The "Integrating the Healthcare Enterprise" (IHE) medical data exchange feasibility demonstration project in Senegal, funded by Invest for Jobs - Special Initiative "Decent Work for a Just Transition, represents a significant step forward in strengthening digital health and interoperability. The project, supported by the African-German Health Association (AGHA), the European company Visuapps and its partner in Senegal, Kaikai, aims to integrate international standards for the exchange of medical data within Senegalese healthcare establishments.
Since the IHE training in early 2023, hospital management solution providers have been working with Visuapps to integrate the interfaces into their solutions. The mini-connectathon, from 14 to 16 November 2023, enabled HIS providers to test and validate compliance in preparation for patient enrolment tests. This project, supported by Invest for Jobs, is part of an innovative approach to contribute to the shared medical record of patients in Senegal, and to improve the quality of healthcare.
Check out our first article for a more detailed introduction of the project
Background and justification
The project is part of the development of the 2018-2023 Santé Digitale strategic plan of Senegal's Ministry of Health and Social Action (MSAS), as well as the Senegal Digital Strategy 2025 (SN2025). The MSAS has identified the Shared Patient File Project as a key component of its Health Sector Digitisation Programme.
This initiative has its roots in an in-depth study carried out in 2020, followed by a visit and co-design workshop in Senegal.
Founded in the United States in 1997 with the initial aim of improving the exchange of radiology data, the Integrating the Healthcare Enterprise (IHE) is now a global not-for-profit community of 300 international medical equipment and software suppliers.
This initiative implements a structured process aimed at identifying standards, uses and modes of integration into healthcare information systems.
Through regular test sessions - known as connectathons - the IHE offers a platform and tools for testing the compatibility of solutions with established standards. This provides a guarantee of compliance for institutions that need to implement systems for their national architectures.
A connectathon is a test session, held in Europe, the United States and Japan, where more than 100 systems take part to test interoperability and compliance with IHE data exchange standards. It can also be adapted at national level under the name "Projectathon". The results of each participant are published, providing a valuable reference for calls for tender. Whether face-to-face or remote, this initiative promotes the transparent evaluation of solutions and encourages the adoption of high standards in the healthcare sector.
Why the mini-connectathon?
The term "Mini" is explained by its more restricted and focused format, favouring more direct interaction between participants and agile problem solving. The same tests and IHE profiles are used during a mini-connectathon, but they will only be carried out between 2 systems (connectathon: 3 systems). This more condensed format allows for greater efficiency and focus on specific objectives, contributing to a more targeted and intensive connectathon experience.
The objectives of the mini-connectathon
The aim is to demonstrate that different medical data management systems, deployed in different hospitals, can exchange patient records using IHE standards and methodologies. This will ensure effective coordination between health establishments and improve patient care, reduce travel and improve the availability of quality public health information.
Assessing compliance with IHE standards
Hospital solution providers taking part in the Mini Connectathon have the opportunity to test their products and systems against IHE standards, ensuring their compliance and ability to integrate seamlessly into a national patient record using IHE standards.
By bringing together experts, developers and healthcare professionals, the Mini Connectathon encourages collaboration between the various players in the healthcare sector and enables them to share knowledge and experience.
Raising public awareness
The Mini Connectathon aims to raise public and media awareness of the challenges of interoperability in healthcare. A press conference on 16 November provided an opportunity to share the results and benefits of the initiative, reinforcing understanding of the importance of this breakthrough for the digitalisation of the healthcare sector.
Preparation stages before the mini-connectathon
These strategic steps enabled us to ensure a holistic approach, from the selection of HIS providers to the definition of requirements and use cases.
The key players in the mini-connectathon
Following consultations with various stakeholders and an in-depth analysis of their needs and constraints, we developed an architecture based on a model ensuring data security and regulated access for authorised users.
This model incorporates a reference system equipped with an interface that validates access rights, manages patient data and maintains audit records. In line with the IHE profiles identified, this reference system facilitates the exchange of data with the hospital information systems deployed. These transactions are verified during the mini-Connectathon, with a demonstration of data exchange on the final day of the event.
Tests carried out
These tests are specifically designed to assess system security, patient data management and access to healthcare documents, ensuring compliance and interoperability of solutions within the project.
Several crucial points were evaluated to guarantee the integrity of the system. The "Time Client for Consistent Time (CT)" test verified the synchronisation of the time of the various systems with a reference server, thereby ensuring essential time consistency. The evaluation of the "Secure Application for Audit Trail and Node Authentication (ATNA)" focused on secure event logging, reinforcing the traceability of transactions. The "Authorization Client for Internet User Authorization (IUA)" test validated the secure management of user access, guaranteeing precise control of authorizations.
Patient Data Management
The tests also focused on system interoperability. The "Patient Identity Source for Patient Identifier Cross-referencing for mobile (PIXm)" was evaluated to guarantee the reliable source of patient identities. Similarly, the 'Patient Demographics Consumer for Patient Demographics Query for Mobile (PDQm)' test verified the ability to perform accurate queries on basic patient demographics.
Patient Document Management
The tests focused on the accessibility of health information. The "Document Source for Mobile access to Health Documents (MHD)" provides secure access to health documents, while the "Document Consumer for Mobile access to Health Documents (MHD)" test examined the quality of consumption. These assessments have ensured that patient document management complies with the standards defined by the project.
Senegal's mini-connectathon compared with other connectathons
The mini-connectathon organised in Senegal used the same methodologies and the same rigour as the large-scale international events. The participation of key players and medical management systems demonstrated its relevance in the context of health data interoperability.
