When it comes to the timeline of outbreak response, every minute and every day counts. The World Health Organisation uses the The 7-1-7 framework, developed by Resolve to Save Lives, to benchmark outbreak response worldwide, with targets of 7 days to detect a suspected outbreak, 1 day to notify authorities, and 7 days to complete early response actions. The Framework represents an innovative and significant improvement on outbreak response globally – but in the Pacific, fundamental problems remain.

What’s not working in the Pacific? Detection is largely manual, usually relying on a surveillance officer doing weekly reviews of data from sentinel sites. Syndromic surveillance occurs only from a limited number of ‘sentinel sites’ which misses many outbreaks and does not provide the statistical output to generate data signals. Notifiable diseases occur only irregularly and facilities often lack pathways for reporting. The consequences can be devastating.

As an example, Samoa’s 2019 measles outbreak was declared 16 days after its index case, already more than double the 7-day target. The outbreak went on to infect over 5,700 people and 83 people died in just four months, mostly children under five, in a population of just over 200,000. In Australia that would translate to roughly 10,375 deaths: more than our entire road toll for over eight years combined (Australia sees around 1,200 road deaths a year). In Samoa’s case, the slow start to detection left less time for effective early response that can limit outbreaks and save lives (though to be fair, measles outbreaks are notoriously difficult to respond to and local authorities did an incredible job under the circumstances and with the tools available at the time.

More often though, deadly disease outbreaks in the Pacific are of much less high-profile diseases, they’re often geographically limited to a single island or village and consequently go completely undetected. The biggest killers of children remain community-acquired pneumonia and diarrhoea.

That’s where AI can help. 

Overlaying an AI data layer to existing disease detection data sources

An increasing number of countries in the Pacific are using EMRs/EHRs to record and manage every single clinical encounter in the public sector, in real-time. Samoa and Nauru are already there and other countries are catching up. Our idea is to build an AI layer on top of existing EHR tools, matched to what each country’s digitisation already looks like. The tool will support earlier outbreak detection by leveraging existing patient data, which is already being passively collected. In most cases, clinical staff will not be required to manually report anything else than information they are already collecting. The AI layer would alert authorities to disease threats in near real-time (minutes/hours, not days), enabling earlier detection, and thereby, notification, and response. In regards to infrastructure, the data pipeline, encounter records and visualisation layer already exist; the work is the AI layer, scoped specifically to detection. 

Health authorities using data visualisation tool Tupaia to support decision making.

The difference BES would bring – infrastructure and relationships

BES’s involvement will leverage our existing relationships and data infrastructure deployed in Pacific Island Countries. The infrastructure includes two of BES’s flagship products, The Tamanu Electronic Medical Record (EMR), and the Tupaia data visualisation platform. By way of introduction:

• Tamanu is the national EMR in six Pacific Island Countries
• 15 million clinical encounters have been tracked in Tamanu
• Almost 5000 healthcare workers are using Tamanu across the Pacific
• 2 million patients from Pacific Island Countries have a patient record in Tamanu

What’s the relevance of these data platforms to an AI layer? Every patient visit recorded in Tamanu is tracked live. When a cluster of patients turns up at the same clinic in a short window with the same set of symptoms – for example, fever, cough and a rash – it can be an early sign that an outbreak is underway. The AI layer watches for this: it checks incoming data against a set of pre-built thresholds and indicators, and the moment a cluster looks abnormal, it sends an automatic alert to the relevant health authorities, giving them the chance to respond before the outbreak spreads.

It still relies on local doctors and nurses capturing clinical details correctly – but the AI layer can also be trained to detect where this is not happening, enabling us to direct improved training and support.

Who would benefit the most from the AI layer?

Findings from a recent review of 84 outbreaks in Uganda found that faster detection is associated with fewer cases, fewer deaths, and shorter outbreaks. Surveillance timeliness is a determinant of outbreak impact. 

