Giving health officials real-time information during a pandemic

A version of this article was originally published by IntraHealth International here.

When Ebola spread through Liberia in August 2014, health workers needed information—and they needed it fast. mHero saw exactly the same need during the COVID-19 pandemic.

mHero is a two-way, mobile phone-based communication system that connects ministries of health and frontline health workers. It was created in 2014 by IntraHealth International and UNICEF to support health sector communication in Liberia during the Ebola outbreak.

mHero’s original version connected Liberia's health workforce information system, iHRIS, with RapidPro, a platform that delivers basic text and audio messages. Linking the two information systems made it easier to reach most Liberian frontline health workers who were using basic mobile phones.

Today, mHero is a vital communications tool and health worker registry platform—for COVID-19 and other urgent health needs—that countries around the world are using to:

• Communicate both routine and urgent messages to health workers.

• Target messages to health workers based on cadre, location, or other demographic information.

• Collect critical information about services and disease outbreaks that powers resilient health systems.

• Keep health workers' skills up to date.

• Provide frontline health workers with the information and support they need.

mHero’s primary function and feature is interoperability. Since it was first developed, mHero has distinguished itself from other digital health platforms by not being just another technology, but rather a tool that integrates and leverages existing systems, platforms, and data.

Advancements in technology and the individual needs of partner countries inspired IntraHealth to make mHero interoperable with even more information systems. mHero can now operate with any health information systems compliant with the global Fast Healthcare Interoperability Resource (FHIR) standards —the framework for sharing, integrating, and retrieving clinical health data and other electronic health information.

The IntraHealth team is currently exploring how to convert information collected via mHero into standard FHIR formats. This would mean information collected via mHero could be used in other health information systems, which would make it more useful for health workers and ministries of health, providing government officials with more data to inform their analysis and decision-making as they respond to COVID-19 and future health threats.

Focusing specifically on COVID-19 response, IntraHealth began to think hard about how they could change mHero and FHIR tools so that health workers and ministries of health can sync and share data about pandemic response? They identified some exciting possibilities.

For example, a health worker at a health facility may need to report daily on the number of staff and patients who received COVID-19 vaccinations. IntraHealth determined which elements of those data should be synced and/or shared (such as the facility’s location and client data) and outlined the message flow—that is, the messages that ministry officials and health workers might send back and forth to each other to report and collect information about vaccinations using mHero.

IntraHealth then went on to do the same for other common COVID-19 reporting scenarios a health worker might be part of using the World Health Organization’s guidelines—global parameters that allow message flows to be used widely.

From this exercise, IntraHealth found that health workers' contact information, information about the facility and its location, and data about staff and clients are data elements that it may make sense to sync. mHero can sync contacts in messaging platforms with FHIR—which already harmonizes contact information and identifies the health worker submitting the data—but now it can also provide more structure for the data, providing context and, therefore, more useful information.

IntraHealth further expanded mHero’s conversion capabilities by developing a tool that can convert message flows developed in RapidPro or other compatible messaging platforms into FHIR resources so the responses to message flows can also be converted.

So now, the vaccine data submitted by health workers, for example, can be automatically synced with health information software like DHIS2 and OpenLMIS. This means health officials at different levels of the health system can have access to more complete information that previously would have been stored in separate systems. This could help countries keep track of vaccination rates, determine where demand is high (or low), and make sure health facilities have access to sufficient vaccines, personal protective equipment, and other supplies to meet demand.

Building sample message flows and outlining the methodology for converting, syncing, and extracting data elements represents a major advancement in the global understanding of what is possible with SMS messaging and FHIR, and helps narrow down the best approach for each channel used to capture data. This work is helping expand what can be done when more health information systems are based on FHIR.

Short messaging like SMS and WhatsApp are still the most prevalent channels for communication worldwide. However, the ability to convert data collected via SMS—a very basic and widely accessible channel—into a format that can be synced with many different systems opens up the possibilities for collecting information from rural areas. This could provide a real-time understanding of the conditions everywhere and inform decision-making that provides essential support and resources where needed.

The development and testing of FHIR-compliant COVID-19 workflows with mHero was funded by Digital Square and supported by members of several global digital health communities including OpenHIE (specifically the OpenHIE COVID-19 Task Force), the World Health Organization (WHO), the global goods community, the Centers for Disease Control and Prevention (CDC), and Health Level Seven International (HL7).

Digital Square is a PATH-led initiative funded and designed by the United States Agency for International Development, the Bill & Melinda Gates Foundation, and a consortium of other partners.