric Nderitu, and Racheal Wanjiru
of the MOH-ICT department.
We also recognize expert guidance and contribuions provided by the Health Data and
Informaics Experts Technical Working Group drawn from the Ministry of Health, Oice
of the Deputy President, insituions, academia, and various government departments for
their dedicaion and commitment towards compleion of this KHISIF document, namely
the President’s Emergency Plan for AIDS Relief Global and Kenya team (Larry Sperling,
Acknowledgments
Kenya Health Informaion Systems Interoperability Framework | 7
Christalyn Steers, Heather Smith, and Anne Ojijo), as well as Maxwell Max and Kate Mbaire,
and Oice of the Deputy President- Amb. Ken Osinde, Dr. Korir Singoei and Philip Thigo.
The lead development team included Mr. Solomon Simba, Ms. Karen Bet, Mr. Tom Orrell, and
Mr. Davis Adieno, who led the Global Partnership for Sustainable Development Data (GPSDD)
team; Prof. Peter Waiganjo, Mr. Raphael Pundo, Mr. Oliver Munyao, Mr. Steve Waweru, Mr.
Dennis Banga, and Ms. Teresia Wangui from University of Nairobi (UoN-HealthIT); Mr. Nicky
Kibor from AMPATH; Dr. Ruben Thuo from JKUAT; Mr. George Owiso from ITECH; Dr. Jacob
Odhiambo, Mr. Joseph Njung’e, and Mr. Danson Koske from Palladium; and Ms. Margaret
Ndisha and Mr. Daniel Macharia from Center for Disease Control Kenya.
We also thank all those whose names may have been inadvertently omited but who
contributed to the development of the KHISIF.
This work would not have been possible without inancial support from the President’s
Emergency Plan for AIDS Relief, through the Global Partnership for Sustainable Development
Data, and the United States Agency for Internaional Development, through HealthIT. The
Ministry will support implementaion of this KHISIF as one of the drivers towards UHC. We
therefore request all stakeholders to embrace the framework.
Susan Mochache, CBS
Principal Secretary
This framework was funded in part by a grant from the United States Department of State. The
opinions, indings, and conclusions stated herein are those of the author(s) and do not necessarily
relect those of the United States Department of State.
Kenya Health Informaion Systems Interoperability Framework | 8
Execuive Summary
The launch of the Sustainable Development Goals (SDGs) in September 2015 by the
United Naions put the spotlight on the need for beter data to monitor progress and inform
decision-making. However, imely and relevant data that can help decision-makers and other
leaders beter understand the current state of play for the 2030 Agenda for Sustainable
Development are in short supply. Too many governments, companies, investors, mulilateral
insituions, and civil society organizaions have limited access to the data they need to make
the right decisions to drive progress on the SDGs.
As part of its ive-year Big 4 Agenda (2018–2022), the Government of Kenya has prioriized
the atainment of universal health coverage (UHC). The use of Informaion and Communicaion
Technologies (ICT) for health
3
will improve quality, and safe paient-centric health services.
A key part of eHealth will be the imely, seamless, and fricionless sharing of health data and
informaion.
The MOH is commited to fulilling the right to the highest atainable standard of health
through universal health coverage as envisaged in the Consituion of Kenya, 2010. Several
investments have been made to improve the quality of health care. One such investment
is the strengthening of health informaion systems across the spectrum of data collecion,
informaion generaion, analysis, and uilizaion to support efecive decision-making among
producers and consumers of health informaion.
4
The MOH has also developed several policies and guidelines that relate to the use of naional
health informaion systems. These systems have generated a massive pool of data at diferent
levels, oten stored in diferent formats across various systems and locaions, making access,
sharing, and analysis diicult or impossible to achieve. Ongoing eforts by the Ministry of
Health are geared towards digiizing health records and making diferent health informaion
systems interoperable.
The KHISIF supports the Ministry of Health’s strategy of providing paient-centric, joined-up
health services by facilitaing the interoperability of health informaion systems.
The term “interoperability” describes the ability of diferent informaion systems, devices
and applicaions (‘systems’) to access, exchange, integrate and cooperaively use data in a
coordinated manner, within and across organizaional, regional and naional boundaries, to
provide imely and seamless portability of informaion and opimize the health of individuals
and populaions across all levels.
5
The KHISIF deines a collecion of speciicaions aimed at facilitaing the interoperability of
health informaion systems. By implemening these interoperability speciicaions, health
systems owners can ensure interoperability between HIS while at the same ime leveraging
Kenya Health Informaion Systems Interoperability Framework | 9
exising or new digital health infrastructure. The KHISIF applies to both public and private
health service providers ofering health services, and with an obligaion to return health
informaion reports to the Ministry of Health, as sipulated in the Health Act, 2017 (Part XVII,
chapter 112 (e)). All new Ministry of Health, HIS, hardware, and sotware infrastructure will be
developed in compliance with the KHISIF, and it is highly recommended that all other new
HIS conform to the KHISIF appropriately.
For exising HIS, given the diversity of current platforms and systems, conformance and
compliance to certain speciicaions may not be readily achieved. Henceforth, HIS owners
will be subjected to MOH HIS compliance tesing on health informaion exchange (HIE)
capabiliies aligned to KHISIF requirements. The KHISIF implementaion at naional and
county levels is a long-term MOH strategy that must be coninually reviewed and updated.
Given the emergence of new HIS requirements and the pace of eHealth advancements,
there are likely to be frequent changes to the speciicaions. The technical speciicaions
under the KHISIF will be reviewed periodically or as-needed based on the evolving technology
environment.
Scope and structure of KHISIF document
Chapter 1: Overview of the KHISIF, including objecives, scope, and interoperability principles.
Chapter 2: The management of the KHISIF, including terms of reference for the governance
bodies, membership criteria, change management issues, and compliance, including
compliance policy and governance with other insituions.
Chapter 3: Interoperability architectural technical specii-caions selected for the ideniied
interoperability components.
Chapter 4: HIS ceriicaion and procedure.
Dr. Patrick Amoth
Ag. Director General for Health
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Introducion
While recognizing eHealth as a mode of health service, the Kenya Health Act, 2017
emphasizes the need for the standardizaion of health informaion exchange through
an interoperability framework, and establishment and maintenance of a comprehensive
integrated health informaion system. Accurate, readily available, imely, and complete data
for health planning, workforce management, policy development, monitoring, and eval-
uaion are criical for opimal health system funcioning and can only be achieved from well
matured and integrated HIS.
The Government of Kenya’s (GoK) atenion to e-government, with a focus on health
informaion systems in paricular, has resulted in a reasonably mature HIS ecosystem.
The Ministry of Health has been at the forefront of strengthening the health informaion
ecosystem in Kenya by opimizing availability and use of informaion for decision-making
in the health sector through the implementaion of targeted health informaion systems.
These HIS implementaions have, however, been tailored around speciic funcions resuling
in the mushrooming of domain-speciic and parallel HIS, some of which do not adhere to the
requisite HIS standards.
Government and private health care providers have invested considerably in the acquisiion
of various systems, but these systems cannot generate expected outcomes unless they are
integrated to achieve common naional goals such as measuring health service delivery
and morbidity control. A fundamental concern in health management is the integraion of
health informaion across distributed, heterogeneous, and disparate informaion systems.
Lack of interoperable health systems is one of the major barriers to the use of health data
and informaion in policy and decision-making. Moreover, it is not in the interest of the
government to discard exising systems, as a lot of data and investment will be wasted.
Rather, it should integrate these systems as far as possible to generate a holisic approach to
collecion and use of health data.
This document sets out the overarching framework towards achieving large-scale and
feasible interoperability in the health sector through the adopion of good pracices in
HIS governance and standardizaion. It also sets out recommendaions for health infor-
maion exchange architecture and ceriicaion requirements and provides a roadmap to
impactful interoperability.
Overview of the Kenya Health Informaion
Systems Interoperability Framework and
Interoperability Principles
CHAPTER 1
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1.1 Interoperability
The term interoperability describes the ability of two or more informaion systems or
components to exchange informaion based on standards, and to use the informaion
that is exchanged. Interoperability enables diferent HIS to work together in and across
organizaional boundaries to advance the health status of individuals and communiies and
the efecive delivery of health care to them.
6
There are three levels of health informaion technology interoperability:
I. Foundaional interoperability allows data from one informaion technology system
to be received by another. It does not require the ability for the receiving informaion
technology system to interpret the data.
II. Structural interoperability is an intermediate level that deines the structure or
format of data exchange (i.e., the message format standards). There is uniform
movement of health care data from one system to another such that the clinical or
operaional purpose and meaning of the data is preserved and unaltered. Structural
interoperability deines the syntax of the data exchange. It ensures that data exchanges
between informaion technology systems can be interpreted at the data ield level.
III. Semanic interoperability provides interoperability at the highest level. This is the
ability of two or more systems or elements to exchange informaion and to use the
informaion that has been exchanged. Semanic interoperability takes advantage of
both the structuring of the data exchange and the codiicaion of the data, including
vocabulary, so that the receiving informaion technology systems can interpret the
data. This level of interoperability supports the electronic exchange of paient summary
informaion among caregivers and other authorized paries via potenially disparate
electronic health record (EHR) systems and other systems. It allows improvement of
quality, safety, conideniality, and eiciency of health care delivery.