With this AI layer, surveillance teams would become aware of potential outbreak risks much earlier, gaining precious time to mobilize an effective, systematic response through actions like awareness raising campaigns, contact tracing and case finding, positioning of commodities and surge staffing.

Healthcare workers would be able to react more quickly and in the best cases, reduce the impact of disease outbreaks, improving quality care, reducing the spread of transmission and saving lives.

As the response actions reached communities, people could take action to reduce their own risk,  as well as seek care earlier and more easily. Patients and their communities could be diagnosed and treated more quickly and with better care, before an illness has the chance to spread widely. From there, the benefit reaches neighbouring countries and the wider region, since containing an outbreak locally reduces the risk of it crossing borders.

Nothing in the AI removes the human factor required to properly respond to disease outbreaks. Highly trained field epidemiologists, ‘surge’ staff providing clinical care, and public health communication campaigns also need support and strengthening, playing the critical role of using data in their decision making.

But AI can help a lot.

A laboratory technician adding a solution to a sample. Credit: Rawpixel.com

Next steps

Next steps could include:

• Potential partnerships to explore linkages in the Pacific, with donors and Governments
• Conducting feasibility study in a single Pacific Island Country to generate evidence for the initiative
• Conducting a pilot of the AI layer for disease surveillance in one of the countries.
• Seeking grant funding from philanthropists, Governments etc for distinct phases of the initiative, leveraging the results of the feasibility study
• Developing the AI layer with BES’s software developers and data engineers
• Seeking additional funding from Governments, philanthropy and corporations
• Scaling the initiative across nine Pacific Island Countries.

Not forgetting the bigger picture  

Now that we’ve made early disease detection sound straightforward, it’s worth being upfront about the real challenges that apply to any health initiative, even more so in a low-resource setting. This isn’t a simple problem to solve. It starts with the data itself: the consistency and quality of what’s being collected in the first place. Then the build – securing the system, and the genuine complexity of programming AI to detect disease patterns reliably, whilst ensuring data integrity and sovereignty remain paramount. And then implementation – making sure the workforce has the capacity and technical skill to run it, and that the authorities receiving the alerts have the resourcing to act on them with a comprehensive, coordinated response.

Realistically, delivering this sustainably and at scale might take two to three years, and it needs real commitment from funders and partners. But the payoff – automating early outbreak detection to speed up outbreak response and contribute to minimizing preventable deaths- is worth that investment.

Belau National Hospital (BNH) is the only public hospital in Palau, based in Koror and serving as the referral point for the whole country. Every department and unit in the hospital, from the wards to outpatients, relies on a steady, well-managed supply of medical items to keep running. Getting that ordering process right matters, and until recently, it was still being done on paper.

At the start of 2026, the Medical Supplies team at BNH replaced handwritten order requisition forms with improved, semi-prefilled digital forms, to make ordering medical supplies easier, more consistent and quicker for hospital departments and units.

The old system asked staff to hand write the items they wanted to order and estimate the quantities needed. With more than 450 different items in the catalogue, that process was a recipe for error. Item names were easy to confuse, quantities were often just a guess, and handwriting wasn’t always legible once the form reached the supplies team.

mSupply is used at BNH to enter andfulfil orders and whilst the mSupply suite of products allows hospital wards and departments to be digitised within mSupply with a range of tools, the BNH senior team felt they needed a lower-tech solution. Taking mSupply to the wards can be a complex activity requiring extensive training, hardware and change management. The team also wanted to take a step-wise approach with a lower-tech solution that could allow them later to move towards more modern approaches.

The old paper-based forms being replaced

A form that does the thinking

The new forms pull data straight from mSupply, the electronic Logistics Management Information System the medical supplies team already uses to track stock. Instead of writing out item names from memory, staff now see the items their department has ordered in the past, already listed on the form. The average quantity ordered over a two week period is also pre-filled, giving staff a sensible starting point.

