Individual Consultancy to Support Assessment of Electronic Medical Records and Hospital Management Systems in Rwanda

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Job no: 534684
Contract type: Consultancy
Level: Consultancy
Location: Rwanda
Categories: Health, Consultancy

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Information:

Title of Assignment: 

Feasibility Study for the Upgrade of Rwanda Electronic Medical Records (EMR) & Hospital Management Information Systems (HIMSs)

Category of the Consultancy:     International

Proposed level of Consultancy: Middle Level

Section: Health

Duration: 3 months

Location:  Rwanda (at central level, in health facilities and communities)

Background and PurposeRwanda has made significant progress in implementing various Digital Health solutions over the past decade. A five-year Digital Health strategic plan was endorsed in 2009 and the country has been exemplary in Africa in implementing Digital Health solutions at a national scale.
The Rwandan Health Sector has so far made significant investment in eHealth initiatives in a bid to improve the delivery of health service. A number of information systems have been put in place including: the integrated routine reporting Health Management Information System,  Electronic Medical Records, Electronic Logistics Management Information Systems, Mobile community based information systems, Human Resources Information system, Resource tracking information system, Laboratory Information System, Integrated Disease Surveillance Information Systems, Health Resource Tracking Tool, Blood bank information system and telemedicine network.These interventions were needed considering that the Health Sector was dealing with epidemics such as HIV/AIDS, TB, Malaria, other new diseases and needed to provide efficient healthcare services, obtain timely and quality data in order to make informed public health decisions.
Despite many successful interventions and major investments in the sector, there are still challenges such as:
• The earlier interventions focused more on routine reporting and disease surveillance systems; 
• The deployed systems are in silos and with little integration;
• There are challenges to collect timely information for easy and quick decision-making, not enough ability to track service levels across the entire health sector.
Particularly, for the electronic Medical Records and Hospital the Health Sector faces the following key challenges:
• OpenMRS deployments are not standardized. Different health facilities have different module packages installed; Patient journey not fully automated from registration to exit;
• Medical records in hospitals and health centers are not fully digitalized and this renders sharing of medical records and patients follow up very difficult;
• Modules are not smoothly integrated with each other’s, Modules like Pharmacy, Laboratory and Consultation not implemented, Billing Module not fully automated;
• There is a large number of healthcare facilities that need HIMS/EMR deployment including health posts;
• Due implementation on local servers, systems are not stable and present risks considering that backups are kept on the same servers;
• OpenMRS is running on an old version. Due to the extensive customization that has been done, it will take significant effort to upgrade it to the latest version later on adding more modules to have a full integrated Hospital Management information System;
• All current OpenMRS installations are not integrated with each other with other health information systems such as HIMS, eLMIS, etc.
• There is a very small local IT team at the facility to support the installation of OpenMRS thus difficulties to implement and maintain local, separate installations;
• There is a lack of standardized governance and security processes for health records considering that Information security and data privacy are very key elements to cater for. There is a great need to guarantee that Patients medical records are secure and respect privacy;
• Lack of Infrastructure in some of health facilities (LAN, internet connectivity.)At health Post level, there is not specific individual based reporting system implemented but HMIS has been disaggregated to allow health post entering their routine data (monthly basis).At community level, the Rapid SMS is mostly used by all CHWs for emergency notification. It is used to track the pregnancy life cycle, neonatal care (NC) and postnatal care (PNC), community case management (CCM), severe malaria and nutrition status (CBN) for a complete tracking of the mother and newborn throughout the first 5 years of the child’s life.