The KHISIF aims to deine the set of speciicaions to facilitate MOH HIS to communicate
and interoperate, both within public and with private health care HIS owners. It also seeks
to to collaboraively support delivery of health care services, with an obligaion to return
health informaion reports to the Ministry of Health. The KHISIF will promote and foster
health informaion exchange, providing paient-centric and linked-up health informaion for
eicient and efecive delivery of health services across the coninuum of health care.
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According to the World Health Organizaion Health Metrics Network Framework and
Standards for Country Health Informaion Systems,
7
a health informaion system consists
of six components. The standards for each are clearly described below, including what
consitutes a HIS and how its components interact with each other to produce more accurate
informaion for beter decisions and beter delivery of health care services.
To support the establishment of the interoperable HIS, it is necessary to clearly understand
the HIS components in the following key areas: inputs, processes, and outputs.
Inputs refer to (i) health resources, while processes touch on how (ii) indicators and (iii)
data sources are selected and (iv) data is collected and managed. Outputs deal with the (v)
producion, (vi) disseminaion and use of informaion.
The KHISIF’s overarching focus is on the atainment of the above-menioned six components
of a HIS. Henceforth, the KHISIF will foster collaboraion among HIS owners to jointly work
out interoperability speciicaions more efecively.
It covers:
I. A set of standards and data standards that help deine the interface across diferent
systems.
II. Guidelines for project teams to work out some of the HIS business-oriented
speciicaions, where it is feasible to provide guidelines in that area.
III. Other standard documents that deine infrastructure architecture, convenions, and
procedures aligned to internaional standards, guidelines, and best pracices.
IV. The technical standards are listed in Chapter 2 of this document. The data standards
are being progressively developed in the form of common services as per Kenya MOH
health-sector prioriies. The common services deine the informaion model of data
elements that are oten used in HIS, and they serve as reusable components for HIS
data speciicaions. See Chapter 3 for more details.
1.2 Scope of the KHISIF
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The KHISIF is intended to guide naional- and county-level approaches towards
implementaion of the HIS, with informaion-sharing capabiliies. It helps to create a shared
understanding of interoperability in the Kenya eHealth ecosystem.
The speciic objecives of this framework are:
I. To promote the use of interoperability concepts and standards in harmonizing health
informaion exchange technical and architectural aciviies within the Kenya eHealth
ecosystem;
II. To enhance the applicaion of interoperability guidelines to facilitate interoperability
design, analysis, and assessment;
III. To introduce appropriate governance mechanisms and organizaional pracices in
support of interoperability;
IV. To provide an interoperability conceptual framework; and
V. To provide guidance on interoperability maturity.
The lack of interoperability is a major obstacle to universal health coverage and efecive
management of paients across the coninuum of care. Using the KHISIF will foster health
informaion systems’ interoperability iniiaives, contribute to a coherent interoperable
environment, and facilitate the delivery of services that work together within and across
naional and county levels.
The interoperability principles are fundamental behavioral aspects to drive interoperability
acions. This secion sets out general interoperability principles, aligned to the principles for
digital development,
8
with guiding pracical implementaion use cases, which are relevant to
inform the process of establishing interoperable HIS ecosystems. They describe the context
in which HIS are designed and implemented.
1.3 KHISIF Objecives
1.4 Underlying Principles
Kenya Health Informaion Systems Interoperability Framework | 15
The underlying principles of the KHISIF are grouped into three categories:
1. Core interoperability principles;
2. Principles related to generic user needs and expectaions; and
3. Foundaional principles for cooperaion among public administraions.
1.4.1 Core interoperability principles
Transparency
Transparency, in the KHISIF context, refers to:
1. Enabling visibility and endorsement inside the health administraive environment at
the naional and county level. This is about allowing all health stakeholders, public and
private, to view and understand the role of health informaion systems’ administraive
rules, processes, data, services and decision-making.
2. Ensuring availability of Applicaion Programming Interfaces (API)
9
with internal
informaion systems. HIS environments oten consist of muliple systems that are
heterogeneous and disparate. This is necessary, as they have to respond to the data
needs of domain-speciic internal processes. If policymakers are to obtain cross-
domain insights from muliple HIS, these systems must interoperate. This requires
ensuring that APIs are available to these systems and the data they handle.
3. Securing protecion of personal data, by respecing applicable legal frameworks on
health informaion sharing and conideniality (Heath Act, 2017, Data Protecion Act,
2019). This will also require the applicaion of appropriate standards-based technical
safeguards, including encrypion of databases and iles, as well as pseudonymizaion
and anonymizaion of potenially (re)ideniiable data ields within datasets housing
sensiive medical and other personal data.
Reusability
Health systems developers and implementers confronted with a speciic problem can beneit
from the work done by other health systems developers. This beneit is realized by looking
at what is available, assessing its usefulness or relevance to the problem at hand, and, where
appropriate, adoping soluions that have proven their value elsewhere. Doing so requires
health systems developers and implementers to openly share their interoperability soluions,
concepts, frameworks, speciicaions, tools, and components with others.
Reusability of IT soluions (e.g., sotware components, APIs, standards), informaion, and
data enables interoperability and improves quality because it extends operaional use and
Kenya Health Informaion Systems Interoperability Framework | 16
saves money and ime. The use of open-source sotware technologies and products can
help save development costs, avoid a lock-in efect,
10
and allow fast adaptaion to speciic
business needs because the developer communiies that support them are constantly adaping
them. (For more informaion, refer to secion 3.2). Health systems developers and
implementers should not only use open source sotware but, whenever possible, contribute
to the perinent developer communiies. Open source is an enabler of the underlying KHISIF
principle on reusability.
1.4.2 Principles related to generic user needs and expectaions
Technological neutrality
The KHISIF will focus on key funcional needs to minimize technological dependencies and
avoid dependence on speciic technical implementaions or products for HIS ecosystems.
This will enable the framework to adapt to the rapidly evolving technological environment.
User-centricity
Stakeholder engagement and ownership is criical for achievement of long-term success on
KHISIF compliance and implementaion. Thus, a mechanism for engaging all care providers
including public and private health care stakeholders, at naional and county levels during the
design process of digital development intervenions, soluions, technologies, and programs
for evoluion of HIS ecosystems, is key.
1.4.3 Foundaion principles
Inclusion and accessibility
Inclusion is about enabling everyone to take full advantage of the opportuniies ofered by
new technologies to access and make use of KHISIF. Accessibility ensures that companies,
individuals, government, partners, and private developers and implementers can uilize
the KHISIF.
Inclusion and accessibility are also improved by the KHISIF’s ability to allow third-party
applicaions and stakeholders to uilize its resources and beneits.
Security and privacy
Clients must be conident that when they interact with the framework they are doing so
in a secure and trustworthy environment and in full compliance with relevant regulaions,
e.g., the Kenya Data Protecion Act, 2019. The framework must guarantee ciizens’ privacy,
conideniality, authenicity, and integrity of informaion provided by client.
Kenya Health Informaion Systems Interoperability Framework | 17
Security and privacy are primary concerns of interoperability, and the implementaion of
interoperability should ensure that:
» Privacy-by-design and security-by-design approaches are used to secure their complete
infrastructure and building blocks;
» services are not vulnerable to atacks that might interrupt their operaion and cause
data thet or data damage;
» legal requirements and obligaions regarding data protecion and privacy acknowledge
the risks to privacy from advanced data processing and analyics.
Development and implementaion of interoperability should comply with the MOH’s Data,
System Governance and Change Management Framework
11
for HIS, by addressing the
following consideraions:
» “Risk management plans” to idenify risks, assess their potenial impact, and plan
responses with appropriate technical and organizaional measures. Based on the latest
technological developments, those measures must ensure that the level of security is
commensurate with the degree of risk.
» “Business coninuity plans” and “back-up and recovery plans” that put in place the
procedures needed for funcions to operate ater a disastrous event and bring all
funcions back to normal as soon as possible.
» A data access and authorizaion plan, which determines who has access to what data and
under what condiions, to ensure privacy. Unauthorized access and security breaches
should be monitored, and appropriate acions should be taken to prevent any recurrence
of breaches.
» Use of qualiied trust services to ensure the integrity, authenicity, conideniality, and
non-repudiaion of data.
» Transfer mechanisms should facilitate informaion exchanges between systems that
are:
» registered and veriied, so that both sender and receiver have been ideniied and
authenicated through agreed procedures and mechanisms;
» encrypted, so that the conideniality of the exchanged data is ensured;
» ime stamped, to track electronic records’ transfer and access; and
» logged, for electronic records to be archived, thus ensuring a legal audit trail.
Kenya Health Informaion Systems Interoperability Framework | 18
Appropriate mechanisms should allow secure exchange of electronically veriied messages,
records, forms, and other kinds of informaion between the diferent systems. It should
handle speciic security requirements and electronic ideniicaion and trust services, such
as electronic signatures/seals creaion and veriicaion, and should monitor traic to detect
intrusions, changes of data, and other types of atacks. Informaion must also be appropriately
protected during transmission, processing, and storage.
KHISIF Governance, Management, and
Compliance
CHAPTER 2
Kenya Health Informaion Systems Interoperability Framework | 20
Interoperability governance refers to decisions on KHISIF, insituional arrangements,
organizaional structures, roles and responsibiliies, policies, and agreements. It also includes
other aspects of ensuring and monitoring interoperability at naional, county, and facility
levels.
