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.

In early 2024 the Tonga Pharmacy and Medical Facility (TPMF) warehouse opened in Veitongo, Tongatapu. The warehouse has provided much needed additional suitable storage space for drugs and pharmacy items needed by Tonga’s public health service, hospitals and health centers.

Tonga is a Polynesian country in the southwestern Pacific Ocean consisting of approximately 170 islands, of which 36 are inhabited, with a population of around 107,000 people.The country’s health system includes central hospitals, peripheral health centers and community-based services.Key health challenges facing Tonga include rising rates of non-communicable diseases such as diabetes, obesity, heart disease and cancer, while communicable diseases such as tuberculosis, and vaccine-preventable diseases persist.

Prior to the new warehouse opening, all of the national-level medicines and medical supplies were stored in the Central Pharmacy and Medical Supplies (CPMS) unit office in Nuku’alofa which was converted from Tonga’s original old hospital. This old site was overcrowded, difficult to access, and not a fit-for-purpose national storage facility. The new TPMF warehouse has allowed for storage layout improvements, proper stock management processes and a full, accurate stock take to be completed.

With the support of BES, Warehouse Standard Operating Procedures (SOPs) were developed and adopted in late 2024 and mSupply has been implemented throughout the warehouse. Now, in late 2025, the dedication and hard work by the CPMS staff is generating significant results.

In 2024 weekly cycle-count spot checks were commenced to routinely audit that the stock on hand quantities in storage matched the records in mSupply, the electronic logistics information management system used by CPMS. In 2024 the accuracy rate of the random spot checks was regularly between 20-60%. By late 2025, after implementing annual and quarterly stock takes, the average accuracy rate of random spot check has reached 90%. With dedicated storages spaces for medicines and medical supplies there is more room for logical storage layout planning and easier maneuverability for staff to pick orders and regularly stock take items.

The facility is also safer, and cleaner with stock now stored on proper steel shelving, improving efficiency as well as staff welfare. The use of forklifts and other warehouse aids reduces the risk of physical injury or accident.

Knowing that the stock on hand data is accurate has been essential for determining how much to order in future. mSupply, the electronic logistics information management system used by CPMS, generates suggested order quantity data that is now more accurate and reliable. The increased trust in the stock management data from mSupply has led to improved ordering of medicines and medical supplies and reduced under and over ordering items, further helping to efficiently manage the storage spaces.

At the same time, medical item availability has consistently been above 90% at the central warehouses and in fact has averaged close to 95% throughout 2025, based on an indicator item list which has been set for measurement.

BES have been supporting Tonga since 2018

Fehi Tu’iha’angana, a Pharmacist at CPMS, says the new warehouse SOPs that detail processes for purchase order management, goods receiving, managing expires, monthly reporting and other processes …“are really useful for having specific written processes to go back to refer to and follow. The flow diagrams are particularly helpful.”

The CPMS Stock Control Coordinator, Sesi Lea’aetoa, acknowledges the new warehouse SOPs have also helped define staff specific duties and roles: “It helps us with teamwork and directs co-workers to have a hand in doing all the work,” she says.

Beyond Essential Systems (BES) and The mSupply Foundation (TMF) under the DTAC initiative supported by the New Zealand Ministry of Health Polynesian Health Corridors program have supported Tonga’s CPMS unit every step of the way to achieve these outcomes. For example, BES have provided training on operationalizing the warehouse SOPs and TMF have helped create tailored data reporting dashboards that allow the easy tracking of key supply chain performance indicators.

BES and TMF are pleased that the New Zealand Ministry of Health Polynesian Health Corridors program has extended funding to continue to provide tailored support to Tonga until June 2027.

The achievements of Tonga’s CPMS unit in warehousing and stock management for drugs and medical supplies illustrate that tailored supply chain support combined with dedicated staff can create tangible differences and significant improvements over time, saving money, improving medicines availability and using data to inform decision making. These differences need multi-facted support however, combining digital tools, physical storage infrastructure, policy & processes, and – most importantly – highly engaged and effective staff. In Tonga, we are lucky to be working now with all four!

