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OpenELIS 2

FHIR-FIRST, NATIONAL HIE, TESTABLE FHIR IG, COVID-19 RESPONSE

CASEY IIAMS-HAUSER, OLIVER GADABU, JAN FLOWERS

Digital Initiatives Group (DIGI) at I-TECH

OpenMRS | OpenELIS | OpenHIE

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What Is OpenELIS?

The OpenELIS Global software is an open source enterprise-level laboratory information system built on open source web-based technologies that has been tailored for low-and-middle income country public health laboratories.

The software serves as both an effective laboratory software solution and business process framework. It supports the effective functioning of public health laboratories for best laboratory practice and accreditation.

Designed to support quality laboratory services and test results from high volume clinical and reference laboratories

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Enhanced Laboratory Workflow

Biological/Manual Validation

Technical validation

Lab Analyzer Test Import

And Results capture

PRE-ANALYTICAL

ANALYTICAL

POST-

ANALYTICAL

Results Reporting and Laboratory Service Reports

Testing

Quality Assurance

Sample Collection and Registration

Patient Registration and Test Order

OpenELIS covers the full laboratory testing workflow, including all 3 phases: pre-analytical, analytical, and post-analytical.

The pre-analytic testing phase occurs first in the laboratory process. This phase may include specimen handling and identification issues that occur even prior to the time the specimen is received in the laboratory. It’s important to use an appropriate digital tool to capture accurate and timely data on the reasons for rejecting specimen. Such data can be used to take corrective actions in the pre-analytic phase. The LIS must support rigorous control measures to avoid unwittingly allowing problems or errors to travel further "downstream."

The second phase is the analytic phases. This phase includes what is usually considered the "actual" laboratory testing or the diagnostic procedures, processes, and products that ultimately provide results. The LIS must have the ability to navigate the complex interactions between the analyzers, electronic processes, human manual processes, and the quality assurance checks and balances throughout in order to provide an accurate test results for providers to count on in their diagnoses.

The post-analytic phase is the final phase of the laboratory process. This phase culminates in the production of a final value, result, or in the case of histology, a diagnostic pathology report. This is the laboratory’s endorsement of the result to provide to the clinician for his care of a patient. An LIS must be architected correctly within a robust software development cycle that includes end-to-end quality testing of the software product to ensure that the results provided and the reports that are generated can always be trusted.

Those pictured here are not the full coverage of features that OpenELIS offers, but shows that the testing process is part of the business processes that OpenELIS addresses.

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As of October 2020

Bahmni OpenELIS 1.x implementations globally

104 Reference + Clinical Labs in Cote d’Ivoire, scaling

41+ Reference + Clinical Labs in Haiti, scaling

20 Clinical Labs in Vietnam

National laboratory network, Mauritius, scaling

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WHAT CHANGED

Rewrite onto Spring
Security upgrades - USG scanned and certified for government networks
HL7 Interface for Electronic Analyzer Results transmission
FHIR API for placement in HIE
Test Catalog Management
Additional analyzer interfaces, bi-directional foundation
Additional workflow functionality
Referral and EMR Electronic Order redesign
Consolidated Server, facility registry, e-referral workflows
OpenMRS-OpenELIS FHIR bridge (direct and HIE)

Technology Overhaul of OpenELIS 2.0

WHAT WE GAINED

Modern, open-source supported frameworks
Easier coding and reusable code
Improved security
Improved interoperability
Matching capacity coming out of universities and tech schools

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OpenELIS Core Technologies: Open Source

v8.5

v16.04 LTS

V9.9

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Key Features

FHIR R4 & HL7 Interoperability with OpenMRS
Analyzer Interface Plug-In Library
Viral Load Scaleup
Multilingual - English and French
Customizable workflow
Viral Load Dashboard – Cote d’Ivoire
COVID testing workflows

OpenELIS Global

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Ordering and resulting

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Purpose: Longitudinal Record, Source of Truth in Exchange, Secondary Data Use

Enables OE to OE referrals or global interoperability

Currently holds the Facility Registry - moving to GoFR (open source)