Important parts of interoperability governance include the Kenya Health Informaion Systems
Interoperability Framework; the Data Protecion Act No. 24 of 2019; the Kenya Health Act
No. 21 of 2017; the Kenya Standards and Guidelines for eHealth Systems Interoperability,
Version 2, July 2015; the Kenya Naional eHealth Policy 2016–2030; and the Data, System
Governance and Change Management Framework of 2018.
Poliical support is necessary for interoperability eforts to facilitate cooperaion between
public and private health insituions. For efecive cooperaion, all stakeholders must share
a vision, agree on objecives and imeframes, and align prioriies. Interoperability between
public and private health insituions at diferent administraive levels will only be successful
if the Ministry of Health gives suicient priority and assigns resources to their respecive
interoperability eforts.
The lack of the necessary in-house skill sets is a barrier to implemening interoperability
policies. Stakeholders should include interoperability skills in their interoperability strategies,
acknowledging that interoperability is a mulidimensional issue that needs awareness and
skills in legal, organizaional, semanic, and technical ields.
The implementaion and delivery of a given health service oten rely on components that
are common to many health services. Interoperability should be guaranteed in a sustainable
way and not as a one-of target or project. Interoperability governance is the key to a holisic
approach on interoperability, as it brings together all the instruments needed to apply it.
The MOH shall set guiding principles for digital health, eHealth, HIS developments, and
implementaion through coordinaion of a health-sector partnership mechanism. The MOH
will work to foster poliical goodwill and administraive authority to manage naional HIS
afairs, and consultaively advise subnaional governments on HIS governance maters.
2.1 Interoperability Governance Framework
2.2. Leadership and Governance
Kenya Health Informaion Systems Interoperability Framework | 21
The MOH shall ensure that the exising stakeholders’ coordinaion mechanisms such as the
naional HIS Interagency Coordinaion Commitees (ICC) or health-sector working groups
across all levels progressively include representaives from key HIS subsystems and relevant
partners supporing the MOH to strengthen its leadership and governance structure.
On this level, compaible legislaion and regulatory guidelines shall deine the boundaries for
interoperability across borders, at naional and subnaional levels. A bilateral or mulilateral
writen agreement, or memorandum of understanding, between health-sector players shall
anchor the interoperability areas and means by which they will collaborate on health data
exchange. Hence, health insituions shall align to the said guidelines for health data ex-
change as recommended by the Data Protecion Act No. 24 of 2019, part V, and secion 46(1).
The MOH shall ensure implemening partners and stakeholders adhere to health sector
policies, procedures, and best pracices related to HIS while implemening health data
exchange. This includes open standards for data exchange, messaging, security, and
adherence to Data Protecion Act No. 24 of 2019, part V, and secion 46(1). MOH shall moderate
and coordinate HIS stakeholders on the HIS ceriicaion process and ensure HIS owners
adhere to MOH reporing requirements, open interoperability standards, and standardized
health informaion outputs.
2.3 Legal and Regulatory Interoperability
2.4 HIS Interoperability Compliance
Kenya Health Informaion Systems Interoperability Framework | 22
Ethics is concerned with jusice, rights, respect of human dignity, autonomy of the individual,
and respect for the community.
12
Hence, ethics in the interoperability of health care systems
refers to pracice, aitudes, values, principles, and codes that guide health care professionals
and paients during the exchange and use of health informaion in an unambiguous way.
The KHISIF governance commitee will deine a set of procedures and coniguous plans to
be executed.
The coordinaion of KHISIF implementaion shall be governed through exising coordinaion
and collaboraion mechanisms outlined as follows:
2.6.1 KHISIF management process
Appropriate management mechanisms are required to develop and manage the common
schemas used within the Ministry of Health, as well as to ensure prompt review and updaing
of the set of speciicaions that comprise the KHISIF.
At the naional level, the Interagency Coordinaion Commitees is the muli-stakeholder body
that brings together all the players in the health sector. It is the highest decision-making
forum for naional-level Ministry of Health acions. The funcions of the ICC are coordinated
through three technical working groups (TWGs):
1. Health Informaics (HI);
2. Health Metrics (HM); and
3. Research and Innovaion (R&I).
These working groups are established according to the policy orientaions set out in the
Kenya Naional eHealth Policy 2016–2030. Each TWG sets out to address priority issues
and areas of focus and to beter coordinate the investments of health sector stakeholders.
2.5 Data Ethics
2.6 Oversight and Accountability
Kenya Health Informaion Systems Interoperability Framework | 23
These management mechanisms share several key requirements:
» They have to be suiciently lexible to address the changes within the respecive subject
areas, such as technology changes;
» They have to address the fact that certain aspects, such as business-speciic convenions
or technical speciicaions, would be more efecively owned and managed by program
domain experts or dedicated specialist groups rather than under a common ownership;
and
» The coordinaion of the change management process of the KHISIF shall be the
responsibility of the HIS Interagency Coordinaion Commitees TWGs and informed by
relevant established sub-TWGs. This entails:
» Appointment of a KHISIF review coordinaion team, to be conducted by MOH-
ICC members. The appointed team will oversee the organizaion of the review by
coordinaing health stakeholders and academics to be involved, preparaion of
background materials, ideniicaion of funding partners and potenial donors, and
consultaively building naional interest in the review.
Health Informaics
The purpose of this TWG is to coordinate HIS and electronic medical records/electronic
health records (EMR/EHR) stakeholders. Its aim is to strengthen HIS, promote informaion
exchange, and promote real-ime data and standard analyical tools to improve health care
delivery within the country.
Funcions
» Provide leadership and coordinaion of HIS and EMR/EHR-related aciviies with the
relevant stakeholders in order to avoid duplicaion of efort and deliverables.
» Provide guidance on HIS and EMR/EHR-related requirements aligned to naional
policies, standards, and guidelines for disseminaion and implementaion by county
governments, development partners, civil society organizaions, and other end users in
line with relevant strategies.
» Insitute mechanisms for efecive liaison between naional or county governments,
development partners, communiies, county proximate university, and implemening
partners.
» Establish and maintain a country inventory of exising eHealth soluions across counies
and monitor implementaion to idenify key milestones towards improved use of eHealth
soluions for real-ime informaion exchange.
Kenya Health Informaion Systems Interoperability Framework | 24
» Guide the health programs at naional and county TWGs in HIS and EMR/EHR
prioriizaion and coordinate informaics capacity-strengthening approaches across all
levels.
» Promote interoperability by developing and disseminaing HIS interoperability
framework and standards among the eHealth soluions stakeholders across all levels.
» Consultaively collaborate with counies on eforts to operaionalize and track
Interoperability Implementaion Roadmap of the eHealth components in the county
health annual work plans and County ICT department annual work plans. (See Annex I).
» Idenify, establish, and encourage compliance with standards and legal frameworks to
guide implementaion of eHealth soluions across all levels.
» Guide the establishment of HI TWGs at county levels to coordinate and promote
physical security of health infrastructure and promote conideniality of health data and
informaion during access.
» Report to and take on responsibiliies as may be assigned by the health stakeholders’
forums, e.g., the Interagency Coordinaion Commitees, Council of Governors peer-to-
peer learning, Health Metrics, and Research & Innovaion TWG, among others.
Health Metrics
The main objecive of this TWG is to coordinate the HIS monitoring and evaluaion
stakeholders. Its aim is to strengthen health informaion systems and monitor the progress
of the Health Sector Strategic Plan, which relects a series of health indicators that are
supposed to be measured monthly, quarterly, and annually through surveys or surveillance.
Funcions
» Keep abreast of the progress of the health sector’s planned M&E intervenions.
» Assess the need for correcive measures to achieve health targets set in annual plans.
» Monitor the collecion of informaion on health services based on rouine and non-
rouine HIS.
» Make recommendaions to the ICC on prioriizaion of indicators that provide useful
measures of health performance.
» Expand disease and demographic surveillance, encourage more collaboraion between
health programs, and provide input to the creaion of a naional health research agenda.
» Provide guidance and oversight to all M&E-related aciviies to streamline the number
of registers and reporing tools while maximizing the relevance and efeciveness of the
indicators and measures they produce.
Kenya Health Informaion Systems Interoperability Framework | 25
» Promote the objecives of the Naional Integrated Data Analyics Framework
(see Annex V), by outlining the structured processes of heath data and informaion
analysis, for tracking of SDG 3 indicators aligned to UHC Kenya health targets and
generaion of strategic informaion products to inform acionable insights at naional
and county levels.
» For cross-cuing issues, the HM TWG needs to collaboraively monitor the progress of
M&E subcommitee TWGs at the county level.
Research and Innovaion
Research and innovaion are essenial tools for the Directorate of Health Policy, Research,
Monitoring & Evaluaion, as they support coninuing eforts to address issues and concerns
for the health sector. The Directorate will oversee and provide an advisory role to all
prioriized research aciviies. The ICC-R&I TWG will provide support services to health-
sector stakeholders on ideniicaion and coordinaion of the health research agenda.
Funcions
» Review proposed research and innovaion topics, agendas, and proposals.
» Provide necessary technical assistance to the stakeholders at naional and county levels
in line with research and innovaion in health.
» Recommend regular capability-building and skills enhancement aciviies for both
naional- and county-level members regarding research and innovaion development.
For more details on terms of reference for the TWGs, refer to Annex IV.
