EDHIN stands for Ethiopian Digital Health Interoperability Network. Digital health systems have an important role in the delivery of integrated health care services. They can improve the functioning and efficiency of the healthcare system by ensuring interoperability of individual digital health systems to speak to and understand each other. Efficient and accurate sharing of health information within and between health services, enabled by digital health system, allows the system as a whole to function more effectively, respond more quickly to emergencies and public health threats, and better understand service needs in real time. Despite the global recognition of the importance of interoperability and integration of digital health systems, the implementation progress has been slow.
The World Health Assembly’s resolutions on eHealth (WHA58.28 (2005)), on eHealth standardization and interoperability (WHA66.24 (2013)), and on digital health (WHA71.7 (2018)) recognize the role of interoperable digital systems in achieving sustainable development goals. As such, many countries are implementing different electronic information systems that collect health data – but the quality and sharing of data gathered remain inadequate. Many of the developing countries lack national information standards to guide their system development and deployment, for example:
- Many of these information systems operate independently.
- Information is stored in different locations, managed by different authorities, and captured in different electronic formats, making it difficult to harmonize and share/exchange data across countries for improved continental surveillance, disease control, and emergency response.
- The lack of interoperability is an increasing concern for donors, partners, and countries, which have invested heavily in these systems, but still lack a “big picture” view of all the data relevant to health, and how to integrate diverse data/information for developing a comprehensive understanding of national health goals and developments.
- Interoperability in this context is not only related to human and animal health directly, but also equally relevant for ensuring that health- related risks and events are combined with data/information from other areas of relevance for the continued well-being and sustainable development of the continent (e.g., security, climate, and biodiversity).
In Ethiopia, the Ministry of Health has recognized the transformative role of digital health in advancing national efforts to deliver quality healthcare to all populations across every region of the country. It has invested directly in HIS development under past Health Sector Development Programs (HSDP), and as a result, the country has made significant strides towards establishing an effective, simplified and harmonized digital health systems. Within the context of the current Health Sector Transformation Plan II (HSTP II) (2020-2030), improving the performance of digital health systems is seen as essential for achieving national health system and health status goals.
Ethiopia has made remarkable achievements in the implementation of digital health systems over the years. In 2006, the MoH undertook Health Management Information System (HMIS) reform focusing on data management, human resources and Information Communication and Technology (ICT). In 2014, the MoH standardized indicators, recording and reporting forms, procedures, and reporting channels to improve performance. In 2017, the MoH developed various national digital health applications to improve its health system, including District Health Information System (DHIS2), Electronic Community Health Information System (eCHIS), Electronic Logistics Management Information System (eLMIS), and Electronic Public Health Emergency Management System (ePHEM). There is also work underway to develop additional digital health systems capabilities like Health Commodity Management Information System (HCMIS) that supports drug dispensing, stock, and other projects across all levels of the health system.
Another remarkable achievement of the country is the development of Ethiopia's eHealth architecture (eHA) (1) which is a breakthrough to coordinate and streamline the various fragmented eHealth initiatives. The eHealth Architecture depicts a conceptual framework on how the different digital health systems interact. It also defines how interaction among these systems can be made possible through interoperability service (FMOH-HER Standards, 2021). Despite the existence of an eHealth architecture that includes health information exchange as one component, interoperability among these systems is not yet realized as required. To overcome this limitation and best move from siloed applications to interoperable national digital health ecosystems sustainability, there is a need to provide continuous leadership and technical supports on interoperability to the Ministry of Health, partners, and health facilities. Such supports can be achieved by creating a platform for continuous interactions amongst interoperability practitioners including stakeholders involved in the broader health information system. To achieve this, an interoperability Community of Practice (CoP) called Ethiopian Digital Health Interoperability Network is thus needed.