The latest round of improvements, made in June 2026, went a step further. Now staff just enter how much stock they currently have on hand, and the form automatically calculates how much they need to order for the next two weeks. Each department orders enough supplies for a fortnight every week, so there is always a week of buffer stock in reserve. The forms are built in Excel and are emailed weekly to a shared medical supplies address for processing, so no separate system or login is needed to submit an order. From there, they can be easily imported into mSupply by pharmacy staff, eliminating the risk of transcription errors.

What has changed

All wards and units across Belau National Hospital are now using the new forms. The Medical Supplies team is seeing more orders processed in full, and more consistent use of items across departments, a direct result of staff no longer having to guess at names or quantities.

Darnelle Worswick, Hospital Administrator, says the change has been significant, but not without its own learning curve:

“The updated medical supplies order forms have really helped us. We’ve learnt the importance of training the Hospital Departments to use them and also taking on board their feedback to make further improvements. For example, in the latest updates to the forms, we’ve included automatic formulas for calculating order quantities and allowed Hospital Departments to submit the form by email.”

That feedback loop, listening to the departments actually filling out the forms each week, has been central to how the forms have evolved from the first version to the current one.

What BES did

Beyond Essential Systems (BES) Health Supply Chain Project Manager, Catherine Harris, worked with BNH staff to design and update the new medical supplies order forms, and provided training and training materials to help departments make the switch from paper to digital. The approach was discussed with the mSupply Foundation team in NZ and Nepal, who agreed it was an approach that would be easy to implement within mSupply and free to maintain within Palau’s existing support model.

Looking ahead

BES is grateful to the Australian Government for its ongoing support through the Partnerships for a Healthy Region initiative, which allows BES to provide tailored, dedicated support to Belau National Hospital in Palau. A form re-design is a small change on paper, but one that is already making ordering medical supplies faster and more reliable for every department at BNH. More importantly, it’s a demonstration that the best tools are the ones that come from understanding the context, listening to local leadership and making appropriate choices.

Last week, Tamanu EMR went live across all inpatient departments at TTM Hospital in Samoa. Nineteen wards and departments came online on the same day, across more than 300 staff, with usage increasing for workflows across the week. It was the biggest single-day go-live for a digital health project in the Pacific this year, and the culmination of 12 months of work.

For anyone outside the digital health sector, a “go-live” might sound like flipping a switch. In reality, it is closer to a small, carefully choreographed operation, and one that looks very different depending on where in the world it happens.

The basics

The formula we aim for is always the same… after months of build-up, the Go-Live team arrives at the hospital in the week leading up to the big day. This is comprised of an international team from BES, put together with a local team of Change Champions from (in this case) Samoa. The team will wear high-vis vests throughout the week and be stationed throughout the hospital supporting staff, answering questions and identifying issues. Any problems are shared via messaging apps with the control room, staffed by a senior Project Manager and local IT staff. In Samoa, we supplemented this with a ‘virtual’ control room based in Suva, who were on rotation with one staff member allocated full-time to Samoa throughout the entire week.

The night before, the team meets for pizza and a final walk-through of the hospital, testing equipment and network access. Ribbons and balloons go up, the final ‘thumbs up’ decision is taken, senior staff are informed and at 6am on the day of Go-Live, Tamanu blinks to life.

Smooth sailing? Never! But with the right resourcing, calm staff and a lot of laughter, everything is manageable.

Go-lives are not the same everywhere

In a very highly-resourced hospital system, a go-live might come with a budget in the millions, a dedicated project office, and months of parallel running between old and new systems. In the Pacific, that model simply does not exist, and trying to force it rarely works.

At TTM, the same outcome – that is, a safe, complete transition to digital records across a 200-bed tertiary hospital – has to be achieved with a fraction of the resourcing. Every hour of planning has to count, every risk has to be understood in context and anticipated in advance and the people on the ground have to be trusted to make real-time decisions when something doesn’t go to plan. Lower-resourced does not mean lower-standard. It means different, and it means smarter.