2.6.2 KHISIF change management
Responsible: The Health Informaics TWG has its secretariat in the Department of Health
Sector Monitoring & Evaluaion and Informaics. The Department provides policy and strategic
advice, capacity-building and technical assistance at naional and county departments of
health. In addiion, the department is tasked with developing and maintaining enterprise-
level eHealth applicaions and digital health soluions. Some of the electronic systems under
its purview include Kenya Health Informaion System for aggregate reporing, and Kenya
Master Health Facility List, among other digital health soluions.
The HI-ICC TWG terms of reference provide the scope of work and guides on the duies,
responsibiliies, composiion, and operaions of the: Systems Management Team, selected
from its members and from the MOH HIS Unit to act as the secretariat to support the
efecive funcioning of the TWG; and the EHR task force technical team as part of the Health
Informaics TWG.
Kenya Health Informaion Systems Interoperability Framework | 26
One of the HI TWG’s responsibiliies shall be to deine the KHISIF terms of reference (aligned
health sector prioriies).
» It shall consist of health managers and IT management and control the formulaion and
implementaion of the KHISIF Roadmap.
» The HI TWG shall concentrate on transforming KHISIF implementaion as needed to
meet the present and future demands for management of HIS.
» It shall implement support of the KHISIF.
Compliance with the KHISIF is mandatory for all HIS system owners, for ensuring
standardizaion of health informaion exchange between HIS subsystems, and among
interoperaing HIS subsystems. Compliance means all HIS system owners are required to use
those technical speciicaions and matured common services, plus guidelines, shared health
digital infrastructure, and procedures speciicaions listed in the KHISIF document library.
The Health Informaics TWG will coordinate the ceriicaion process for all HIS through the
Kenya HIS ceriicaion framework.
The MOH shall ensure involvement of representaives from relevant government
ministries such as the Ministry of Informaion and Communicaions Technology and the
Communicaions Authority of Kenya. This should include representaion from implemening
partners supporing the MOH with ICT for health and health informaics. Experts in HIS, with
knowledge of HIS enterprise architecture, data management processes, and data exchange
standards are likewise criical.
2.7 Complying with the KHISIF
2.8 HIS Governance
Kenya Health Informaion Systems Interoperability Framework | 27
The MOH shall ensure representaives from all MOH departments, programs, semi-
autonomous agencies, civil service, private sector, and health service delivery and
implemening partners, and development partners, among others, are informed on KHISIF
and involved during implementaion of KHISIF at naional and county levels. The coordinaion
process will be through the insituionalized Interagency Coordinaion Commitees Health
Informaics, Health Metrics, and Research and Innovaion TWGs.
2.9 Human Resource Health
Interoperability Architectural
Technical Speciicaions
CHAPTER 3
Kenya Health Informaion Systems Interoperability Framework | 29
This chapter proposes a conceptual model for integrated architecture to guide the planning,
development, and implementaion of the KHISIF. It is relevant to all governmental levels.
The model is modular and comprises loosely coupled components interconnected through
shared infrastructure.
The conceptual model promotes the idea of interoperability by design and is anchored in
the open health informaion exchange (OHIE) framework.
13
This means that for Kenya health
systems to be interoperable, they should be designed in accordance with the proposed model
and with certain interoperability and reusability requirements in mind.
The model promotes reusability as a driver for interoperability, recognizing that the health
systems should reuse informaion and services that already exist and may be available from
various sources inside or beyond the organizaional boundaries. Informaion and services
should be retrievable and made available in interoperable formats as proposed by the Kenya
Standards and Guidelines for eHealth Systems Interoperability.
The basic components of the conceptual model are presented in Figure 1, aligned to OHIE
component layer, interoperability services layer, and point of service through mapping of
exising in-country plans and implementaion on common services and relevant digital
health soluions.
Figure 1: Kenya Health Interoperability Architecture
3.1 Interoperability Architectural Framework
Source: MOH technical team (HealthIT) adaping the OHIE model
14
Mobile Health
Apps
EMR/EHRs
Medical Lab
& Imaging
Dianosics
Info Systems
Pharmacy
Info Systems
Logisics MIS Hospital MIS
Finance &
Insurance
POINT OF SERVICE
COMMON SERVICES
Stakeholder/Partners’ Registry
Health Product & Technologies
Registry
Health Worker Registry
Community Unit Registry -
KMCUL
Facility Registry - KMHFL
Client Registry
Terminology Services
Authenicaion &
Authorizaion and
Encrypion Service
Interlinking &
Rouing Services
Transformaion,
Translaion and
Validaion Service
Alering, Logging,
Queue and Audiing
Service
ADVANCED ANALYTICS &
BUSINESS INTELLIGENCE
AND SUPPORT SERVICES
Naional Level Dashboards
(Situaion Room, KHRO, UHC
Dashboard)
Program Level Dashboards
Knowledge Repository
Expert & Decision Support
Integrated Service Desk
EXTERNAL
SYSTEMS
IFHIS
KNBS
Other External
Systems
Secure
Environment
INTEROPERABILITY LAYER
BUSINESS SERVICES
Data Services Layer
Health Insurance Management
Informaion System
Health Management
Informaion System - KHIS
Logisic Management
Informaion System
Shared Health Record
Kenya Health Informaion Systems Interoperability Framework | 30
The model’s structure includes the following:
Common services such as:
» Stakeholders registry;
» Health product and technologies registry;
» Facility registry and community unit registry;
» Client registry;
» Health worker registry;
» Terminology services; and
» Interoperability layer.
Business services:
» Data services layer;
» Health insurance management informaion system;
» Logisics management informaion system; and
» Shared health record.
Advanced analyics and business intelligence, and support services:
» Dashboards;
» Knowledge repository;
» Expert and decision support system; and
» Integrated service desk.
Point of Service Applicaions.
External Systems.
Kenya Health Informaion Systems Interoperability Framework | 31
These are resources that are shared to support funcionality and enhance standardizaion
within the interoperability environment. Common/shared services enable resources to be
leveraged across an enire enterprise, resuling in lower costs with agreed-upon customer-
service levels and standardized data formats and semanics. The following present the
exising and currently prioriized common services for Kenya HIS ecosystems.
3.2.1 Facility registry
A health facility registry serves as a central authority to uniquely idenify all places where
health services are administered within the country. A health facility registry serves as
the central authority to collect, store, and distribute an up-to-date and standardized set of
facility data.
3.2.2 Client registry
A health care client is a person who is eligible to receive, has received, or is receiving health
care services. The client registry is the deiniive source for a health care client’s idenity,
facilitaing the unique, accurate, and reliable ideniicaion of individual clients and others
who receive care. The registry provides a unique paient ideniier for each client. It includes
the funcionality of the Enterprise Master Paient Index, a service that matches records
from diferent sources referring to a single health care client. It contains demographic and
ideniicaion cross-reference data for health care clients registered in one or more point-of-
service applicaions. The client registry is designed to uniquely idenify ciizens receiving
health services within the country.
Some of the services provided by the registry include:
» Validaion of health care client idenity informaion;
» Searching and resolving informaion from muliple sources that refer to the same health
care client idenity;
» Obtaining summary and detailed demographic informaion about a health care client;
» Adding and updaing a health care client record;
» Merging and unmerging health care client records (because they either do, or do not,
refer to the same individual);
» Reconciling duplicates; and
» Managing publish/subscribe noiicaions of adds, updates, merges, and splits to
downstream systems.
3.2 Common Services
Kenya Health Informaion Systems Interoperability Framework | 32
3.2.3 Terminology service
Health care systems may use diferent local names, codes, or wording for the same clinical
concepts – for example, labs may have diferent names or numerical codes assigned to a
lab test. When health care data from diferent sources is being shared, it is essenial to be
able to translate or resolve these diferences, to ensure correct interpretaion by both people
and systems. A terminology service serves as a central authority to uniquely idenify the
clinical aciviies that occur within the care delivery process by maintaining a terminology set
mapped to internaional standards such as Internaional Classiicaion of Diseases (ICD10/11)
15
,
Logical Observaion Ideniiers Names and Codes (LOINC)
16
, Systemaized Nomenclature of
Medicine (SNOMED CT)
17
, and others.
In addiion, the terminology service provides a centralized source for the health informaion
exchange standards and deiniions, including terminologies, ontologies, dicionaries, code
systems, and value sets. Other HIE components can use these standards and deiniions to
normalize clinical data and achieve consistent aggregaion and reporing. Using terminology
services actualizes semanic interoperability, which enables accurate, consistent reporing
and aggregaion of clinical data. It also facilitates accurate exchange of informaion among
members of the provider community, including labs, clinics, pharmacies, hospitals, and
imaging centers, which leads to improved paient care decisions.
Terminology services also support other architecture components such as the health facility
registry and shared health record.
Funcions of the terminology services include:
» Code system query;
» Concept/code validaion;
» Code translaion;
» Value set (subset) query; and
» Value set resoluion.
(See Annex III for more details.)
3.2.4 Health worker registry
A health worker registry is the digital, central authority designed to interoperate with other
systems using internaional standards.
18
It contains a minimum set of details pertaining to
all health workers. The registry assigns a unique ideniier to each provider and maintains
informaion about them, including professional accreditaions (e.g., licenses, professions,
Kenya Health Informaion Systems Interoperability Framework | 33
specialies). It is fed by regulatory colleges, Ministry of Health and long-term care databases,
hospitals, and other organizaions. The health worker registry performs the following tasks:
» Creates a minimum data set from diferent data systems;
» Harmonizes data from several data sources, which helps in the support analysis for
quality measurement, reporing and research, validaion, and interoperability;
» Allows queries of health worker informaion by various users; and
» Entails rules and standards for sharing data between systems whereby a beneicial
outcome is improved data quality and integrity.
