Workforce solutions at PSI

When PSI decided to move to FHIR, we discussed and agreed on the principles that we will use to select our technology stack. I’m referring to backend and frontend tools, which include solutions for health workers, which at PSI we refer as workforce. They includes a variety of app that they use to manage their interactions with clients, and which currently (early 2023) include an internal developed solution for managing clients that we refer as WFA (Workforce App).

First and foremost we have made the commitment to align all our client-based systems to a FHIR backend. This means that all our clients (Sara, IPCs or Service Provider), their profiles and all interactions will be recorded in a FHIR compliant database, segregated and secured by country. We used standardized mechanisms to comply with anonymisation requests, send reminders on personalised schedule, and many other features, while at the same time we can secure all applications using industry standard IAM (identity and access management) protocols for controlling who has access.

The benefits of using FHIR go beyond the data standardisation and the interoperability that it brings. It represents also an opportunity to accelerate our analytics, as we now collect and analyse data in an standardised way. We are creating standardized warehouse to secure an analyse data. This is in contrast with the current practice that each project needs it own warehouse design and setup.

FHIR is much more than a standard data model - it is also a standard for defining the logic on how the health worker's app operate, with protocols designed and supported by other agencies. WHO is working on the creation of standard protocols, which are referred to as WHO Smart Guidelines. Many other groups are also working using the same principles. They are all based on the use of Clinical Quality Language (CQL) which allows the publishing of medical protocols on a common standard, which is part of FHIR, that can be deployed as part of your health worker applications.

So the future of the application(s) to be used by PSI's health workers is no longer limited to selecting a single app, and sticking to it. We will be able to use more than one application, move applications, all without changing the backend, while expecting to reuse the workflow logic and the same data model.

Hence it is imperative that all new workforce app(s) that PSI adopts are FHIR native, rather than just having a FHIR adaptor/ connector that can write to a FHIR repository. Our focus should be on identifying one or more communities with active apps (using web technologies as well as android based tech), and becoming active participants. Currently the Android community is the one that shows more progress, thanks to Google’s FHIR SDK (software development kit), developed to facilitate the creation of FHIR based android apps. We may have to start our journey there, recognising the extra cost that running an android project carries, while we try to find other web options.