People who understand context matter more than credentials

One of our clearest lessons from years of Pacific go-lives is that technical skill alone does not get you through the experience. The staff who make the biggest difference during a go-live are the ones who have worked in similar clinical and public health environments before, and who understand what it means to run a busy ward with limited staff, intermittent power, or a shared laptop between three nurses. Air conditioners leak, members of the public might have greater access to sensitive areas of the hospital, family priorities can pull crucial staff away at inopportune times, rain sometimes falls inside the building, rats chew through cables in the ceiling… none of those are a crisis, that’s just a normal Monday.

Placing people with that lived experience alongside local teams changes the dynamic of a go-live entirely. It is the difference between a support person who can only follow a script and one who can look at a ward at 7am and immediately understand what is about to go wrong, keep their sense of humour, roll up their sleeves and just help.

Local teams lead, we support

It is easy to frame a go-live around the visiting support staff. But the truth is that these projects are led by local health information and IT teams, not by BES. Our staff are there to back them up, not to run the show.

That distinction matters throughout the months of preparation before a go-live, and just as much on the day itself. The relationship with local teams, built over months of requirements gathering, configuration, testing, and training, is what allows a go-live to hold together under pressure. Without that trust, no amount of external support can make up the difference.

No half measures

Perhaps the hardest lesson to apply, and the easiest to get wrong, is that a go-live has to be all-in. If clinical data is allowed to move back and forth between paper and digital systems, even temporarily, the project is in trouble. Staff quickly learn which system is “real,” duplicate records creep in, and the continuity of care the system was meant to improve starts to break down instead.

At TTM, that meant a genuine cut-over. By the end of week one, every incoming patient had a fully digital experience, with handovers, triage, bed management, clinical care, and clinical administration all running through Tamanu. There is no fallback to paper.

Of course, there are still paper workflows in the hospital – forms that were missed, practices which are hard to break, departments which are more complex than others. That’s why the Go-Live isn’t the end of the story, it’s just the start. There are still months of work ahead, making sure that the new systems adapt to the workflows (and vice versa) until everything works seamlessly.

A genuinely regional effort

Last week’s go-live was also a reminder of how connected the Pacific digital health workforce has become. Staff from New Zealand, Fiji, Australia, and Samoa worked together on the ground and remotely, including through a virtual control room based at our regional support centre in Suva, supporting the Samoa Ministry of Health IT team in Apia.

This regional model matters. It means expertise built in one country’s health system can be shared with another. TTM becomes the sixth national hospital in the Pacific to implement Tamanu across all departments, and the second largest hospital to use the system. The cohort of staff that is building are mutually supporting and represent a very real peer-to-peer network which can eventually take BES out of the loop.

Twelve months in the making

Last week did not happen overnight. It followed 12 months of preparation, with the last four in particular given over to intensive requirements gathering, configuration, testing, and training, all underpinned by a broader change management strategy. Over the same period, the team also delivered go-lives at more than ten smaller facilities and outpatient departments across Samoa, each one building the experience and confidence that made today possible.

On the ground in Apia, the day itself scaled up gradually. Final hardware inspections were completed on Sunday night. On Monday morning, staff worked side by side with local teams to migrate current inpatients ahead of each critical shift change, and ward rounds were digitised progressively across the first 48 hours. Support will continue through July, starting with five BES staff on the ground and reducing progressively to one project manager as the local team takes full ownership.

After that, the focus shifts from go-live support to something arguably more important: using the data now being captured for evidence-based decision making and improved clinical care.

What the data already shows

Even before today, Tamanu’s impact in Samoa was measurable. Since the system was first introduced in 2021, more than 1.2 million encounters and 4.6 million clinical events have been recorded across Samoa’s public health facilities. More than 210,000 patients have had more than one encounter in the system, and for 74,000 of those patients, encounters spanned different facilities, a strong signal that longitudinal, connected care is genuinely happening.