There is also a monthly SISCOM report aggregated at HC level to be uploaded in DHIS2. The CHWs of a village give a monthly activity report to the cell supervisor. The cell supervisor combines the reports from all villages in the cell into a monthly cell report and the CHWs coordinator at the health center consolidates the cell reports into a single Health Center report he uploads into DHIS2. The current system presents some limitations:
• Limited on emergency cases (not cover all programs);
• Difficult to manipulate (uses SMS);
• Parallel reporting between RapidSMS and SISCOM
• No Smooth interaction between CHW and their supervisors
• Mixing both paper and electronic reporting Operates in silos Justification Considering the challenges to have a fully digitalized and integrated health system across all points of care in the health sector, the following improvements have been proposed:• Automate processes including medical records and billing to improve patient experience and service delivery in all health facilities;
• Have fully fledged Hospital Management Information system that can be customized according to health service package in public health facilities starting from Health center to referral hospital. The HIMS solution should fulfill all the requirements of hospitals as well as health centers by automating the entire patient journey starting from appointment scheduling, registration, consultations, billing, imaging, laboratory order and responses, prescription of medication and dispensing;
• To centralize the deployment of EMR and HIMS in a cloud environment for easy deployment, operation and maintenance;
• To provide interconnection capabilities with external modules including health insurance (RSSB, MINECOFIN’s, Pharmacies, etc…);
• To put a suitable EMR system at health posts;
• To put in place a new comprehensive system that incorporates all CHWs activities including emergency reporting. The new system for CHW should work on Smart phones for increased functionality;
• Implement an integrated, comprehensive information system across all the healthcare facilities nationwide in a timely, efficient and seamless manner.
• Enable Implement data interoperability at all levels (CHW, Health Post, Health Center, Hospitals) and ensure data exchange with other systems within and outside the health sector;
• Transforming the delivery of healthcare services by creating a shared patient record that will serve as the primary source of information for all patients, healthcare providers and other related health service users
• Transforming the overall level of healthcare delivery in Rwanda while lowering costs and protecting patient confidentiality.
• Improve patient care and management mechanisms in healthcare facilities as well as improving accessibility to quality of health care services at all levels of health care provision.
• Improve the quality and timeliness of routine data for public health decision-making, disease surveillance and response, medical stock and human resource management and planning.
• Improve the quality and impact of preventive treatment care through patient centric service delivery care, accountability, and transparency in the delivery of medical procedures
• Provide standardization across the health sector and at all levels of healthcare service provision.
• Improve system integration and interoperability both within the Health Sector and with the relevant systems that are external to the Health Sector.The proposed upgrades of EMR and HIMS have been grouped into two categories:
• Full EMR & HIMS: for health centers and hospitals (District hospital, Provincial Hospital and Referral Hospital)
• Lightweight EMR: for community health workers (CHWs) and Health Posts (HPs)
To achieve the planned improvements mentioned above, a Feasibility Study has been proposed to make a detailed assessment of the proposed improvements for the EMR and HIMS, proposed the proper approach and a solid implementation plan that are prerequisite for successful implementation of the planned upgrade of EMR and the overall HIMS.