The health worker registry should:
» Support the updates of health worker data through querying of source data systems;
» Support the ability to retain source data systems updates;
» Support the capacity to retain the old versions of health worker data ater updates; and
» Respond to stored queries on health worker data.
Other Common Services
» Stakeholder/partners’ registry; and
» Health product and technologies registry.
Note: The last two are yet to be fully deined.
A health interoperability layer receives all communicaions from point-of-service applicaions
within a health geography and orchestrates message processing among the point-of-service
applicaion and the hosted infrastructure elements.
In a complex health care system with muliple stakeholders using siloed health care soluions,
it is diicult to share informaion across disparate systems, making accurate, imely, and
complete informaion hard to obtain and increasing costs and security risks.
3.3 Interoperability Layer
Kenya Health Informaion Systems Interoperability Framework | 34
To enable sharing that will allow data from muliple sources to be used, it is important to
create an architecture that enables systems to beter communicate with one another using
lexible processes and technologies that can respond to rapidly changing health informaion
needs. The open health informaion exchange architecture is designed to provide lexibility
in meeing country-speciic needs through a component-based architecture. The arch-
itecture is designed to enable components to work together while providing a secure
mechanism for sharing health care informaion and maintaining a decoupled architecture
designed for lexibility.
When sotware applicaions can be combined rapidly without complicated and expensive
interfaces, soluions can be deployed much more quickly. This is because doing so extends
the use of exising systems rather than replacing them with a new soluion or redeveloping
them to meet new requirements.
Interoperability also encourages technology innovaion by providing a means by which
smaller companies can compete with larger, more established ones through a standards-
based mechanism for connecing systems. This means that the beneits of new, emerging
technologies can be harnessed more rapidly and may also assist with prevening vendor
lock-in
19
. As health informaion needs evolve in a complex and rapidly changing health care
environment, HIS need to be highly adaptable. Standards-based interoperability supports
this adaptability.
At the core of the HIE architecture is the interoperability layer, a middleware component
that is designed to receive and coordinate transacions in the exchange. Its role is to provide
a façade to point-of-service systems and abstract the interfaces between them and the
other components within the exchange. This de-coupled approach reduces dependencies
and allows for a single point of control and contact into the exchange, enforcing a common
security mechanism and allowing for centralized logging and monitoring. An interoperability
layer provides the capability to electronically move clinical informaion between diferent
health care informaion systems within the exchange while maintaining the accuracy and
meaning of the exchanged informaion.
As a single point of entry, the interoperability layer receives transacions from point-of-
service health care systems and coordinates interacion among the diferent components of
the HIE. It also provides common core funcionality to ensure that transacions are secured,
authenicated, and authorized. Essenially, the interoperability sotware allows diferent
systems to talk to each other and exchange informaion in a secure and controlled fashion.
While the roles of other OHIE components that provide services may be more easily
understood, it is the interoperability layer that secures and orchestrates the exchange of
informaion. Similar to an orchestra conductor, the interoperability layer provides the central
force that enables all of the OHIE components to work together and interact with point-of-
service systems outside the OHIE.
Kenya Health Informaion Systems Interoperability Framework | 35
At a high level, the interoperability layer performs the following funcions:
» Acts as a single entry point for the OHIE.
» Manages the security of the OHIE through authenicaion (idenity veriicaion),
authorizaion (permission to interact with speciied HIE components), and encrypion
and decrypion of messages.
» Routes messages to the appropriate architecture component or external point-of-
service system.
» Provides a central logging mechanism for the messages sent through the exchange by
logging copies of the messages that travel through the interoperability layer for audit
and reporing purposes.
» Allows for the rerunning of failed transacions at a central level, alleviaing the need for
point-of-service systems to resend data, for example, in the event of a problem with an
infrastructure component.
» Provides, as necessary, implementaion-speciic adapters to translate incoming
messages into a form that the other HIE components can interpret.
» Provides addiional mediaion funcions for transacions within the HIE to simplify the
business logic required by service consumer systems to interact with the HIE, providing
a bufer between point-of-service systems and the HIE components.
» Provides a mechanism for error management and tracking, e.g., a console for viewing
failed transacions.
» Captures monitoring staisics, such as transacion loads and performance metrics, and
provides a view of these for monitoring the low of messages through the HIE.
Summary of the funcions of the interoperability layer:
» Authenicaion, authorizaion, and encrypion;
» Interlinking and rouing;
» Transformaion, translaion, and validaion; and
» Alering, logging, queueing, and audiing.
See Annex II for more details.
Kenya Health Informaion Systems Interoperability Framework | 36
The health management informaion system is a repository containing the normalized version
of aggregate-level content created within the community, ater being validated against
each of the previous registries. It is a collecion of indicator-centric records for cohorts with
health and health related informaion for exchange. The following list presents the ideniied
business services for prioriizaion;
» Data services layer;
» Health insurance management informaion system;
» Health management informaion system;
» Logisics management informaion system; and
» Shared health record.
Note: Items not covered below are yet to be fully deined.
3.4.1 Data services layer
The data services layer is designed to leverage the progress made through strengthening
Kenya’s HIS ecosystems and providing an environment for further convergence of muliple
factors that afect health for efecive decision- and policymaking. The data services layer
presents the capability to analyze, predict, and anicipate diverging and converging factors of
health for evidence-based decision-making. Hence, it is a platform to facilitate collaboraion
and sharing of health data and informaion, to aide M&E, to contribute to the discovery of
complex interlinkages in health determinants, and to create health informaion products to
shape health policy, among other outcomes.
3.4.2 Kenya Health Informaion System for aggregate reporing
KHIS2 is an open-source sotware program for rouine reporing, analysis, and disseminaion
of health data for all health programs, across all health faciliies in-country for aggregate
health data reporing.
20
3.4.3 Logisics management informaion systems
Logisics management informaion systems are digital health soluions used in health care
delivery that enable resupply worklows for clinical locaions and the verical programs
targeing families of commodiies. They also serve as an interface with suppliers’ IT
systems to ensure that supplies are re-upped as needed. An efecive logisics management
3.4 Business Services
Kenya Health Informaion Systems Interoperability Framework | 37
informaion system should ensure that adequate quanity and quality of all medical supplies
including vaccines, essenial medicines, and non-pharmaceuicals are always available to
meet facility demands.
The funcions include:
» Capturing accurate rouine administraion, dispensing, and consumpion data.
» Real-ime, end-to-end logisics management from point of origin to service delivery
point (including minimum and maximum levels).
» Demand forecasing, capacity planning, and modeling based on consumpion.
» Applying user interface pracices in a consistent manner throughout the system.
» Uilizaion of the naional list of essenial medicines, or, in its absence, the World Health
Organizaion global list, serves as the basis for monitoring availability and afordability.
» Linking logisics data to health service delivery data to match demand for essenial
medicines with availability.
» Maintaining transacion log history.
» Automaion and Monitoring of the pull systems on requirements.
» Requisiion, receiving, procurement, storage, dispatch, transport, and dispense business
processes.
» Linkages to post-markeing surveillance of medicines and monitoring adverse drug
reacions.
» Uilizaion of the normalized names for clinical drugs and link its names to many of
the drug vocabularies commonly used in pharmacy management and drug interacion
sotware from Drug Informaion Unit of the Pharmacy and Poisons Board
21
on the
naming system for generic and branded drugs, and supports semanic interoperaion
between drug terminologies and pharmacy knowledge base systems.
» Supporing open-data standards to enable seamless interoperability with consituent
applicaions and other health informaion system applicaions (e.g., DHIS2, master
facility registry, EMR).
» Accessibility both on the web and oline for rouine worklows, e.g. compaible and
mobile opimized for General Packet Radio Service (GPRS) and the Global System for
Mobile Communicaions (GSM) data exchange, local server, or cloud-based hosing
opions.
Kenya Health Informaion Systems Interoperability Framework | 38
The Naional Integrated Data Analyics Framework, as referenced in Annex V, outlines the
structured processes of heath data and informaion analysis for tracking of SDG 3 indicators
aligned to UHC Kenya health targets and generaion of strategic informaion products to
inform acionable insights across all levels. The Kenya HIS ecosystem, applicaions, and
platforms that enhance strategic and operaional decision-making by consolidaing and
analyzing health data and informaion are categorized as follows.
» Naional-level dashboards
» Kenya Health and Research Observatory
» Universal Health Coverage
» HIV/AIDS Situaion Room
» Program-level dashboards
» Early infant diagnosis (EID), Viral load (VL), ani-retroviral therapy (ART),
reproducive, maternal, newborn and child health (RMNCH) among others
» Knowledge Repository
» HIS Online Learning
22
» Expert and decision support system
» Data services layer
» Integrated service desk
» MOH Service Desk
23
3.5 Advanced Analyics and Business
Intelligence, and Support Services
Kenya Health Informaion Systems Interoperability Framework | 39
These are digital health soluions used by health workers to facilitate service delivery.
» Mobile health applicaions
» Electronic medical records and electronic health records
» Medical lab and imaging diagnosic informaion systems
» Pharmacy informaion system
» Logisics management informaion system
» Hospital management informaion system
» Billing and revenue collecion
» Other systems that support facility funcions
These are organizaions or systems that provide data or support data exchange but fall
outside the Ministry of Health.
