Roshan Hewapathirana

Open Source Software Ecosystems in Health Sector: A Case Study from Sri Lanka

A software ecosystem consists of a software platform, a set of internal and external developers and domain experts in service to a community of users that compose relevant solution elements to satisfy their needs. Open source is well-known for its potential to frame software ecosystems with its networking tendency and provision for further customization with access to software source code. Open source is increasingly becoming the choice for health information system implementations in low resource settings.

1028 Facing information challenge in injury surveillance with open source solution

Background Injuries are a major public health issue in low and middle-income countries (LMIC) where lack of information has been identified as a key stumbling block in injury prevention. LMIC cannot afford to use proprietary software due to high costs. Currently there is a lack of free and open source (FOSS) injury surveillance systems (ISS). However, District Health Information Software version 2 (DHIS2) is a web-based generic FOSS framework which is widely implemented in over 50 countries providing a wide range of possibilities for building information systems for a range of public health issues. Methods We decided to use DHIS2 to face the challenge of carving out an ISS out of a generic public health information system framework. Features that were lacking in the native application were improvised using JavaScript. Data elements and datasets were defined abiding the WHO guidelines. The system was piloted at a base hospital in Sri Lanka with a daily turnover of 10 injury patients and later at a tertiary care hospital with a daily turnover of 70 during past 8 months. Results Generic DHIS2 platform was flexible enough to be customised to a functional ISS. The system inherited features inherent to the DHIS2 framework, such as data validation, data backup and handling missing information in addition to the customised injury surveillance functionalities. Further, it allowed changing data and process needs without major rework. The report dashboard had detailed visualisations where injury information could be analysed in different tabular and graphical representations. However, inbuilt graphical user interfaces and workflows seemed to restrict the efficiency of data entry to a certain extent. Conclusions Our study reveals that DHIS2 has the potential to be customised as a low cost and sustainable ISS. The source code of our ISS is freely available and free to modify, so anyone could customise it to suite their own national needs withstanding the uniqueness of country specific ISS requirements.

Using Training as a Tool for Cultivating Communities of Practice around Health Information Systems in Low and Middle Income Countries: A Longitudinal Mixed Method Study

Many attempts at implementing health information systems (HISs) in Low and Middle Income Countries (LMICs) have failed to mature or scale into desirable levels due to various reasons. Among these reasons, not identifying the design reality gap, inability to form support networks and non‐availability of ‘hybrids’ who can link between health and information systems domains can be highlighted. In organizational contexts, such challenges can be overcome by cultivating communities of practice (CoPs). However, HIS projects in LMIC contexts may not have the opportunity to create an environment similar to an organization to facilitate cultivation of CoPs. This paper argues that HIS projects in LMICs can utilize formal, informal and workplace based online and face‐to‐face training methods along with the networking power of free and open source software (FOSS) communities as a means of cultivating CoPs. In substantiating this argument, the paper utilizes a mixed method longitudinal study design to follow‐up a group of implementers trained in a FOSS HIS in Sri Lanka. The paper presents a practical training model usable in information system implementations in LMIC settings with the added benefit of being able to facilitate cultivation of CoPs. The paper also contributes theoretically by extending the conceptualization of ‘cultivating CoPs’ beyond organizational contexts.