More than 900 users now work using Tamanu, from clinicians to public health and health information staff. TTM’s go-live adds a national tertiary hospital to that picture, with 24/7 digital records now underpinning emergency care, paediatrics, ICU, and surgical theatres.

Thank you

None of this would be possible without our donors and partners, including the Australian Department of Foreign Affairs and Trade through the Global Health Division and Partnerships for a Healthy Region (PHR), the World Bank Group, and the Tautua Human Development for All Program, delivered by Palladium.

Congratulations to the local health information and IT teams in Samoa who led this project, and to everyone across Samoa, Fiji, New Zealand, and Australia who supported them to get here.

The name change reflects something real. We have always operated without a profit motive and over the years, nearly all our profits have gone back into our projects and our products. We have never believed that companies should profit from providing healthcare in low- and middle-income countries, and we have never operated as though they should. Becoming a not-for-profit formalises what has always been true in practice.

Our software is free and open-source and an open-source philosophy sits at the heart of our culture. All our documentation and training resources sit in the public domain. We have always believed that what we build should be freely available to the people and systems that need it and it feels right that our organisation itself should now reflect that same principle.

We also believe this change will strengthen our relationships with the partners we work alongside. Trust matters in this work – operating as a not-for-profit makes our intentions clearer and our commitments more tangible. We hope it makes us easier to work with, and we hope it opens doors to deeper collaboration with partners, governments, and funders who share our values.

It is particularly nice to be able to do this from a position of strength – BES has run as a successful business for 10+ years now, we have no debt, we have never had to give away equity, we have 60 wonderful staff who are on board with our plan and we are working in more than 12 countries around the world on projects that we believe in.

For existing partners, we will be working with you directly to manage the transition thoughtfully. It may not be possible to immediately move all our contracts and grants over to BES International but new work will be delivered wherever possible under BES International, and we will work through the due diligence process together with partners to ensure continuity and clarity.

We set ourselves a high bar from the beginning – if we achieve normal things, we have failed. Becoming BES International is not a departure from that standard, it is an expression of it.

The challenge of supplying medicines across 3.5 million square kilometres

Kiribati is one of the most geographically dispersed countries in the world. Its 21 inhabited islands are spread across 3.5 million square kilometres of ocean, making coordinated health service delivery a logistical challenge. For health workers on outer islands like Tamana, getting the medicines and supplies their patients need has long depended on infrequent transport links and limited visibility into what is available, and when it is running low.

The consequences of gaps in supplying medicines are felt across the full range of health conditions. Non-communicable diseases including diabetes, hypertension, and cardiovascular disease place a significant and growing burden on the health system. Stock outs of essential medicines for these conditions are not just inconvenient, they directly affect patient outcomes. Reproductive and sexual health supplies have also historically been difficult to maintain on outer islands, despite sustained demand from communities. Without reliable data on what is in stock at the facility level, ordering decisions are made on estimates of supplying medicines, rather than evidence. Resupply can arrive too late, in the wrong quantities, or not at all.

A broader push for digital transformation on Tamana Island

The deployment of Open mSupply sits within a wider effort to bring digital services to Tamana. The Smart Island Project a joint UN programme by the Joint SDG Fund, led by the International Telecommunication Union (ITU) in partnership with Kiribati’s Ministry of Information, Communication, and Technology; has been working to expand Wi-Fi connectivity, build community digital literacy, and strengthen digital health services on the island, including through a partnership with the Ministry of Health. The project is also designed as a replicable model for other outer islands across Kiribati. This improved connectivity and growing digital capability on Tamana makes this the right moment to introduce digital supply chain management at the medical centre.

What Open mSupply does

Open mSupply is an open-source Logistics Management Information System (LMIS) developed by the mSupply Foundation. It is used in health facilities across the Pacific and beyond to manage supplying medicines and medical supplies, from national warehouses all the way to remote clinics. The system is built to work reliably in low-resource environments with limited or intermittent internet connectivity.