Mini-Connectathon results: Outstanding performances
The results of the mini-connectathon were exceptional, with the three partners involved successfully completing 24 test scenarios, all of which were confirmed as valid.
The cybersecurity tests were successfully verified on Tuesday afternoon, underlining the importance attached to data security. Despite a slight problem identified on the IUA profile, the team reacted effectively, resolving the situation in less than an hour.
The event also demonstrated live patient search and document retrieval, highlighting the impressive capabilities of interoperable healthcare systems.
Monitor's conclusions: Successful tests and a robust methodology
All the tests were successfully verified using IHE's Gazelle platform validators, confirming the reliability of the performance of the systems involved. The validation methodology applied complies with the standards established by all IHE Connectathons.
WORDS FROM HIS PROVIDERS
Solution providers shared their feedback. These valuable insights will guide the next stages of the project to ensure an effective and inclusive digital transformation.
El Hadji Babacar Fall, CEO of PatientPro: innovation in digital health
For him, this project comes at just the right time, constituting an essential element of the international standard that is interoperability. He highlights the specific nature of this approach, which ensures total transparency in the exchange of medical data.
Henri Ousmane Gueye, Co-founder and CEO of EYONE: On the practical impact of interoperability
Henri Ousmane Gueye, co-founder of EYONE and an expert in digital health, shares his positive experience of the project. He emphasises that this initiative has given concrete expression to the aspects linked to interoperability, offering publishers, of which he is one, an essential development opportunity.
He emphasises the shared awareness within the industry of the need to develop this crucial aspect. In addition, he highlights the fact that this openness to interoperability creates opportunities not only nationally, in Senegal, but also internationally.
Ndeye-Talla Dioum, Founder and CEO of MEDSEN: On the impact of the mini-connectathon
Ndeye Talla Dioum, founder of MEDSEN, is enthusiastic about the importance of the mini-connectathon. For her, it's a unique opportunity to demonstrate in concrete terms the importance of interoperability within the same system.
She points out that the IHE system makes it possible for doctors using different systems to communicate with each other, thereby improving interoperability. She also highlights the benefits of data standardisation, while emphasising the crucial importance of the security and confidentiality of medical information.
ELGA - AUSTRIA'S IHE ARCHITECTURE
ELGA (Elektronische Gesundheitsakte) is an Austrian project to implement an interoperable electronic health record. ELGA aims to improve the coordination of healthcare by facilitating access to relevant medical data for authorised healthcare professionals.
The ELGA project includes the introduction of an electronic health card and the creation of an interconnected IT infrastructure to enable the exchange of medical data, which is based entirely on the IHE methodology to ensure that the solutions used comply with international standards.
The ELGA teams explained how the Austrian healthcare system is decentralised and how the districts regulate access to healthcare with interoperable solutions in the various healthcare structures. ELGA and the data exchange infrastructure are funded by the national government, the 9 health regions and public health insurance.
It is a model in terms of technical and administrative architecture, which Senegal can draw on and adapt to the local context.
The mini-connectathon project in Senegal provided a wealth of lessons that are crucial to the success of similar initiatives in the future.
The importance of a prior local assessment to identify specific needs and define objectives adapted to the local context was highlighted.
Commitment by the Ministry of Health
The success of the project depends largely on the commitment of the Ministry of Health. This lesson underlines the importance of working closely with national health authorities to ensure the success and sustainability of health digitalisation initiatives.
Capitalising on local resources
The need to capitalise on existing local resources, in particular the private sector of solution providers for hospital information systems, has been clearly established. They are ready to adapt, offering an opportunity for collaboration at both national and international level.
IHE methodology as a guiding framework
The IHE methodology has been identified as an effective guiding framework for managing the different parts of the healthcare system architecture. Compliance with standards is crucial to achieving interoperability, particularly between the public and private sectors. This paves the way for the creation of an African IHE community, fostering collaboration between African software solutions.
Key role of the external monitor
The importance of having an external monitor was clearly demonstrated to validate the work of the mini-connectathon. This external and impartial presence guarantees an objective view of compliance with the specifications.
Ongoing commitment from HIS solution providers
The sustained commitment of Senegalese digital solution providers was a cornerstone of the project. Their constant involvement throughout the project has been crucial to its success. This lesson underlines the importance of the ongoing involvement of local stakeholders for the sustainability of digital health initiatives.
Communicate about the project to promote this unique experience in Africa, in Senegal and internationally.
Deployment of reference system components on SENUM servers
Supporting HIS providers in the production roll-out of their IHE-compatible solutions
Creation of the necessary configurations and certificates to secure the exchange network
Definition of the content supported by the exchange to ensure semantic interoperability
The Mini-Connectathon was much more than a technical event. It was a tangible demonstration of the collective commitment to the future of digital health in Senegal. Thanks to the participation of Senegalese digital solution providers EYONE, PatientPro and MEDSEN, the IHE project has taken crucial steps towards the interoperability of hospital information systems. The support of the Ministry of Health and Social Action and the feedback of participants is paving the way for a more sustainable, connected, secure and patient-centered healthcare ecosystem.
The event confirmed that the IHE approach is a viable option for electronic medical records in Senegal, offering solid interoperability in line with international standards. The positive test results were validated by an impartial external monitor. Using the IHE approach guarantees the Senegalese state the reliability of solutions, avoids dependence on a single supplier or solution, and therefore strengthens digital sovereignty.
The next steps, from deployment on SENUM servers to support for HIS providers, demonstrate our ongoing commitment to making this vision of digital health a reality.
We are grateful to our partners and stakeholders who have made this success possible.