The Power of Tinkertoys: Amplifying Simplicity by Being “Open”

David Potenziani

IntraHealth International | Senior Informatics Advisor

Tinkertoys. Photo by Peter Miller (via Flickr); Attribution-NonCommercial-NoDerivs 2.0 Generic license (CC BY-NC-ND 2.0).

The 2016 Global Digital Health Forum offered a variety of sessions and formats. From simultaneous interactive workshops, panel presentations and fireside chats, one of the challenges for me was that I found all of the content so compelling, I had a hard time prioritizing sessions. One cannot be everywhere—although Co-Chairs Amanda BenDor and Heidi Good Boncana tried to be—and any one person’s observations are really anecdotal. Well, here are my anecdotes.

For me, the conference stretched from the very small to very large, from micro-services (that’s software lingo for very small and specialized routines) to continental data communications networks using balloons, drones, and satellites. Despite the differences in scale and approach, these ends of the spectrum are working towards the same goal—universal access to data. Transitioning from data to useful information that guides action takes a different set of capabilities. Therefore, let us consider a toy.

I grew up when the reigning construction toy was Tinkertoys. With a simple set of component parts, I could make anything in any shape. Such magic was possible because the pieces were different, yet fit together in a uniform way. I was only limited by my imagination and the number of pieces I had on hand. Although it was beyond my understanding at the time, it prepared me for a career in information systems. That field is similar in that it uses standard parts that can fit together in novel and useful ways. Of course, this describes the Forum.

The Forum offered a number of sessions where people were discussing how to put the pieces together. The importance of these efforts was larger than creating a tower out of wooden parts, but held some striking similarities. I participated in two that looked at different scales, but both began with the same word: Open.

I moderated a session on the OpenLMIS (open source logistics management information system) collaborative. It’s one of the new entrants to provide a common set of solutions involving management of medical supplies’ inventories and transportation systems. Their work is in many LMICs, but they focused on West Africa as well as Mozambique to show the geographic breadth. The three presenters were involved in different aspects of its modular architecture. They did a role play with audience members playing the parts of the systems involved--it got people on their feet and participating. Because they are still building the basics of their approach, they are developing the software components (microservices) that can be selected and combined to address different contexts. Some capabilities are still in their future, such as predictive analytics to anticipate inventory needs. Yet, the energy of the group presenting and the active response of the audience makes me hopeful that they will succeed.

While the OpenLMIS looked at a specific area, in the general realm was the OpenHIE (the open source health information exchange) community. It has been around for a few years, and the efforts of many people have helped the approach become capable and useful. The idea is that data is often siloed in a human resources system, a health services system, a logistics system, a laboratory system—you get the idea. But combinations of data across these systems ought to use the same techniques so a solution made in one place is useful in many places. The approach tends to focus on use cases and standards as well as specific software involved. The discussion was how to move this community forward to provide solutions at scale that will serve national and even larger areas of need. One of the implications of these efforts, if successfully adopted, will be national enterprise resource planning systems that allow for comprehensive information across the health domain.

Getting to that enterprise level is becoming a conscious goal in a number of countries. It will take contributions of groups like OpenHIE and OpenLMIS, as well as dozens of other groups doing similar work. All of these can draw upon the types of continental infrastructure investments of the balloons/drones/satellites crowds, but the solutions will be hard won a step at a time.