With Open mSupply, health workers can:

• Record stock transactions digitally: goods received, items dispensed, stock takes completed
• Access automatic reorder suggestions based on real consumption data
• Synchronise stock data with the central supply system in Tarawa
• Have actionable data to reduce both stock outs and wasteful over-ordering
• Kiribati Government Pharmacy in Tarawa, the system provides near real-time visibility into what is on the shelf at Tamana’s medical centre so resupply decisions are based on data, not guesswork.

What this means for Tamana Island

For health workers at Tamana’s medical centre, Open mSupply reduces the time spent on manual stock counts and paper-based ordering, freeing up more time for patient care. For the community, it means greater confidence that essential medicines for diabetes, hypertension, maternal health, and reproductive health will be available when needed.

The Tamana deployment is also an important step in demonstrating that digital health supply chain tools can work at the last mile, in the most remote settings, with limited resources, and with real benefit to patients and health workers alike.

Tamanu is a free and open-source Electronic Medical Record, recognised as a global digital good for health. It is supported in Kiribati by the Government of Kiribati, MHMS, and the Australian Department of Foreign Affairs and Trade’s Global Health Division, through the Partnerships for a Healthy Region (PHR) Initiative.

Featured image caption: Ariel shot of Tamana Island, part of the Gilbert Island group in Kiribati. Supplied by UNDP PO Kiribati.

Kiribati’s digital approach to maternal health care

The Obstetrics and Gynaecology Department at the Tungaru Central Hospital (TCH) in Kiribati are using a digital approach to better manage national maternal health care outcomes. In March 2026, the Department transitioned to using a digital Maternal Health Care Program Registry, embedded within their instance of the Tamanu EMR, giving healthcare workers instant access to patient information across two hospitals locations, and many remotely located clinics.

The implementation of the Registry empowers Kiribati midwives, nurses and doctors to access information of expecting mothers at any time of their journey, from the first antenatal care (ANC) appointment, through to delivery and post-natal care (PNC) in both Tungaru Central Hospital and Betio Hospital in Kiribati.

Pregnant women remain sadly vulnerable

Maternal health outcomes across Pacific Island Countries and Territories (PICTs) remain a significant concern. The WHO estimates that the maternal mortality ratio for the Pacific region was the second highest in the world as of 2020, at approximately 173 deaths per 100,000 live births (albeit with significant variation across PICTs). Despite some positive trends, there remains a substantial burden of preventable maternal and newborn deaths across the 22 PICTs, and reliable data are limited – creating real challenges for monitoring and improving care. High-risk obstetric conditions are a key driver of these outcomes. Hypertensive disorders of pregnancy – including pre-eclampsia, eclampsia, and HELLP syndrome (Hemolysis, Elevated Liver Enzymes, and Low Platelets) – represent a particularly dangerous spectrum of disease: pre-eclampsia (which can progress to eclampsia) and HELLP syndrome, together account for over 50,000 maternal deaths and more than 500,000 fetal deaths globally each year. Around the world, these conditions are most prevalent in lower-resource settings where access to quality prenatal care is limited, reflecting the key role that modern healthcare infrastructure plays in outcomes. Beyond hypertensive disorders, gestational diabetes – which is of particular relevance in the Pacific given the region’s high rates of obesity and non-communicable disease – postpartum haemorrhage, and maternal anaemia compound the risks faced by pregnant women across PICTs.

For conditions which require careful long-term management, such as preeclampsia and gestational diabetes, it is critical that data is managed longitudinally and is available immediately to all healthcare providers who come in contact with expectant mothers. For more acute conditions such as HELLP syndrome, that need escalates. Patients suffering acute conditions are often referred from primary halthcare facilities to tertiary facilities and the ability to avoid re-doing clinical examinations and diagnostics saves critical time. In the case of HELLP syndrome, those precious minutes and hours can literally save the mother’s life.

