A comprehensive standards-based framework for enabling semantic interoperability of disease surveillance data for Namibia through adopting health standards
Authors:   , Angula Nikodemus 
Published: January 2022

The Ministry of Health and Social Services (MoHSS) in Namibia runs silo information systems in the 14 regions of the country, and these silo systems were donated by non-governmental organisations. In addition to a regional District Health Information System (DHIS-2) for each region, there is the main DHIS-2 at the MoHSS. The Health Information Systems (HIS) that include the main DHIS-2 at the MoHSS and silo systems in the regions work in isolation currently. Hence this study aimed at finding a framework to enable semantic interoperability of disease surveillance data in these HIS. This is meant to enable the main DHIS-2 and these silo systems in the Namibian public hospitals to act as an integrated platform that shares and exchanges disease-surveillance information. Semantic interoperability is the ability to automatically interpret the information exchanged meaningfully and accurately to produce useful results as defined by the end users of both systems. To achieve semantic interoperability, both sides must defer to a common information exchange reference. Utilising the Integrating the Healthcare Enterprise (IHE) standard and Health Level Seven (HL7), this research provides guidelines on how to integrate these heterogeneous HIS through the adoption of established health standards. Thus, IHE and HL7 standards were adopted to interface the main DHIS-2 and silo systems at a data level. The result of this research is a framework to enable the semantic interoperability of disease surveillance data in Namibian public hospitals through the adoption of IHE and HL7 standards, in addition to a prototype that demonstrates how disease surveillance data can be integrated in the Namibia healthcare environment. In the Namibian health domain, there is no known protocol that governs or aggregates disease surveillance data from remote heterogeneous HIS. Therefore, the study developed an interlink protocol that can aggregate disease surveillance data from remote HIS. This means that health professionals in Namibia would use the system for fast decision-making simply because they are accessing disease surveillance data in real-time. In this case, the protocol was applied to govern heterogeneous systems in Namibian public hospitals for data semantic interoperability of the main DHIS-2 and these other health information silo systems so that they can exchange health data and information, specifically, disease surveillance data. This interlink protocol is based on JSon. To test the Interlink protocol, a number of use case scenarios were used. The scenarios include integrating crowd-sourced disease surveillance data through the communities’ mobile phones, integrating disease surveillance data collected through community health workers’ (CWH) visits, and also integrating disease surveillance data collected from community members during hospital visits. In each case, the interlink protocol is paired to an HL7 standard to facilitate communication of the disease surveillance data from the source to the integrated HIS. A prototype for each use case is developed as proof of concept, to test that the protocol can enable integration of the disease surveillance data in these HIS. The Retrieval Display profile was identified from HL7 standards as the closest to suit the integration of disease surveillance information obtained through mobile crowdsourcing. The Cross-Gateway Patient Discovery (XCPD) profile that supports the means to locate communities that hold patient-relevant health data and the translation of patient identifiers across communities holding the same patient data was adapted to support communication between CHWs, the DHIS-2 in the MoHSS and silo HIS in the regional hospitals. The Patient Demographics Actor (PDA) profile was adapted to support communication for data collected within the hospitals. The research was conducted in two phases. The first phase was the collection of data on the status of semantic interoperability of HIS in the Namibian healthcare sector. The case study setting was based on public hospitals from eight regions in Namibia using two (2) public hospitals per region, which were purposely sampled. The study population comprised of system analysts, programmers, chief system administrators, system administrators, disease surveillance office, chief disease surveillance office nurses, doctors, therapists, health assistants, public health officers, health administrators, regional health coordinators and regional assistant coordinators. A stratified purposive sampling of the study participants was done. This first phase followed an interpretive approach. This first phase supported a mixed methods approach encompassing both qualitative and quantitative data analyses. The Grounded Theory was the underlying theory of this research. The second phase was the design and development of the semantic interoperability framework. The Design Science Research (DSR) approach guided the development of the framework and prototype. Expert reviews were sought to review and validate the framework and prototype that were developed. The study contributions to the body of knowledge were that the researcher has proven silo HIS in Namibia can be integrated, developed a prototype, integrating health standards to Namibia which hasn’t been done before.