An Affordable and Standard Digital Healthcare management as a Service (HaaS) for Small Clinics in Developing Countries
Authors: Ahmed Ashir , Asyraf Danial Bin Karim Muhammad , Islam Rafiqul , Taufiq Ahmed Mostafa , Nakashima Naoki 
Published: July 2022

Millions of clinics in developing countries are using paper-based health records in their daily operations. Health information is archived in papers, patients use these paper records which are hard to manage. These clinics do not have the technical expertise to deploy electronic health record systems neither can they maintain these systems on their own. Some health data management systems are freely available, but they are not used by these small clinics. Standards such as Health Level Seven (HL7), openEHR, Systematized Nomenclature of Medicine (SNOMED) Clinical Terms, International Classification of Diseases (ICD-11) etc. are becoming more reliable and usable yet they do not reach these clinics.In this study, we propose, design, and implement a Healthcare management as a Service (HaaS) to support such small clinics. HaaS consists of a standards compliant electronic health record system that follows FHIR (Fast Healthcare Interoperability Resources) and openEHR open standards. It provides lightweight, simple, and low-cost front-end applications for small clinics that make the service usable by authorized users without needing technical expertise to store and manage health data. The applications also allow individual patients to store and view their own health data independently. Aside from clinical usage, the platform also supports secondary use of stored health data for medical research purpose. To maintain privacy protection, patients can give different level of health data sharing consent, and only anonymized and consented data are shared to researchers through the platform. To add another layer of privacy protection, clinical data is stored and managed separately by an openEHR compliant server in the platform. Personal and demographic data are stored in a FHIR compliant server.For the implementation, we used open-source software for all components of the platform and deployed the platform using Docker on a local computer. We prepared three applications that can register new patients, record health data, and store them respectively. An application that transforms and stores non-standard compliant health data is also prepared. We prepared an application that displays consented health data. We tested three functions, whether (a) obtained personal and clinical data are separately stored at FHIR and openEHR servers, (b) non-standard compliant data can be fetched and stored to HaaS, and (c) patients’ data privacy are maintained. We manually checked that all data are stored as designed, confirmed the data transfer was made successfully and the privacy was maintained. We transformed and stored 43,835 patient records from Portable Health Clinic system to the platform using the data transformer application. Three dummy patients with a healthcare service provider and 1 independent patient records are also stored to the platform using the three applications. All patient records include personal, demographic, and clinical data. We made a query using the prepared application and checked the result. The result showed that the platform works as designed and is configurable to fit different local needs while maintaining privacy. Future tasks include testing the platform with different small clinics and collect their views to evaluate the effectiveness of the system.