Enables cross facility data analysis for benchmarking and monitoring

Potential: early warning cluster indicators, quality control, secondary data use

Laboratory Consolidated Data Warehouse

Approach: Standards-based (HAPI FHIR, FHIR IG, IHE), Non-transactional

Contains designated lab data (patients, orders, etc) for every OpenELIS transaction

FHIR Based, uses OpenHIE standards and OpenHIM

Data Mart style data warehouse

“FHIR-hose” pipeline for analysis

Potential: dashboards, visualizations, additional integrations in ecosystem

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OpenELIS BorderControl Package

Passenger Embarkation/Disembarkation Test Registry App
OpenELIS Testing at the Airport
Central Surveillance, Case Management, Programmatic Monitoring

CHL Reference Laboratory

High volume (4000+ COVID tests / day), multiple users working in parallel on same tasks in the system to process data - built in many shortcuts for quick resulting and validating of bulk tests
Centralized longitudinal lab data
Central Surveillance, Case Management, Programmatic Monitoring

Flu Clinics and Hospitals

Electronic test ordering, sampling, and referral up to CHL
Resulting -> OE at Flu Clinic, Patient Messaging, Provider Messaging
Centralized longitudinal lab data
Central Surveillance, Case Management, Programmatic Monitoring

OpenELIS Case Study: Mauritius

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Airport Border Control Workflows

OpenELIS Global

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OpenELIS Airport Screenshots

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Vl.openelisci.org , eid.openelisci.org

Example Dashboards

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Example PowerBI Reports

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OpenELIS Releases in 2020-2021

COVID Adaptations
Airport Arrival Self-Registration and Testing App
Lab to lab eReferral orders and results

COVID Response

Clinician and patient options
Help turn around time for key tests (EG: Early infant diagnosis results for PMTCT)

SMS and email integration

Interfacing with clinical systems, such as the OpenMRS based interoperability
FHIR IG based transactions and quality assurance
Interoperability with OpenLMIS

FHIR R4 Interoperability

Consolidated server architecture: building a national lab network communicating in real time
ASTM Analyzer interface
Central Facility Registry
Run national scale aggregate reports

Enhanced Features

Demos Available on our YouTube channel.

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Coming Up in 2022

Building integration with the SORMAS system to send lab results and suspected cases directly to the outbreak surveillance system.

COVID Response

Easier reporting by lab to MOH
Real time population of dashboards

Centralized Reporting Engine

Integrate an enhanced microbiology workflow

Enhanced Microbiology Features

Additional Lab Analyzer Interfacing
Central HIE Provider Registry and Facility registry tooling
STAT ordering
Aliquoting Support
Enhanced TB functionality
Blood Bank integration

Enhanced Features

More details: Roadmap.openelis-global.org

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Participate in the OpenELIS community

South-to-south networking and collaborations
Capacity building working sessions
Code contributions, routine updates available

How can Implementations use this work?

Updating Bahmni or Use Ozone with OpenELIS 2.x codebase

OpenELIS in reference laboratory, network of laboratories

Joining OpenHIE LIS COP community

Global HIE knowledge sharing, standards creation/contextualization
Networking and collaborations
Quality Assurance & Standards Compliance Testing in HIE

Engage UW I-TECH DIGI, if needed

Connection to other implementers, governments using OpenELIS
Capacity building and direct services

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OpenELIS BorderControl: Passenger Test Registration App

OpenELIS-OpenMRS FHIR: Electronic Orders and Resulting

OpenELIS BorderControl: Passenger Test Processing in OpenELIS

OpenELIS Global Website

OpenELIS demo site (user: admin pw: adminADMIN!)

OpenELIS BorderControl Passenger Form demo site

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THANK YOU!

JAN FLOWERS, MS

jflow2@uw.edu

University of Washington

Clinical Faculty, Research Scientist

Faculty Co-Lead of I-TECH DIGI

OpenMRS, Chair BOD

OpenELIS, BOD

OpenHIE Leadership Team

OpenHIE LIS COP Founder | Lead

CASEY IIAMS-HAUSER, MIA

caseyi@uw.edu

University of Washington, I-TECH DIGI

Senior Digital Health Specialist

OpenELIS Product Owner

OLIVER GADABU, PHD

ojgadabu@uw.edu

University of Washington, I-TECH DIGI

Senior Digital Health Specialist

OpenELIS Technical Project Manager