When a mother in a rural clinic in the Pacific goes into labour, the difference between life and death can come down to whether there is electricity in the room. Too often, that electricity is missing. Babies have been delivered by the glow of mobile phone torchlights whilst critical procedures have been interrupted by failing generators or small solar systems that can’t keep up.

For those health workers, this is an obvious, everyday struggle. Behind the scenes though, another challenge exists: how do you even know where every clinic is, what services they provide, and what their power situation looks like in the first place? For Superfly Solomon Islands, this was the challenge facing them setting out on a recent project to bring solar power to clinics across Solomon Islands.

That’s where Tupaia, BES’ flagship data platform, has been transformative.

Tupaia can be used to track infrastructure, equipment, disease surveillance, biomedical assets, environmental health programs or supply chain.

A Map That Goes Beyond Medicine

Tupaia was originally designed to track the availability of medicines and health services across the Pacific. In Solomon Islands, in 2017, Tupaia was used to map out hundreds of facilities, capturing GPS coordinates, service levels, and vital infrastructure details — including whether or not the clinic had electricity. This program of data collection was overseen by the National Medical Stores and the data was subsequently used by the Ministry of Health and Medical Services to populate local MHMS systems such as DHIS2.

For doctors, nurses, and policymakers, that data has been useful – DHIS2 now has accurate coordinates for all health facilities across the country. But its ripple effects reach much further and have been sustained. Companies like Superfly Limited, which designs and installs solar energy systems, have relied on Tupaia for years as a foundation for their work.

A Tool for Second-Tier Stakeholders

Superfly Solomon Islands is the country’s only high quality-focused solar power provider, sourcing best-in-class solar components and supplying them for government, private sector, and retail customers. In the health sector, for Superfly, Tupaia has become a first step in scoping new solar deployment projects.

Roughly 80% of health facilities in the country are off-grid, located in some of the most remote corners of the archipelago. By starting with Tupaia, the team can:

• Identify priority clinics — those without reliable power or medical services that would benefit most from solarisation.
• Estimate energy needs — inferring power requirements based on the level of care and services provided.
• Plan logistics — triangulating GPS coordinates with Google Maps to assess roof space, access routes, and the feasibility of installation.
• View clinics in advance, understanding the services they provide, opening hours, and even viewing images to get a sense of the local situation.

In this way, a tool designed for health sector planners has also become a quiet enabler of energy infrastructure, bridging the worlds of medicine, technology, and logistics. The data (and the software) are available free to Superfly and any other stakeholders, as well as members of the public.

Superfly’s work in Solomon Islands incudes the installation of a solar power system at Good Samaritan Hospital on Guadalcanal

Data as the Foundation of Resilient Systems

Superfly’s work has shown how investments in data and mapping can bolster more than just health outcomes. They help coordinate efforts across sectors: energy providers, logistics companies, donors, and government agencies. The result is stronger, more resilient systems. When facilities are mapped and understood, it becomes easier to bring in electricity, refrigeration for vaccines, internet connectivity, and ultimately, better healthcare.

Lighting the Way Forward

The story of Tupaia in Solomon Islands is not just about databases or maps. It’s about turning data into action. It’s about ensuring that when a baby is born in a rural clinic, the light shining on them comes from a reliable solar system — not a flickering torch.

For non-medical stakeholders like Superfly, tools like Tupaia have been vital. For communities across the islands, they are life-changing.

High quality solar projects can be transformative for health facilities across the Pacific

The financial implications are equally significant. Duplicate records inflate administrative costs, create billing complications, and reduce operational efficiency across healthcare organizations. Staff spend valuable time reconciling conflicting information, while the integrity of health data analytics and population health initiatives suffers from inaccurate patient counts and scattered clinical data.