» Integrated Financial Management Informaion System
24
» The Naional Treasury has rolled out the Integrated Financial Management
Informaion System (IFMIS) electronic procurement (e-procurement) throughout
the country to serve Kenyans efecively on issues relaing to public procurement.
The IFMIS e-procurement module enhances transparency and accountability in the
procurement process, encompassing planning, requisiion, sourcing, and payment.
» Kenya Naional Bureau of Staisics
25
» The Kenya Naional Bureau of Staisics was established by the Staisics Act of
2006 to replace the Central Bureau of Staisics. The Act establishes Kenya Naional
Bureau of Staisics as a semi-autonomous government agency incorporated under
the Naional Treasury and Planning State Department for Planning and Vision
2030.
26
Its core mandate is to collect, compile, analyze, publish, and disseminate
staisical informaion for public use, with the addiional role of coordinaing,
monitoring, and supervising the Naional Staisical System.
3.6 Point-of-Service Applicaions
3.7 External Systems
Kenya Health Informaion Systems Interoperability Framework | 40
» Ministry of Interior and Coordinaion of Naional Government: Civil Registraion Services
» Kenya Medical Supplies Authority (KEMSA)
» Naional Hospital Insurance Fund (NHIF) and other insurance providers
» Non-state health care providers (faith-based, NGOs, and private sector)
HIS Ceriicaion and Procedure
CHAPTER 4
Kenya Health Informaion Systems Interoperability Framework | 42
A ceriicaion framework is driven by the standards or criteria to be achieved, industry
expectaions, and audience needs. KHISIF leverages the Kenya Health Informaion Systems
ceriicaion framework to ensure systems are ceriied and conform to the Kenya eHealth
interoperability standards. The Kenya Health Informaion Systems ceriicaion framework
deines the policies that govern the operaion of the HIS ceriicaion program.
The highlights of the ceriicaion focuses on four main criteria:
» Funcionality for health informaion systems to collate health data, compile, and analyze
health data to help manage populaion health and reduce health care costs. The MOH
will deine the minimum funcions an EHR should perform to help physicians pracice
beter medicine and improve the botom line.
» Reporing and alerts aligned to MOH rouine health data and informaion reporing to
generate complete and quality data and promote data use for decision-making. Now the
health care data analysis can improve paient care and collaboraive care.
» Security, privacy, and conideniality: MOH will put in place safety measures that limit
access on health data and informaion according to policy.
» Informaion exchange and interoperability: MOH advocacy on implementaion;
deployment of Electronic Health Informaion Exchanges (HIE) to health care providers
to improve paient care by eiciently and securely sharing paient’s digital medical
informaion through standards that enable data to be shared across disparate health
care subsystems.
A maturity model is a set of structured levels that depict the organizaional behaviors,
pracices, and processes that reliably and sustainably produce required outcomes.
27
The maturity model concept is used to measure the ability of an organizaion or government
enity, such as a ministry of health, to coninuously improve in a speciic discipline unil it
reaches the desired level of development or maturity.
28
The greater the maturity, the stronger
the system, and the more likely it is to withstand interrupions, such as changes in staf,
luctuaions in funding, changing data needs, or the efects of rapidly evolving technology.
The HIS interoperability maturity model addresses the components that are criical to
interoperability: technology, the broad area of leadership and governance of the HIS, and
human resources.
4.1 Interoperability Ceriicaion
4.2 Interoperability Maturity Model
Kenya Health Informaion Systems Interoperability Framework | 43
The HIS Interoperability Maturity Toolkit Assessment Tool supports the MOHs, their
implemening partners, and other stakeholders in idenifying the key domains for
interoperability and the required levels of maturity to achieve HIS interoperability goals.
The interoperability maturity toolkit should:
» Idenify interoperability domains and subdomains.
» Deine maturity levels.
» Provide an assessment process.
» Provide an assessment tool.
» Provide a maturity model worksheet.
The KHISIF proposes the adapion of global best pracices such as the MEASURE Evaluaion
health informaion systems interoperability maturity toolkit,
29
for progressive monitoring
and evaluaion of the Kenya Ministry of Health interoperability implementaion journey
over ime, as well as Data Interoperability: A Praciioner’s Guide to Joining Up Data in the
Development Sector,
30
to explore opportuniies and idenify good pracices for enhancing
data interoperability in the SDGs. The KHISIF also incorporates other global best pracices
for cross referencing to enrich the KHISIF evaluaion process. For more informaion see
Annex VI.
ANNEXES
Kenya Health Informaion Systems Interoperability Framework | 45
The interoperability roadmap deines the implementaion process for insituionalizing
the deined collecion of speciicaions within the KHISIF 2020, aimed at facilitaing the
interoperability of HIS ecosystems in Kenya. To actualize the interoperability roadmap, the
MOH will foster the process through muli-sectorial collaboraion toward eHealth
development in Kenya. The MOH will coordinate the interoperability work through the exising
stakeholders’ coordinaion mechanisms, the ICC, to ensure that all implementaion plans
are the agreed-upon consolidated acion items elicited from stakeholders’ engagements.
Henceforth, MOH stewardship is to ensure naional-level policies are implemented and guide
towards ataining eHealth impact across all levels.
The primary purpose of the implementaion roadmap is to achieve the following fundamentals:
» Supporing counies towards the implementaion of naional eHealth and HIS One Vision
policies (alignment of HIS Vision across all levels of digital health soluions), strategies,
and plans in collaboraion with development partners for mobilized cost-efecive
technical assistance.
» Insituionalizaion of eHealth interoperability technical standards.
» Ceriicaion and tesing of eHealth soluions to support opimizaion of eHealth products
for improvement of coninuum of care.
» Privacy and security protecion for health data and informaion.
» Advocaing for eHealth, HIS, and Kenya health-sector investments and idenifying
common areas of priority that can be collaboraively and strategically implemented
across all levels.
» Aligning capacity-strengthening strategies with eHealth implementaions and
opimizaion of peer-to-peer and cross-county knowledge sharing.
» Facilitaing a knowledge-sharing and learning platform for in-country eHealth
implementaion for potenial showcasing at regional and global forums as a digital
global good.
» Systemaically coordinaing the monitoring and evaluaion of the impact of eHealth, HIS,
and ICT for health enhancements and soluions, and documening operaional research
on health outcomes and partner support towards an interoperability framework.
Annex I: Interoperability
Implementaion Roadmap
Kenya Health Informaion Systems Interoperability Framework | 46
While recognizing eHealth as a mode of health service, the Kenya Health Act 2017 emphasizes
the need for the standardizaion of health informaion exchange through the KHISIF, and
establishment and maintenance of a comprehensive health informaion system. Accurate,
readily available, imely, and complete data for health planning, workforce management,
policy development, and monitoring and evaluaion are criical for opimal HIS funcioning
and can only be obtained from well-matured HIS.
The Kenya HIS includes muliple stakeholders using disparate health-care soluions, making
it diicult to share informaion across these various HIS. Consequently, accurate, imely, and
complete informaion is diicult to obtain, leading to increased costs and security risks as
well as impacing negaively on paient management.
There is a need to ensure communicaion and HIE between disparate HIS, such as client
registry, provider registry, facility registry, and shared health records through an
interoperability layer. Such communicaion will enable exchange of informaion based on
standards and the ability to use the informaion that is exchanged.
Purpose
» To facilitate the development of minimum requirements of an eicient HIE environment.
» To promote the use of the interoperability concepts and standards in harmonizing HIE,
both technical and architectural aciviies within the Kenya eHealth ecosystem.
» To facilitate interoperability design, implementaion, analysis, and assessment.
» To provide guidance on monitoring and evaluaing interoperability maturity.
Scope
The interoperability layer sotware requirements speciicaions to be adapted for eHealth
digital soluions, as per the health policy, are aligned to the technical speciicaion for KHISIF
implementaion and deployment covered in Chapter 3. Since interoperability layer sotware
requirements speciicaions and standards are globally evolving, the interoperability layer
document will be periodically reviewed and updated, guided by new health areas/domains,
standards, versions, and the like.
This document should be read in conjuncion with the Kenya Health Policy and interoperability
standards and guidelines document that outlines when and how to use the standards in
eHealth digital soluions and the KHISIF.
Annex II: Development of Interoperability
Layer Sotware Requirements Speciicaion
Kenya Health Informaion Systems Interoperability Framework | 47
The Kenyan government is in the process of making sure that all HIS in the country
are interoperable. The majority of HIS are currently not interoperaing on HIE. Hence, a
terminology service is a key component to ensure accurate knowledge sharing, consistent
data collecion, standardized representaion of data elements, and comparable analysis of
health-care uilizaion data. Thus, terminology service will be criical for achieving semanic
interoperability. The terminology service document deines the minimum funcional and
system requirements, in Kenya’s HIS context, and aligned to the technical speciicaions for
KHISIF implementaion and deployment covered in Chapter 3.
Purpose
To provide the funcional and nonfuncional requirements for terminology services in Kenya
and ensure achievement of:
» Accurate and consistent data aggregaion to improve paient care analysis and reporing
of comparable paient data within and between paient populaions, leading to more
consistent care.
» Consistent analysis of health-care resource uilizaion for more informed decisions
about resource allocaion.