Objectives The purpose of this assignment is to provide technical assistance that will inform the detailed requirements, approach, process and steps to upgrade the EMR and HIMS at different levels (CHW, Health Posts, Health Centers and Hospitals). 
The Feasibility study, assessment of existing EMR & HIMS in the public sector and conduct comprehensive user requirements analysis (functional & non-functional) for the upgrade of such systems. Following the detailed requirement analysis, an implementation blueprint and plan will be developed to guide the upgrade exercise. 
The assessment will also include the existing and required infrastructure to support the preferred orientation. The proposed upgrade is to be oriented toward a cloud approach that will be a consolidated national health connected cloud for all digital health systems. The Health Cloud would provide availability, backup and recovery, capacity, scalability, configuration management, reliability, security, and performance with the following services:
• Compute: providing the infrastructure required to run all health systems together with required virtualization, containerization and scalability on demand – elasticity.
• Storage: providing scalable cloud storage for all the needs of the Rwanda health systems including structured as well as unstructured storage, persistent storage and archival storage.
• Networking: providing virtual networks, dedicated connections and gateways, as well as services for traffic management and diagnostics, load balancing, DNS hosting, and network protection.
• Centralized configuration of the virtualized images whereby there is one uniform image of EMR & HIMS. This will also ensure centralized updates and configuration.
• Centralized monitoring and auditing.
• A centralized governance model including identity and access management, policy based management, and cost management.
• A centralized security model for security management and threat protection considering best practices such as HIPAA and ISO27001.
• Centralized business continuity model for backups and disaster recovery.Work Assignment
The consultant shall conduct the following activities:
• Requirement Analysis and Specifications:
o Review of existing documents, policies, strategies and technical documentation.
o Assessment of the existing EMR & HIMS and their working environment at different levels (CHW, Health Posts, Health Centers and Hospitals);
o Develop comprehensive user requirements for EMR & HIMS at all levels (CHW, Health Posts, Health Centers and Hospitals);
• High-level Architecture and Specifications:
o Considering the proposed upgrade solutions for EMR & HIMS for health centers and hospitals (Bahmni), the consultant will evaluate the upgrade approach using Bahmni as a solution and confirm its suitability to meet all the requirements for the upgrade;
o The consultant will provide the Migration strategy from the existing EMRs to the proposed HIMS(Bahmni) including Data Migration;
o The consultant shall provide the terms of reference for the implementation of the proposed HIMS(Bahmni)
o Technical architecture and specification for the upgrade of CHW and Health Post ERM (Lightweight EMR)
o Conduct a cost analysis for the proposed upgrades
o Implementation Plan and Costing for the proposed solutions
o Development of the Terms of Reference and Draft RFP
o Development of a Change Management Plan
Deliverables
The Consultant will provide the following deliverables
1. An Inception Report demonstrating the understanding of the assignment and including the methodology and plan to successfully complete the feasibility study;
2. A Technical Assessment Report of the assessment on the existing EMRs & HIMSs (AS-IS);
3. A Requirement Specification Document that is capturing all the functional and non-functional requirements for the upgrade of EMR and HIMS;
4. A System Design and Architecture Document for the proposed upgrade of EMR and HIMS;
5. The Terms of Reference and Draft RFP for the implementation of the proposed EMR and HIMS including Data Migration;
6. A Change Management Plan including the technical, human and organizational changes needed to ensure the success for the upgrade of EMR and HIMSDesired competencies, technical background and experienceThe Consultant or Team of Consultants should have the following combined experience:
• IT System Analysis, IT Architecture, and Software Development;
• Consultant(s) should have the relevant degrees in computer engineering, computer science, Information Technology, Information system, Medical School Degree or equivalent. Master’s degree is considered an advantage;
• At least 5 years of relevant experience of working in health management information system strengthening;
• Professional technical knowledge/expertise in Software Development, System Engineering and Health Information Systems architecture design;
• Professional technical knowledge/expertise in HIMS standards/protocols, database management, data protection, security standards, etc;
• Skills and experience in user centered design, health systems analysis and health systems strengthening in general, Business Analysis, Health Information Exchange and Health Enterprise Architecture;
• Proven experience in designing IT functional architecture (vision, principles, policy and functional requirements) and technical architecture (information architecture and infrastructure architecture);
• Skills and experience with open source software especially in the health sector
• The technical and organizational capabilities highlighting past projects that are most relevant for this work.
• Good oral, written and presentation skills in English.
Evaluation Criteria The Technical proposal is weighted at 70% and 30% for the Financial proposal.Please note that the final remuneration will be negotiated by HR. Payment Schedule Payment is linked to agreed deliverables upon satisfactory completion and certification of deliverables by the supervisor.

  1. An Inception Report demonstrating the understanding of the assignment and including the methodology and plan to successfully complete the feasibility study 10%
  2. Technical Assessment Report of the assessment on the existing EMRs & HIMSs (AS-IS) 20%
  3. Requirement Specification Document that is capturing all the functional and non-functional requirements for the upgrade of EMR and HIMS bod 20%
  4. System Design and Architecture Document for the proposed upgrade of EMR and HIMS 20%
  5. The Terms of Reference and Draft RFP for the implementation of the proposed EMR and HIMS including Data Migration 10%
  6. Change Management Plan including the technical, human and organizational changes needed to ensure the success for the upgrade of EMR and HIMS 20% 

General Conditions: Procedures & Logistics

The recruited consultant will be required to have expertize for conducting the visibility study. In some circumstances, particular logistic arrangements shall be required to ensure time delivery of assigned tasks in  quality deserved.

