The introduction of computers in the modern world has changed the way people work, live, and communicate. This change has reached all industries from agriculture to aerospace. During the 19th century industrial revolution boosted the economy and lead the development of countries.
From that era, some countries took the title of industrialized nations due to the presence of industries. However, in 21st century with the arrival of new technologies, information technology seems to be the leader of socio-economic development. The computer technology doesn’t know borders. This allows information technology to spread on the entire planet in a shortest time than classic industries which many countries do not have yet.
Due to the need of operations management, industries introduced information technology as a tool to improve their productivity. Different industries introduced computers in their operations early from first computer invention period. The finance industry seems to be the pioneer in using information technology. The healthcare industry was late for ten years to start using information technology compared to finance industry and it has not been disseminated as fast as in finance.
The very simple example is that all banks in industrialized countries have their bank systems to manage all operations, until to serving customers with their mobile devices. However, in health care not all hospitals have implemented electronic health record systems in developed countries.
When it comes to low and middle income countries, the financial industry is far more computerized compared to the health care sector as well.
In industrialized countries, efforts have been made to computerize health care industry to take full advantage of Information and Communication Technology (ICT). A large number of healthcare providers has implemented Electronic Medical Record (EMR) systems. National Health Information Systems (NHIS) projects have been implemented in many countries. In developed countries where there is the required infrastructure, with the initiative of governments and key stakeholders, implementation of Health Information Technology (Health IT) projects has not been challenging in terms of resources. On the other hand, developing countries still have challenges of policies, poor infrastructures and resources to digitize their healthcare sector.
This research aims to figure out what can be a solution for Health IT in developing countries with the case study of Rwanda. Even though the thesis won't cover the whole national health information system, the effort has been made to explore available resources in Rwanda and find out how the national health information system can be developed. It is in this context the architecture has been designed for nationwide Electronic Health Record (EHR) system for Rwanda. The purpose of the architecture is to demonstrate the fundamental organization of the system with its components. It outlines the relationships of those components and specifies the principles guiding the system design and its evolution.
1.1 Thesis objectives
The main goal of this thesis is to design the architectural view of NHIS for Rwanda. The proposed solution in this thesis can also be applied in other developing countries. The specific objectives of the thesis are outlined below:
To figure out the existing resources in the health information system of Rwanda and available ICT infrastructure.
To design a logical architecture of a nationwide EHR system for Rwanda. This architecture will give the plan on which the system can be implemented 1.2 Methodologies
To work on this thesis topic, qualitative research methodologies have been used:
● Interviews with different parties have been conducted to understand Rwanda health model.
Interviews have been conducted especially with e-Health department in the ministry of health of Rwanda.
● Visit healthcare providers in Rwanda to observe existing health IT solutions and we conducted interviews with IT and healthcare professionals.
● To explore other nationwide health information systems in different countries. The internet has been the main tool for search: Google scholar, database like PubMed and springers.
The keywords were National e-Health, national health infrastructure, national health information system, health information system in Africa and health information system architecture. Cross-checking publications available on e-Health, to accumulate broad background in this field and e-Health in developing countries.
● To explore available open source EMR systems to evaluate and compare them in order to know if the ones in Rwanda comply with international standards.
● Participate in conference of developers and implementers of open source EHR software, and visit hospitals where open source EHR is in use, in a developed country (Indianapolis, U.S.A).
1.3 Scope
This thesis will explore NHIS. At this point, it will basically focus on how the NHIS are designed, how they function and requirements for a country to develop a fully functional NHIS. It will figure out also how the open source EHR software can be the best option for NHIS in developing countries. Finally, the architecture of Rwanda’s NHIS will be designed as sample of NHIS in developing country. The thesis will not describe a detailed implementation plan but implementation phases are suggested.
1.4 Thesis outline
This thesis consists of three parts. The first part provides the introduction of the thesis and the background of Rwanda in general and specifically Rwanda’s ICT profile, health care model and the current situation in implementing the health information system. The second part focuses on exploring HIS. This part will explore how some countries have implemented their NHIS, finding key factors to succeed and challenges. The last part consists of the architectural design for NHIS for Rwanda. The first and second chapter covers the first part of this thesis. Next, the chapter three consists of the background knowledge on health information systems and explores open source EMR solutions. Chapter four consists of NHIS in different countries and possible open source
EHR implementation at national scale. The chapter five presents the architecture of nationwide HER for Rwanda. Chapter six discusses the implementation of that architecture in Rwanda. The last chapter is the conclusions of this thesis that summarize what have been done and recommendations for the future studies.