Interoperability and Data Sharing Between Civil Registration, Health Information, Statistics and Associated Systems

This document provides insights into interoperability and data sharing between civil registration, health information, statistics and associated systems in the Pacific region. It examines the current landscape, challenges, and opportunities for digital data exchange among various government entities. The intended audience includes policymakers, ICT experts, and practitioners involved in civil registration, health, and statistical systems. This report offers practical guidance and recommendations for enhancing data sharing capabilities in the Pacific.

Key Insights

Levels of Digital Development in CRVS Systems

Pacific CRVS systems are at different levels of digital development, ranging from emerging digital systems with limited integration to highly integrated and digitized systems.

• Emerging digital systems: Countries are in early stages of digitizing CRVS with limited integration into government systems. Examples include American Samoa, Cook Islands, Niue, Tokelau, and Tonga.
• Digitized and moderately integrated systems: Significant records are digitized with some data sharing. Examples include Samoa, Solomon Islands, and Vanuatu.
• Highly integrated and digitized systems: This includes systems with extensive electronic data sharing across various government departments, exemplified by Fiji.

Data Sharing Opportunities

Data sharing is essential for statistics, social services, passports and identity, and election offices.

• Health facilities provide birth and death notifications.
• Courts contribute documents for adoptions, marriages, and divorces.
• Digital systems enable efficient information exchange for health system integration, digital identity system updating, immigration verification, social welfare provision, voter registration, taxation, personal data verification, land rights enabling, and fraud prevention.

Challenges to Digital Transformation

• Limited interoperability within health ICT systems impedes electronic transfer of data.
• Outdated digital civil registration platforms restrict external access and migration.
• An urban-rural digital divide restricts data sharing.
• Insufficient funding and lack of skilled staff hinder development and maintenance.
• Outdated legal frameworks obstruct modern data-sharing solutions.
• Issues with data accuracy and inter-agency collaboration result in inconsistent records.
• Cultural hesitancy and mistrust create resistance to digital data sharing initiatives.

Periodic Data Sharing Standards

Standards commonly applied to periodic data sharing include:

• ISO/IEC 27001: Focused on information security management systems (ISMS).
• ISO/IEC 27701 – Patient Information Management System (PIMS): An extension to ISO/IEC 27001 and ISO/IEC 27002 for privacy information management.

Real-Time Data Sharing

Real-time data exchange enables near real-time sharing of vital events data as soon as a birth, death, marriage or other life event is registered.

• The basic level involves enabling electronic data exchange between two distinct ICT systems.
• The second level entails creating a nationwide data-sharing platform that enables data sharing among all government ICT systems.
• The most advanced level integrates ICT systems across different countries under a regulated framework adhering to international standards.

Data Standardization Formats

Data standardization formats are a set of guidelines or structures used to maintain consistency in how data is represented and organized across various applications or organizations.

• XML (eXtensible Markup Language)
• JSON (JavaScript Object Notation)
• SQL (Structured Query Language)
• CSV (Comma Separated Values)

Application Programming Interfaces (APIs)

An API is a tool that enables different software applications to interact with each other.

• JDBC (Java Database Connectivity) is an API in Java that allows for the connection and interaction between Java applications and databases.
• ODBC is a standard API used for accessing database management systems (DBMS).

Healthcare Sector Data Standards

In the context of exchanging data with health ICT systems, implementation and compliance with the following health-related data standards will dramatically facilitate creation of data exchange APIs:

• FHIR - This standard defines data formats and elements for exchanging electronic health records. It uses common web standards like JSON and OAuth for easier integration. Adhering to FHIR ensures health data is structured consistently across systems. https://www.hl7.org/fhir/overview.html
• OpenHIE - This provides architectural frameworks and components for sharing health data at scale. It includes record locator services, shared health records, terminologies, and consent. Using OpenHIE frameworks improves the governance and interoperation of health information exchange. https://ohie.org
• HL7 – A set of standards for transfer of clinical and administrative data between health systems. It has popular messaging standards like v2, which defines data structure and semantics for exchange. HL7 ensures common language and meaning when communicating health data. https://www.hl7.org

Message Protocols

In conjunction with standardized data formats, message protocols provide a set of rules and structural conventions that allow data to be packaged, transmitted, and received in an orderly fashion.

• SOAP is a protocol specification for exchanging structured information in the implementation of web services in computer networks.
• REST is an architectural style for distributed systems, particularly used for web services. RESTful protocol based API is used often for their simplicity and stateless operations.

Key Statistics & Data

• Fiji’s CRVS system digitally forwards birth notifications from some hospitals (representing approximately 40% of all births occurring in Fiji) into the civil registration system.
• In American Samoa, a budget of USD 677,000 was proposed for a project encompassing the three New Zealand Realm countries to digitize their CRVS systems and establish interoperability with the New Zealand passport system.
• In Solomon Islands, licensing for upgrade of the Pomadus platform is estimated at AUD 14,200.

Methodology

The data-gathering process spanned from August 1 to October 30, 2023, and was an interactive and collaborative process comprising:

• An in-depth questionnaire evaluating interoperability of civil registration, vital statistics and identity management systems.
• Online consultations offering additional insights, feedback and clarity to the responses.
• A three-day workshop conducted in Auckland, New Zealand in October 2023 with representatives from participating countries, resulting a summary report.

Implications and Conclusions

The implementation of digital data sharing systems in CRVS across the Pacific requires tailored solutions based on specific requirements and constraints.

• A flexible, hybrid model that accommodates both real-time and periodic data sharing, underpinned by standardized practices and a strong focus on security and privacy, emerges as a key strategy for effective and sustainable digital transformation.
• The feasibility and justification for real-time digital data sharing depend significantly on the scale of the country’s needs.
• The use of standardized formats and APIs is crucial for the effective sharing of data between different ICT systems.
• The development of national interoperability frameworks is a key step towards streamlining data sharing across various government systems.
• The adoption of secure and privacy-focused solutions, like verification APIs, ensures the responsible handling of sensitive personal data.