The solutions are not all digital – hospital capacity limitations, limited infection control tools, and other infrastructure challenges also remain common barriers to improving maternal and infant healthcare and the solutions are multi-factorial. Nevertheless, accurate clinical data collection is not just an administrative function – it is a critical tool for identifying at-risk patients, informing clinical decisions, and potentially saving lives.

Care across the ocean

In a country of 32 low-lying atolls spread across 3.5 million square kilometres of ocean, the challenge of managing continuity of care in Kiribati is very real. Kiribati’s health system relies on a small, dedicated health workforce and remotely located clinics. Before this digital approach was implemented, a mother who first visited the antenatal clinic and later presented to the emergency department or was admitted to the inpatient ward may not have had her earlier clinical notes. Important history – such as medications, previous visits or risk factors – could have been missed.

For the midwives, nurses and doctors managing both outpatient clinics and inpatient wards, fragmented patient information only adds to the pressure in already busy clinical environments. This seamless, digital approach not only makes each step of the maternal journey safer and more connected, but also empowers healthcare staff to deliver consistent and informed care to remote locations.

Having a patient’s medical history at their fingertips, health worker errors are minimised, and expectant mothers in Kiribati can confidently rely on a system designed to prioritise their wellbeing throughout pregnancy and childbirth. The Maternal Health Care Program registry is now being used by: ANC/PNC Clinics, ANC/PNC inpatients ward, Gynaecology clinic, and the Gynaecology inpatients ward.

The Obstetrics and Gynaecology Department within Tungaru Central Hospital (TCH) have a digital Maternal Health Care Program Registry

Expecting outcomes

The Department opted for a staged and gradual implementation of the software, allowing ample time for testing and staff capacity development, and have since accelerated their use.

Around 15 staff were trained in the Maternal Health Care Program Registry and provided with 5 laptops and 4 laptop trolleys. In the first week alone, around 45 patients were registered, supporting longitudinal care, regardless of where they seek treatment.

Tamanu will be used to manage patients in both pre and post-natal stages, including patients with gynaecological conditions and high risk factors. The Maternal Health Care Registry will be used to monitor patient care and management.

Tamanu also links patient records from the Emergency department and other inpatient wards for better history and management.

Potential impacts include:

? Enhancing Continuity of Care: Ensuring seamless data flow between outpatient clinics and the inpatients ward, as well as across multiple encounters and providers.

? Improving Patient Safety: Providing clinicians with real-time access to clinical history, reducing manual errors and providing an automated audit system.

? Data-Driven Decisions: Better health tracking for expectant mothers and more efficient ward management.

Tamanu is a free and open-source Electronic Medical Record, recognised as a global digital good for health. It is supported in Kiribati by the Government of Kiribati, MHMS, and the Australian Department of Foreign Affairs and Trade’s Global Health Division, through the Partnerships for a Healthy Region (PHR) Initiative.

The Challenge: Creating a Unified Healthcare Platform

Modern healthcare facilities require seamless communication between clinical systems. When physicians order imaging studies through an EMR, radiologists need immediate access to patient context and clinical history. Conversely, imaging results must flow back into the patient’s electronic record without manual intervention. This bidirectional flow of information is essential for quality care, yet historically, achieving it has been complex and time-consuming.

At Nauru Medical Centre, the national hospital serving the Republic of Nauru, this integration challenge was particularly important. As the country’s primary healthcare facility, the hospital needed a robust, reliable connection between patient records and diagnostic imaging that could support the full continuum of care.

The Solution: HL7 FHIR Standards

The integration was achieved using HL7 FHIR (Fast Healthcare Interoperability Resources), the modern standard for healthcare data exchange. Unlike older HL7 versions that often required extensive custom development and lengthy implementation cycles, FHIR offers a more standardized, web-based approach to interoperability.

FHIR’s RESTful architecture and use of contemporary web standards make it inherently more accessible and maintainable than its predecessors. For this integration, FHIR enabled Tamanu and Voyager to communicate patient demographics, imaging orders, and study results efficiently and reliably.

