Interoperability Can Help Stop Disease Outbreaks in Their Tracks

December 01, 2017
A new system in Liberia is speeding up disease surveillance and response times.
How do you reduce the time it takes to identify a potential disease outbreak in order to manage it effectively?  
In Liberia—where resources are constrained and the devastation of Ebola still lingers—the government, IntraHealth International, and other partners are working urgently to answer this question.
The simple answer? Connect the dots quickly.
IntraHealth is helping the Ministry of Health speed up this process from several weeks to just a few days.

Health authorities must be alerted to a suspected disease or condition in order to act appropriately. Then, information must move across those connections fast. Very fast.
Health authorities require reliable, real-time information about a potential outbreak in order to communicate across departments, locations, and personnel (the dots) to quickly facilitate disease identification and management tasks. In Liberia, IntraHealth is helping the Ministry of Health speed up this process from several weeks to just a few days.
The first step to connecting the dots here was identifying them.
There is the health worker, oftentimes in a remote health facility, who identifies someone with a possible disease or condition requiring surveillance and further testing. The health worker completes a case alert form, and often collects a blood sample or other specimen from the patient. In order to move this information across the country, a carbon copy of the case alert form is then transported to the district level and another carbon copy is sent, along with the specimen, to a lab far away.
That’s a lot of dots.
At best, communication flows slowly, and many things can befall a paper form as it travels between the health worker and the receiving health officials and laboratory specialists. It can take weeks before a diagnosis and, if necessary, treatment and control actions make their way back to the health center, patient, and others potentially at risk.
Many things can befall a paper form as it travels between the health worker and the receiving health officials and laboratory specialists.

But soon, the delays from carbon copies will be no more. Liberia’s new electronic Information Disease Surveillance and Response system (eIDSR) will facilitate a much faster chain of events using real-time outbreak information and alerts.
To do this, Liberia is innovating. Innovation—a vague, pervasive, and necessary concept in today’s global health and development environment—isn’t always something brand new. It can simply mean creatively repurposing existing tools, which is how the eIDSR came to be.
In digital development, creative repurposing is at its best when it uses interoperable technologies—those open source platforms that allow for automated data sharing. Liberia’s earlier investments in open source, interoperable digital tools that adhere to the Principles of Digital Development paved the way for the rapid innovation that resulted in the eIDSR system.
Here’s how this has worked in Liberia.
eIDSR is leveraging mHero, a text message-based (SMS-based to be exact) system that enables two-way communication between health workers throughout the country and officials seated at the central level. mHero was developed in Liberia during the Ebola outbreak to improve real-time communication.
Based on OpenHIE architecture, mHero itself combines two open source, interoperable technologies: RapidPro (a communication platform) and iHRIS (a human resource information system).
This long-term collaboration coupled with a tenacious repurposing of existing technologies makes up the hard work of innovation.

Now, the eIDSR team has made mHero interoperable with DHIS 2 Tracker, a system Liberia uses to track patient-level case data on surveillance of diseases, conditions, and events, including lab results. With eIDSR, instead of using a paper form, a health worker can alert health officials immediately by sending a suspected case and request for specimen pickup via SMS. The information simultaneously populates DHIS 2 Tracker to ensure the information is available in real time to all health authorities. In addition, a feedback loop ensures health workers are informed of the delivery status of the lab sample. Soon, the system will be able to deliver lab results back to the health worker directly.  
IntraHealth is currently helping the ministry develop, test, and train health workers on the new eIDSR system, a process that began in early 2017. Recent testing has been positive. SMS containing the necessary information to pinpoint an outbreak and mitigate its spread are making their way through the system as planned. Health workers in the two counties in the first phase of the implementation are using their mobile phones to transmit this data in real time.
Within only two weeks of implementation, health workers have sent 19 alerts from ten facilities, and the ministry has been able to operate, manage, and troubleshoot these alerts. Alerts to date have included, for example, rabies, lassa fever, measles shigellosis, and neonatal death.
The strong collaboration among the government of Liberia, IntraHealth, and other partners remains, as always, the unsung hero behind the story of Liberia’s progression from carbon copies to digital technologies. Some of those key partners include the US Agency for International Development, Centers for Disease Control and Prevention, World Health Organization, and UNICEF.
This long-term collaboration coupled with a tenacious repurposing of existing technologies makes up the hard work of innovation. And this innovation will not only ensure potential conditions or diseases are tracked, identified, and managed more quickly, but it will also saves lives.  

infectious diseases digital health Global Digital Health ForumLiberia