» Standardized evaluaion of treatment plans that afect health outcomes.
» Reproducible quality, safety, and eiciency measurements of paient care.
» Ideniicaion, evaluaion, and re-engineering of paient care processes.
» Compliance with naional standards for health-care delivery.
» Progress towards evidence-based medicine and the use of clinical decision support.
» Standardizaion and reuse of digital health soluions and reports.
Scope
The terminology service will provide a consistent speciicaion for accessing and managing
terminology content. Terminology services will represent funcions necessary to manage,
search, access, and expand terminology content independent of the underlying technology
stack. Terminology content represents various resources including lists, value sets,
taxonomies, among others. The proposed soluion will provide a mechanism for user
Annex III: Development of Terminology
Service Sotware Requirements Speciicaion
Kenya Health Informaion Systems Interoperability Framework | 48
management, user authenicaion, access control, management of requests and feedback for
user requests.
Deiniions and acronyms
A terminology, also known as a code system, ontology, vocabulary, or dicionary, is a set of
names, codes, and descripions related to a body of knowledge. A terminology can be as
simple as the set of Health Level Seven Internaional (HL7) gender codes
31
or as complex as
Systemaized Nomenclature of Medicine (SNOMED CT).
32
Kenya Health Informaion Systems Interoperability Framework | 49
At the naional level, the Interagency Coordinaion Commitees is the forum that brings
together all the players in the health sector to shape policy. The funcions of the ICC are
coordinated through three technical working groups:
1. Health Informaics;
2. Health Metrics; and
3. Research and Innovaion (R&I).
These working groups are established according to the policy orientaions set out in the
Kenya Naional eHealth Policy 2016–2030. Each technical working group sets out to address
priority issues and areas of focus and to beter coordinate the investments of health-sector
stakeholders.
These management mechanisms share several key requirements:
» They have to be suiciently lexible to address the changes within their respecive
subject areas, such as technology changes.
» They have to address the fact that certain aspects, such as business-speciic convenions
or technical speciicaions, would be more efecively owned and managed by program
domain experts or dedicated specialist groups rather than under a common ownership.
» The coordinaion of the change management process of the KHISIF shall be the
responsibility of the HIS ICC TWGs, informed by the sub-TWGs and taskforce,
respecively.
Key MoH funcions
» Guide the health programs in naional and county TWGs in HIS and EMR/EHR
prioriizaion and coordinate informaics capacity-strengthening approaches across all
levels.
» Promote interoperability by developing and disseminaing HIS interoperability
framework and standards among the eHealth soluions stakeholders across all levels.
» Consultaively collaborate with counies on eforts to operaionalize and track
implementaion of the eHealth components in the county health annual work plan and
county ICT department annual work plan.
» Idenify, establish, and encourage compliance with standards and legal frameworks to
guide implementaion of eHealth soluions across all levels.
Annex IV: Terms of Reference and Ministry
of Health Templates
Kenya Health Informaion Systems Interoperability Framework | 50
The overall objecive of this data and analyics framework is to outline a structured process
of data analysis, towards tracking of SDG 3 indicators aligned to Kenya UHC targets and
generaion of strategic informaion products to inform acionable insights at naional and
county levels. The ICC and its corresponding TWG’s members will advocate and deine the
guiding procedures for ensuring the following speciic objecives of the framework:
1. To outline the key aspects of a data and analyics framework that can guide the process
of formulaing criical health quesions.
2. To outline the key types of health and geospaial data analyics, tools, and techniques
used to help build the analysis.
3. To provide logical steps in discovering insights, associaions, relaionships, and
paterns from data to support evidence-based decision-making.
4. To outline potenial sources of health data, including, but not limited to, paient-level
data, spaial data, and relevant auxiliary atribute data necessary in generaing health
insights.
5. To generate the best value from data and analyics, it is always beter to start from the
health outcomes and the hypotheses, as opposed to the available data.
Aspects of data and analyics framework
There are four aspects to the data and analyics framework:
» Discovery;
» Insights;
» Acions; and
» Outcomes.
Discovery: This phase involves deining the problem, developing hypotheses, and collecing
and exploring data with the view of inding value in data. When deining the problem, it is
important to review exising documents or publicaions that have addressed the problems
you are trying to solve. It is also important to make reference to naional and county-level
priority indicators as deined in the SDGs, M&E framework, and other MOH policies. This will
help you to beter deine or reine the problem and avoid duplicaion in analysis. Common
Annex V: Naional Integrated Data
Analyics Framework
Kenya Health Informaion Systems Interoperability Framework | 51
operaions include data cleaning, data formaing, and exploratory spaial data analysis
through electrostaic deposiion analysis.
Insights: This phase involves applicaion of appropriate analyical techniques to exising
and new data to generate new knowledge. It is also important to create a test-and-learn
environment for coninuously harnessing insights.
Outcomes: This phase involves unlocking the value of data and analyics by transforming
insituional funcions. To deliver improved health outcomes, it is necessary to develop a
training strategy that will improve the skills of personnel.
Acions: This phase involves linking insights with decisions and acions to deliver quick wins.
Kenya Health Informaion Systems Interoperability Framework | 52
Annex VI: Interoperability Suite of Tools
Components
Readiness assessment
(operaional - checklist)
Maturity model module
(strategic - organizaional)
Governance:
Oversight and data control
(insituional and human
layers)
A literal checklist across all
these areas.
Start with easy wins and
clear proposiions as
suggested by focus group at
UNSC.
See for instance the
Measure Evaluaion HIS
Interop toolkit.
Also see, World Bank
Open Data Readiness
Assessment tools.
US Digital Services
Playbook.
Develop an “interoperabili-
ty module” that can it into
other maturity models. This
will require assessment of
other models and processes
– desk review of:
1. GSBPM interop links
2. IBM Informaion
Governance Model
3. Gartner maturity model
for data and analyics
4. UNICEF administraive
data maturity model
5. UK + Australia maturity
model for FPOS
6. Carruthers and Jackson
7. Data Orchard
We should consider the
example of UNICEF in terms
of idenifying clear outcome
statements for each compo-
nent
Interopability pillars
(technical and data layers):
- Data and metadata
- Classiicaions and
vocabularies
- Interfaces and access
- Linked open data
Addiional management
funcions (not covered in
our model but to be aware
of with links to resources
in Guide):
- Data security (Ch. 1)
- Storage and operaions
(Ch. 2 & 4)
- Data warehousing (Ch. 2)
- Quality assurance (Ch. 2)
- Reference and master
data (Ch. 3)
- Document and content
management (Ch. 5)
Kenya Health Informaion Systems Interoperability Framework | 53
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for Novice Researchers. The Qualitaive Report, Volume Volume 13, p. 546.
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Available at: htps://ohie.org/architecture/
[Accessed 30 April 2020].
htps://ohie.org/architecture-speciicaion/, 2019. OpenHIE Architecture Speciicaion - Version 2.0,
s.l.: htps://ohie.org/architecture-speciicaion/.
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[Online] Available at: www.intrahealth.org
[Accessed 14 September 2016].
Annex VII: References
Kenya Health Informaion Systems Interoperability Framework | 54
Laws of Kenya, 2010. The Consituion of Kenya. Naional Council for Law Reporing.
MEASURE Evaluaion, 2020. htps://www.measureevaluaion.org. [Online]
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interoperability-toolkit
[Accessed 30 April 2020].
Ministry of Health, Kenya, 2016. Kenya Naional e-health policy 2016-2030, Ministry of Health ,Afya
House, Cathedral Road, P.O. Box:30016–00100, Nairobi, Kenya.: Ministry of Health, Kenya.
Ministry of Health, Kenya, 2018. Data, System Governance and Change Management Framework,
Nairobi: htps://www.health.go.ke/resources/policies/.
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Available at: health.go.ke/wp-content/uploads/2019/01/UHC-QI-Policy-Brief.pdf
[Accessed 2020 April 2020].
MOH, 2015. Devolved HRM Policy Guidelines. Human Resources for Health, p. 2.
