Introduction and context

There are many health organisations that run hospitals/clinics in underserved regions across the world. The population around the hospital depend quite heavily on these organisations because of the good quality service provided by them at affordable prices. Bahmni is an open-source software system for such hospitals, clinics and electronic medical records.

On the other hand, there are many health organisations that provide community-based health services like health screening, counselling, public health interventions, doorstep follow up for chronic diseases, providing nutrition, and so on. Avni is open-source software for all types of frontline work, including for such community health services.

There are some organisations that provide both the services to the same population. In such organisations, there are two sub-organisations for each — as the nature of service to be delivered is quite different. For such organisations — a person who is provided health services in the community is also a registered patient to them when they visit the hospital. While for the larger organisation, the objective is to improve the health status of individuals — but there is a lot of friction and difficulties in accessing health information across these two verticals within the same organisation.

Community health records of an individual are with the frontline health worker who does not (cannot) travel with every individual to the hospital. Hence the community health records are not available in the hospital. Similarly, when a person goes back from the hospital, the community health team is in the dark about the diagnosis, medicine prescribed, followup date to hospital, etc — which are stored in the hospital’s patient file. Some of these problems are mitigated via ad-hoc communication between two sub-organisations, any health records retained by the individual themselves, telephone calls and so on* — but they are quite sub-optimal and hence are used sparingly. The when, how, what, to-whom, about-whom, of the communication between the two sub-organisations, are quite difficult to streamline and make effective. For example — how should the CHW know, for which of their client, whom they should contact in the hospital, and when. How should they receive and store the information provided?

When an organisation uses software for the hospital and community health services both, then an opportunity presents itself which you may have guessed already— what if both the systems are integrated with each other. This can potentially make the data on each side available to the other side.

Further, if both the software are open source products (not a bespoke and/or proprietary solution), then this problem has to be solved only once — and many such organisations can benefit from it. Avni Bahmni integration idea is a simple idea like this.

The idea of this integration is to improve service delivery certainly but it has another important consequence. A connected dataset of community health records and clinical health records presents a unique opportunity to perform health research on important topics. If this can be done for populations which are underserved, which is where Avni and Bahmni are used — that makes it even more valuable.

The first such integration is being developed and will be implemented. It is a collaboration between Ashwini, ThoughtWorks, and Samanvay. Needless to say that the integration work will be generic and open source as well.

*One may wonder why health records are not given to the individual themselves and then this problem wouldn’t exist in the first place. The indisputable experience of this is that most people do not maintain their health records and lose them readily, let alone those who are much poorer and live with much lesser facilities. Hence even when an organisation are running one of the two services — they maintain a lot of records with themselves.

Icons thanks to icons8.com

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