Therefore, in presenting proposals, bidders should take these elements into serious consideration that UNICEF will not be responsible for any unexpected additional cost or arrangement required during the implementation of the assignment.

UNICEF will hire one consultant for this assignment, and the hired consultant shall be responsible for hiring and paying own sub-contractors as will be necessary.

To qualify as an advocate for every child you will have…

  • Consultant(s) should have the relevant degrees in computer engineering, computer science, Information Technology, Information system, Medical School Degree or equivalent. Master’s degree is considered an advantage;
  • A minimum of 5years of relevant professional experience in 
  • of working in health management information system strengthening;
  • Professional technical knowledge/expertise in HIMS standards/protocols, database management, data protection, security standards, etc;
  • Skills and experience in user centered design, health systems analysis and health systems strengthening in general, Business Analysis, Health Information Exchange and Health Enterprise Architecture;
  • Proven experience in designing IT functional architecture (vision, principles, policy and functional requirements) and technical architecture (information architecture and infrastructure architecture);
  • Skills and experience with open source software especially in the health sector
  • The technical and organizational capabilities highlighting past projects that are most relevant for this work.
  • Fluency in English is required. 

How to Apply

UNICEF is committed to gender equality in its mandate and its staff. Well qualified candidates, particularly females are strongly encouraged to apply.

Interested candidates should send their complete Personal History (P11) form, which can be downloaded form (http://www.unicef.org/about/employ/files/P11.doc). or a CV/resume, as well as a cover letter explaining what makes them suitable for this consultancy. 

Qualified and experienced candidates are requested to submit a letter of interest including a Technical Proposal outlining a road map for review and implementation timeline. In their letter of interest, candidates should highlight their previous work experience relevant to the assignment, the attributes that make them suitable, their proposed approach to the assignment.

 The Selected candidates will be requested to submit a Financial Proposal outlining the total costs for this consultancy with payment linked to the main deliverables outlined above.

For every Child, you demonstrate…

UNICEF’s values of Care, Respect, Integrity, Trust, and Accountability (CRITA) and core competencies in Communication, Working with People and Drive for Results.

View our competency framework at

UNICEF is committed to diversity and inclusion within its workforce, and encourages all candidates, irrespective of gender, nationality, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of the organization.

UNICEF has a zero-tolerance policy on conduct that is incompatible with the aims and objectives of the United Nations and UNICEF, including sexual exploitation and abuse, sexual harassment, abuse of authority and discrimination. UNICEF also adheres to strict child safeguarding principles. All selected candidates will be expected to adhere to these standards and principles and will therefore undergo rigorous reference and background checks. Background checks will include the verification of academic credential(s) and employment history. Selected candidates may be required to provide additional information to conduct a background check.

Remarks:

Mobility is a condition of international professional employment with UNICEF and an underlying premise of the international civil service.

Only shortlisted candidates will be contacted and advance to the next stage of the selection process.

Individuals engaged under a consultancy or individual contract will not be considered “staff members” under the Staff Regulations and Rules of the United Nations and UNICEF’s policies and procedures, and will not be entitled to benefits provided therein (such as leave entitlements and medical insurance coverage). Their conditions of service will be governed by their contract and the General Conditions of Contracts for the Services of Consultants and Individual Contractors. Consultants and individual contractors are responsible for determining their tax liabilities and for the payment of any taxes and/or duties, in accordance with local or other applicable laws.

Advertised: 24 Sep 2020 South Africa Standard Time
Deadline: 08 Oct 2020 South Africa Standard Time

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