Muga, , D. R., Kizito, D. P. & Mbayah, M. M., 2004. Overview of the Health System in Kenya. Chapter 2,
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Kenya Health Informaion Systems Interoperability Framework | 55
Annex VIII: Stakeholders’ Engagement
Reference List
Organizaion Paricipant’s Name
Oice of the Deputy President Philip Thigo
MOH – Directorate Head Dr. Charles Nzioka
MOH – Department Head Dr. Joseph Siienei
MOH – Health Informaics Mr. Onesmus Kamau
MOH – Health Informaics Abdullahi Kimogol
MOH – Health Informaics Dr. Ayub Manya
MOH – Health Informaics Dr. Wesley Oghera
MOH – Health Informaics Dr. Martha Muthami
MOH – Research and Innovaion Dr. Joyce Wamicwe
MOH – ICT Rachael Wanjiru
MOH – ICT Eric Nderitu
MOH – Health Informaics Julius Muiso
MOH – Health Informaics Dr. Muile Wanyee
MOH – Health Informaics Nancy Amayo
MOH – Health Informaics Sophia Karanja
MOH – UHC Pepela Wanjala
MOH – Health Informaics Dr. Liz Wangia
MOH – Health Informaics Dr. Helen Kiarie
MOH – Health Informaics Jeremiah Mumo
MOH – Health Informaics Samuel Cheburet
MOH – Health Informaics Dianne Kamara
MOH – Health Informaics Patrick Warutere
MOH – Health Informaics Dorcas Gichigi
MOH – Community Health Diana Kamar
MOH – Clinical Services Judy Kabathi
MOH – Health Informaics Paul Malusi
MOH – Health Informaics Peris Wanjiru
MOH – Health Informaics Oieno Elizabeth
MOH – Health Informaics Gilbert N. Mboro
Kenya Health Informaion Systems Interoperability Framework | 56
NASCOP – M/E, SI Dr. Violet Oramisi
NASCOP – M/E, SI Rose Agweny
NASCOP – M/E, SI Faith Shelmith
NACC – Head Dr. Nduku Kilonzo
NACC – M/E, SI Mr. Joshua Gitonga
NACC – M/E, SI Mr. George Onyango
NACC – M/E, SI Mercy Khasiani
Council of Governors Benter Owino
Council of Governors Stephen Osingo
County ICT Director (Kakamega) Mr. Sam Wetungu
Kakamega County Dr. Mike Ekisa
AMREF Dr. Elizabeth Wala
AMREF Janekellen Mbai
KEMSA Mr. Eliud Muriithi
Communicaions Authority of Kenya Nixon Mageka
PEPFAR Larry Sperling
PEPFAR Christalyn Steers
PEPFAR Dr. Heather Smith
PEPFAR Kenya Anne Ojijo
USAID Mr. Washington Omwomo
USAID Peter Yegon
USAID Brian Onyango
CDC Dr. Davies Kimanga
WHO Victor Achieng
WHO Cosmas Leonard
UNICEF Eunice Ndungu
UNICEF Dr. Khaing Soe
UON/HealthIT Prof. Peter Waiganjo
UON/HealthIT Mr. Raphael Pundo
UON/HealthIT Mr. Dennis Banga
UON/HealthIT Mr. Felix Ongai
UON/HealthIT Duncan Ndiithi
UON/HealthIT Benzer Bet
Kenya Health Informaion Systems Interoperability Framework | 57
UON/HealthIT Teresia Wangui
FHI360
Dorothy Muruki
I-TECH Kenya
George Owiso
Palladium
Dr. Jacob Odhiambo
HIGDA Rose Nzyoka
HIGDA James Kwach
HIGDA Fredrick Onyango
HIGDA John Gichangi
HIGDA Marin Kinyua
PATH Priscah Teka
Tupime Kauni Lilian Mageto
Tupime Kauni Hesbon Ooko
Clinton Health Access Iniiaive Bety Wariari
RTI Dr. Marin Osumba
JKUAT Dr. Ruben Thuo
JKUAT Prof. Fred Wamunyokoli
JKUAT Prof. Simon Karanja
JKUAT Dr. Agnes Mindila
Afya Switchnet Steven Wanyee
Afya Switchnet Anne Njoroge
EMR implementer Dennis Henry
GPSDD Victor Ohuruogu
Kenya Health Informaion Systems Interoperability Framework | 58
Endnotes
1 Vision 2030, “Towards 2030.” Available at htps://vision2030.go.ke. Accessed April 30, 2020.
2 www.data4sdgs.org/resources/interoperability-praciioners-guide-joining-data-development-sector
3 World Health Organizaion Global Observatory for eHealth. Available at www.who.int/goe/en. Accessed
May 26, 2020.
4 The classiicaion of digital health intervenions.
5 Healthcare Informaion and Management Systems Society, “HIMSS 2020 Deiniion.” Available at htps://
www.himss.org/what-interoperability. Accessed May 26, 2020.
6 HIMSS, 2013.
7 World Health Organizaion Health Metrics Network, Framework and Standards for Country Health Informa-
ion Systems, 2nd ed., 2012. Available at htps://www.who.int/healthinfo/country_monitoring_evaluaion/
who-hmn-framework-standards-chi.pdf. Accessed on May 26, 2020.
8 Adele Waugaman, “From Principle to Pracice: Implemening the Principles for Digital Development,”
Washington, DC: The Principles for Digital Development Working Group, January 2016. Available at
htps://digitalprinciples.org/wp-content/uploads/From_Principle_to_Pracice_v5.pdf.
9 An API is a set of deiniions and protocols for building and integraing applicaion sotware. APIs let your
product or service communicate with other products and services without having to know how they’re
implemented. This can simplify app development, saving ime and money. See Red Hat, “What Is an API?”
Available at www.redhat.com/en/topics/api/what-are-applicaion-programming-interfaces. Accessed on
May 26, 2020.
10 A soluion “lock-in” can happen when a department procures a proprietary data soluion from a private
company that only interoperates with other products developed by the same company. Thus, soluion lock-
ins prevent interoperability by design and can be costly and diicult to recify once procured. A technical
soluion’s ability to interoperate with exising MOH HIS should therefore be an important consideraion
during the procurement of new IT tools and other digital soluions. Mary Shacklet, “5 Ways to Avoid Ven-
dor Lock-in,” Tech Republic, October 8, 2018. Available at www.techrepublic.com/aricle/5-ways-to-avoid-
vendor-lock-in/.
11 Ministry of Health, Kenya, Data, System Governance and Change Management Framework, 2018.
12 Iroju Olaronke and Olaleke Olusola, “Ethical Issues in Interoperability of Electronic Healthcare Sys-
tems,” Communicaions on Applied Electronics, May 2015. Available at www.researchgate.net/publica-
ion/277921194_Ethical_Issues_in_Interoperability_of_Electronic_Healthcare_Systems.
13 OpenHIE, “Framework.” Available at htps://ohie.org/architecture/#framework. Accessed on May 26, 2020.
14 OpenHIE, “Architecture.” Available at htps://ohie.org/#arch. Accessed on May 26, 2020.
15 ICD10/11, “Internaional Classiicaion of Diseases.” Available at htps://www.who.int/classiicaions/icd/en/.
Accessed on May 26, 2020.
Kenya Health Informaion Systems Interoperability Framework | 59
16 Logical Observaion Ideniiers Names and Codes (LOINC). “Available at htps://loinc.org/guides/. Accessed
on May 26, 2020.
17 Systemaized Nomenclature of Medicine - Clinical Terms (SNOMED CT).” Available at htp://www.snomed.
org/snomed-ct/why-snomed-ct. Accessed on May 26, 2020.
18 OpenHIE, “Architecture Speciicaion.” Available at htps://ohie.org/architecture-speciicaion/. Accessed
on May 26, 2020.
19 A soluion “lock-in” can happen when a department procures a proprietary data soluion from a private
company that only interoperates with other products developed by the same company. Thus, soluion lock-
ins prevent interoperability by design and can be costly and diicult to recify once procured. A technical
soluion’s ability to interoperate with exising MOH HIS should therefore be an important consideraion
during the procurement of new IT tools and other digital soluions. Mary Shacklet, “5 Ways to Avoid Ven-
dor Lock-in,” Tech Republic, October 8, 2018. Available at www.techrepublic.com/aricle/5-ways-to-avoid-
vendor-lock-in/.
20 Kenya Health Informaion System. Available at htps://hiskenya.org/. Accessed on May 26, 2020.
21 Drug Informaion Unit of the Pharmacy and Poisons Board. “Available at htps://pharmacyboardkenya.org/
medicines-informaion. Accessed on May 26, 2020.
22 MOH Virtual Academy. Available at htps://elearning.health.go.ke/.
23 MOH Service Desk Portal. Available at htp://servicedesk.health.go.ke/portal.
24 Naional Treasury, Kenya, “IFMIS e-Procurement Rolled Out throughout the Country to Enhance Service
Delivery to the Public. Available at www.treasury.go.ke/media-centre/news-updates/224-ifmis-e-procure-
ment-rolled-out-throughout-the-country-to-enhance-service-delivery-to-the-public.html
25 Kenya Naional Bureau of Staisics. Available at htps://www.knbs.or.ke/
26 History of KNBS, “Kenya Naional Bureau of Staisics. Available at htps://www.knbs.or.ke/?page_id=86
27 W. Ed Hammond, Christopher Bailey, Philippe Boucher, Mark Spohr, and Patrick Whitaker, “Connecing
Informaion to Improve Health,” Health Afairs, February 2010. Available at htps://www.healthafairs.org/
doi/10.1377/hlthaf.2009.0903.
28 J. V. Carvalho, Á. Rocha, and A. Abreu, “Maturity Models of Healthcare Informaion Systems and Technolo-
gies: A Literature Review,” Journal of Medical Systems, 2016.
29 MEASURE Evaluaion, USAID. Available at htps://www.measureevaluaion.org/resources/publicaions/tl-
17-03b. Accessed on May 26, 2020.
30 L. M. Gonzalez and T. Orrell, “Data Interoperability: A Praciioner’s Guide to Joining Up Data in the De-
velopment Sector,” Global Partnership for Sustainable Development Data, n.d. Available at htp://www.
data4sdgs.org/resources/interoperability-praciioners-guide-joining-data-development-sector
www.data4sdgs.org/sites/default/iles/services_iles/Interoperability%20-%20A%20praciioner’s%20
guide%20to%20joining-up%20data%20in%20the%20development%20sector.pdf.
31 Value set for administraive gender, “Available at htp://hl7.org/hir/valueset-administraive-gender.html
32 Systemaized Nomenclature of Medicine - Clinical Terms (SNOMED CT).” Available at htp://www.snomed.
org/snomed-ct/why-snomed-ct. Accessed on May 26, 2020.