Recognizing these challenges, the Tamanu EMR has developed a comprehensive, multi-layered approach to patient deduplication that addresses both prevention and remediation. This systematic strategy ensures that healthcare providers can maintain clean, accurate patient databases while delivering safe, coordinated care.

At the centre of any patient management strategy of course, are good processes and procedures, implemented by diligent staff. Tamanu can only help – we recognise though that it is the people at the heart of the system who determine its success.

The five Tamanu strategies for de-duplication

Strategy 1: Patient Master Index Integration

The foundation of effective duplicate prevention lies in establishing a unified patient identity management system through a Patient Master Index (PMI) integration. A PMI serves as the authoritative source for patient identities across an entire healthcare network, maintaining a single, comprehensive registry of all patients served by the organization.

Tamanu’s PMI integration offers remarkable flexibility to accommodate diverse healthcare environments. In small to medium sized healthcare systems or those starting fresh, Tamanu can function as the primary PMI, becoming the central repository for patient identities across all connected systems and departments. This approach ensures seamless coordination between different clinical areas, from emergency departments to specialty clinics or allied health, with each patient maintaining a single, consistent identity throughout their care journey.

For larger healthcare networks or those with existing infrastructure investments, Tamanu can consume data from external PMI systems already in operation. This integration capability means organizations don’t need to abandon their current patient identity management investments. Instead, Tamanu synchronizes with these existing systems, ensuring consistency while leveraging established workflows and data governance practices.

Whether consuming data or making it available to other systems, Tamanu achieves this through an HL7 FHIR compliant API, which defines the resources and the business rules around which the data is exchanged.

The PMI approach creates a robust foundation for preventing duplicates at the source. By establishing unique patient identifiers that persist across all systems and encounters, healthcare organizations can eliminate the confusion that arises when patients are known by different identifiers in different departments or facilities.

Strategy 2: ID Card System

Physical patient identification represents a practical, user-friendly solution to many duplicate creation scenarios. Tamanu’s ID card system addresses the common registration challenges that lead to duplicate records—misspelled names, forgotten dates of birth, or variations in how patients provide their personal information.

The system supports both basic ID cards containing essential patient identifiers and more sophisticated photo ID cards that provide visual verification. When patients present their ID cards during registration or subsequent visits, healthcare staff can quickly and accurately retrieve their existing records without relying on potentially inconsistent verbal information. Each ID card contains a barcode, which is scanned in seconds across any part of the health system and all points of care.

This approach proves particularly valuable in busy clinical environments where registration staff may be working under time pressure or dealing with patients who may be distressed, confused, or unable to clearly communicate their details. The ID card system also benefits patients who frequently interact with the healthcare system, creating a streamlined experience that reduces wait times and administrative friction.

Furthermore, the physical ID card serves as a tangible connection between patients and their healthcare records, encouraging patients to maintain and present their identification consistently across different healthcare encounters and providers within the network.

ID cards can be configured for local context and printed directly from Tamanu

Strategy 3: Real-Time Duplicate Detection

Tamanu’s newly released real-time duplicate detection represents a significant advancement in proactive duplicate prevention. This intelligent system operates at the point of patient registration, analyzing incoming patient data against existing records using sophisticated matching algorithms that consider multiple data points simultaneously.

The system evaluates various criteria including name similarities (accounting for common spelling variations and phonetic matches), birth dates, contact information, and other identifying characteristics. This multi-factor analysis helps identify potential duplicates even when exact matches aren’t present, recognizing that patient information may be provided differently across various encounters.

One of the system’s most significant advantages is its offline capability. Many healthcare facilities, particularly in rural or resource-limited settings, face connectivity challenges that can interrupt their workflows. Tamanu’s offline duplicate detection ensures that patient safety measures remain active regardless of internet availability, making it an ideal solution for diverse healthcare environments.

When potential duplicates are identified, the system presents them to registration staff for review, enabling informed decisions about whether to link to an existing record or proceed with creating a new patient entry. This human-in-the-loop approach combines the efficiency of automated detection with the nuanced judgment that healthcare professionals bring to patient identity verification.

