E-Heza Data Solutions

Primary health care prioritizes the prevention, early diagnosis, and early treatment of potentially life- threatening conditions. The success or failure of primary health care delivery depends on the ability of frontline healthcare workers to encourage early and ongoing engagement in care and to inspire healthy behavior change. The relationship between frontline health workers and the community members they serve becomes the cornerstone to effective primary health care by incentivizing delivery of high-quality care, encouraging maternal engagement in care, and mitigating the risk of burnout by reinforcing a sense of purpose and accomplishment.

Current primary healthcare systems often strain this relationship beyond effectiveness. Routine antenatal care- the quintessential proxy for effective primary healthcare- could prevent as many as 50,000 maternal deaths each year in East Africa alone; yet less than 55% of women receive the four antenatal care visits recommended by the WHO in East Africa and this decreases to 44% in Rwanda. Over 7 million children are chronically stunted, which is preventable with appropriate primary care. Nearly 70% of healthcare providers in East Africa reported experiencing burnout, and burnout is well-documented to decrease quality of care and discourage maternal engagement in care.

According to the WHO, frontline health workers spend 40% of their time on data reporting tasks as opposed to direct patient care provision. This exacerbates the heavy workloads of frontline health workers, and leads to competing priorities that place further tension on the relationships with their patients. Existing electronic data reporting systems exacerbate the problem because they are designed for upstream reporting rather than to support the needs of frontline health workers. The undue strain placed on health workers risks delivery of poor-quality care that discourages engagement in care and ultimately results in their failure to achieve the Sustainable Development Goals for health.

E-Heza Data Solutions is a comprehensive point-of-care digital health platform that ensures high quality, efficient care when and where it is needed most.

First established to serve the Rwandan primary care ecosystem that is comprised of nurses and midwives in health centers and community health workers (CHW) in villages, E-Heza is designed to support existing government health systems and facilitates the most common workflows of frontline health workers at the community and facility levels in Sub Saharan Africa (SSA) where large electronic medical record (EMR) systems are often impractical and where existing CHW tools struggle to adequately support the two-way communication and data management capacity that facilitates an effective and efficient local healthcare ecosystem at scale.

E-Heza utilizes API integration and FHIR interoperability standards to deliver critical patient information to existing electronic medical record systems. This full-service primary care platform serves multiple levels of care in one system rather than requiring cumbersome integrations at each level of the health care delivery system, facilitating high quality care that encourages patient retention in care and sustained improvements in health outcomes.

E-Heza was created to ecourage high quality care by easing workloads, providing personalized care, and streamlining data reporting to national governments. It incentivizes accurate data by using data trends to celebrate success and identify problems before they become emergencies. Similarly, filterable dashboards provide real-time insight into the health of communities from the village, health center, district, and national levels. E-Heza ensures that vital individual clinical information is available at each level of care through a shared progress report that can also be sent directly to the individual via WhatsApp.

E-Heza incorporates best practice clinical protocols established by the World Health Organization (WHO) and seamlessly guides frontline health workers through assessment, diagnosis, treatment, referral and case management. The activities are tailored for the skill level of the user based upon user type log-in identifiers, and refers patients to the next level of care based upon the severity of the patient’s presentation. E-Heza provides comprehensive clinical protocol and decision support for COVID-19 screening, referral, home-based care, treatment and contact tracing functions, Integrated Management of Childhood Illnesses (IMCI) such as malaria and diarrhea, Case Management, Pediatric Care, Immunizations, Early Childhood Development, Family Planning, Antenatal Care, HIV services, Tuberculosis screening, Non-communicable Diseases, Laboratory and Medication management

E-Heza is built with a decoupled architecture providing both a “frontend” (where healthcare workers enter data) and a “backend” that receives and organizes that data. The frontend is developed in Elm, an open source and functional, statically-typed language that compiles to JavaScript. The back end application is served by Drupal, an open source PHP content management system. The front and back ends communicate through a RESTful API, which is modeled on digital health standards including FHIR-HL7.

Drupal was chosen specifically with scalability in mind, as its sophisticated data abstraction layer is well tested and can efficiently handle millions of nodes of data without the need for high-level infrastructure resources and management. Drupal’s large open-source community (one of the largest in the world with millions of members) provides assurance that most problems they encounter have been seen before, and that there will always be a large developer community to draw talent.

A recent scalability test indicates that E-Heza could scale to serve an entire national context in a single instance without changes to architecture or infrastructure. Elm, on the other hand, was chosen for its efficiency in development – as a highly-opinionated and statically-typed language, it provides a smooth onramp for new developers and a clear path for interoperability. The tool uses Docker and DDEV as a packaging and containerization tool, and is also integrated with Gitpod so it can be spun up in a single click for evaluation and testing.

The application is served to the client via progressive web app (PWA) technology. The application registers a “service worker” with the client browser allowing the web application to use local cache and storage to deliver an offline experience and store captured data during periods of low or no connectivity. Opportunistic syncing in the background, sends data in small packets to the backend making bandwidth use minimal and ensuring the data stays on the device only as long as it needs to. Integration with Google Chrome allows users to “install” the app to a home screen and delivers a more “app-like” experience to the user.

E-Heza Data Solutions supports the achievement of the Sustainable Development Goals for health in Sub Saharan Africa through the scale-up of their technology-enabled model for strong community-driven primary healthcare delivery ecosystems that ensure high quality care that leaves no one behind. It is the only digital health platform that serves the entire primary care ecosystem of local healthcare delivery systems while also achieving cost-effective multinational scale by building from standard WHO clinical care guidelines and available Digital Adaptation Kits, supporting multiple languages and workflow contexts, and ensuring scalable data architecture.

E-Heza enables the rapid expansion of our approach for effective primary care delivery. By ensuring quality data collection at the point of care, national and international governments have access to reliable and real-time data to provide early warning and to drive decisions. By prioritizing high quality individual care as a path by which TIP can achieve successful public health measures, they build equity into the system and ensure inclusive and successful public health responses.

Because it serves all levels of primary healthcare delivery- in villages, health posts, and health centers- E-Heza breaks down the vertical silos created by digital health platforms that serve only one level of care while facilitating data sharing through integration and interoperability. Dashboards highlight aggregated metrics that are used by communities for planning purposes and to easily complete national data reports. Integration and interoperability functions further increase efficiency by delivering this information directly to larger facility-based EMR systems like OpenMRS and national data reporting systems like DHIS2.