Why This Integration Stands Out

What made this implementation particularly impressive was the speed and efficiency of the process. Voyager’s technical team demonstrated exceptional capability by utilizing Tamanu’s FHIR documentation to complete the integration with minimal additional technical input from our side. This streamlined approach delivered results in a remarkably short timeframe.

This experience highlighted several important advantages:

Technical Excellence: Voyager’s ability to work independently from comprehensive API documentation demonstrates sophisticated technical capabilities. Their team clearly understood FHIR principles and could implement them effectively without requiring extensive back-and-forth communication.

Documentation Matters: The success of this integration validates Tamanu’s commitment to thorough, clear technical documentation. When systems are well-documented using standardized protocols like FHIR, integration partners can work efficiently and independently.

Scalability Through Standards: Perhaps most significantly, this implementation proves that FHIR-based integrations are more readily replicable than older approaches. The same documentation and approach that worked for Voyager can serve as a blueprint for future integrations with other PACS systems or healthcare IT platforms.

The Tamanu-Voyager Partnership in Action

Tamanu brings a comprehensive, free and open-source EMR solution designed specifically for resource-constrained healthcare settings. Built on five core principles—free and open-source licensing, desktop and mobile functionality, seamless integration capability, sync-enabled offline operation, and robust data security—Tamanu provides a birth-to-death patient record across all healthcare settings.

The system’s HL7 FHIR compliance means it’s designed for integration from the ground up. Whether connecting with laboratory information systems, pharmacy management software, or PACS like Voyager, Tamanu’s architecture supports the interoperability that modern healthcare demands.

Voyager PACS complements this with enterprise-grade medical imaging capabilities. As a web-enabled, server-based PACS, Voyager provides medical images to authorized users anytime, anywhere. The system’s Voyager Integrator specifically enables seamless interfacing with other healthcare systems via HL7, making it an ideal partner for an integration-ready EMR like Tamanu.

Real-World Impact at Nauru Medical Centre

For Nauru Medical Centre, this integration means:

• Streamlined Workflows: Clinicians can order imaging studies directly from Tamanu, with orders automatically transmitted to Voyager PACS
• Complete Patient Context: Radiologists accessing studies in Voyager can view relevant clinical information from the patient’s Tamanu record
• Unified Documentation: Imaging reports and results flow back into Tamanu, creating a complete patient record
• Reduced Errors: Elimination of manual data entry between systems minimizes transcription errors
• Improved Care Coordination: All members of the care team work from the same integrated information source

Looking Forward: The FHIR Advantage

This successful integration reinforces our confidence in FHIR as the foundation for future healthcare interoperability. The standard’s modern approach to data exchange offers clear advantages over legacy HL7 versions:

Faster Implementation: As demonstrated with Voyager, FHIR integrations can be completed in shorter timeframes with less custom development.

Easier Maintenance: Standardized resources and RESTful APIs mean updates and troubleshooting are more straightforward.

Greater Replicability: The same integration approach can be adapted for additional facilities or partners with minimal rework.

Future-Ready Architecture: FHIR’s design anticipates emerging healthcare IT needs, including mobile health, telehealth, and patient-generated data.

For organizations implementing Tamanu, this means confidence that integrating with PACS systems, laboratory information systems, and other healthcare IT platforms will be increasingly straightforward as more vendors embrace FHIR standards.

Conclusion

The successful integration of Tamanu and Voyager PACS at Nauru Medical Centre demonstrates that modern interoperability standards can deliver on their promise. When vendors commit to thorough documentation and standards-based development, complex integrations become manageable projects rather than multi-year endeavors.

We’re grateful to the Voyager team for their technical excellence and efficient approach. Their work not only benefits Nauru Medical Centre but also establishes a template for future implementations across the region and beyond.

As healthcare continues its digital transformation, partnerships like this prove that open standards, quality documentation, and technical expertise can overcome traditional integration challenges. The result is better-connected systems and, ultimately, better patient care.