Building consensus on common features and interoperability use cases for community health information systems: a Delphi study

Isaac Holeman; David Citrin; Mohamed Albirair; Nancy Puttkammer; Madeleine Ballard; Brian DeRenzi; James O'Donovan; Beatrice Wasunna

doi:10.1136/bmjgh-2023-014001

Building consensus on common features and interoperability use cases for community health information systems: a Delphi study

BMJ Glob Health. 2024 Apr 24;9(4):e014001. doi: 10.1136/bmjgh-2023-014001.

Authors

Isaac Holeman¹, David Citrin^{2

3

4}, Mohamed Albirair¹, Nancy Puttkammer^{1

5}, Madeleine Ballard^{6

7}, Brian DeRenzi^{1

8}, James O'Donovan⁶, Beatrice Wasunna⁹

Affiliations

¹ Department of Global Health, University of Washington, Seattle, Washington, USA.
² Department of Global Health, University of Washington, Seattle, Washington, USA dcitrin@uw.edu.
³ Medic, San Francisco, CA, USA.
⁴ Department of Anthropology, University of Washington, Seattle, Washington, USA.
⁵ International Training and Education Center for Health, University of Washington, Seattle, Washington, USA.
⁶ Community Health Impact Coalition, New York, New York, USA.
⁷ Arnhold Institute for Global Health, Icahn School of Medicine, New York, New York, USA.
⁸ Dimagi, Cape Town, Western Cape, South Africa.
⁹ Medic, Nairobi, Kenya.

Abstract

Introduction: Information systems for community health have become increasingly sophisticated and evidence-based in the last decade and they are now the most widely used health information systems in many low-income and middle-income countries. This study aimed to establish consensus regarding key features and interoperability priorities for community health information systems (CHISs).

Methods: A Delphi study was conducted among a systematically selected panel of CHIS experts. This impressive pool of experts represented a range of leading global health institutions, with gender and regional balance as well as diversity in their areas of expertise. Through five rounds of iterative surveys and follow-up interviews, the experts established a high degree of consensus. We supplemented the Delphi study findings with a series of focus group discussions with 10 community health worker (CHW) leaders.

Results: CHISs today are expected to adapt to a wide range of local contextual requirements and to support and improve care delivery. While once associated with a single role type (CHWs), these systems are now expected to engage other end users, including patients, supervisors, clinicians and data managers. Of 30 WHO-classified digital health interventions for care providers, experts identified 23 (77%) as being important for CHISs. Case management and care coordination features accounted for more than one-third (14 of 37, 38%) of the core features expected of CHISs today, a higher proportion than any other category. The highest priority use cases for interoperability include CHIS to health management information system monthly reporting and CHIS to electronic medical record referrals.

Conclusion: CHISs today are expected to be feature-rich, to support a range of user roles in community health systems, and to be highly adaptable to local contextual requirements. Future interoperability efforts, such as CHISs in general, are expected not only to move data efficiently but to strengthen community health systems in ways that measurably improve care.

Keywords: global health; other study design.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Community Health Services
Community Health Workers
Consensus*
Delphi Technique*
Female
Focus Groups
Health Information Interoperability
Health Information Systems* / standards
Humans
Male