Strategy 4: Patient Merge Tool

Despite the best prevention efforts, duplicate records sometimes occur, particularly when integrating legacy data or managing complex patient populations. Tamanu’s patient merge tool provides a secure, comprehensive solution for consolidating duplicate records while preserving the integrity of all associated clinical data.

The merge process is designed with both safety and usability in mind. Authorized administrators can access the merge functionality easily through Tamanu’s admin panel, using a simple user interface. Here they can review duplicate records and complete the consolidation process. The system preserves all medical history, appointment records, clinical notes, laboratory results, and other patient data, ensuring that no information is lost during the merge operation.

This comprehensive data preservation is crucial for maintaining clinical continuity and meeting regulatory requirements for medical record retention. The merged record provides clinicians with a complete, unified view of the patient’s healthcare history, enabling more informed clinical decision-making and better care coordination.

The merge tool also maintains an audit trail of the consolidation process, documenting which records were merged and when, supporting quality assurance efforts and regulatory compliance requirements.

Strategy 5: Database-Wide Reporting

Maintaining long-term database integrity requires periodic assessment and cleanup of existing patient data. Tamanu’s comprehensive reporting tool addresses this need by analyzing entire patient databases to identify potential duplicates that may exist within legacy data or have been missed by real-time detection systems.

The reporting system employs advanced pattern recognition algorithms to examine patient data across multiple dimensions, identifying subtle similarities that might indicate duplicate records. Like the real-time duplicate detection, this analysis goes beyond simple name matching to consider combinations of demographic information, contact details, and other identifying characteristics that could suggest the same individual is represented multiple times in the database. The system is also designed to improve as it goes. We leverage machine learning to enhance the identification of potential duplicate patient records. Our models are trained to account for regional naming variations and cultural nuances—for instance, recognizing that “Jenny” and “Jennifer” may refer to the same individual. This is done by labelling pairs of potential matches as duplicate, different or unsure. This approach improves accuracy across diverse datasets and geographies.

The reports provide actionable insights, presenting suspected duplicates in a format that enables efficient review and decision-making by administrative staff. This systematic approach to database maintenance helps healthcare organizations conduct regular data hygiene audits, ensuring ongoing database quality and supporting accurate healthcare analytics and reporting.

These periodic cleanups are particularly valuable for organizations transitioning from paper-based systems or consolidating data from multiple legacy electronicsystems, where duplicate creation may have occurred during data migration processes.

The Importance of Integrated Systems and Processes

While Tamanu’s built-in deduplication strategies provide robust protection against patient duplicates, the most effective approach to patient identity management can involve integration with complementary systems and processes that strengthen identification accuracy from multiple angles.

Biometric Identification Systems

Biometric identification represents a powerful complement to traditional patient identification methods, offering unique advantages in accurately distinguishing between individuals. Simprints, an open-source biometric identification platform, is one such example which exemplifies how these technologies can enhance patient identity management in healthcare settings.

Biometric systems capture unique physiological characteristics—such as fingerprints, iris patterns, or facial features—that remain consistent throughout an individual’s lifetime. When integrated with EMR systems like Tamanu, biometric identification can provide definitive patient verification that transcends the limitations of traditional identifiers like names, addresses, or even identity documents, which can be forgotten, lost, or shared between family members.

Simprints has demonstrated particular effectiveness in challenging healthcare environments, including refugee settings, rural communities, and populations with limited documentation. The system’s open-source nature makes it accessible to healthcare organizations with varying resource levels, while its offline capabilities ensure functionality in areas with limited connectivity—a critical consideration for many healthcare deployments.

Biometric identification is not a panacea – in larger populations across broad age and ethnic spectrums, biometrics can help to massively reduce patient duplication and improve patient identification, but the systems still need to be backed by strong patient management systems and high quality policies and procedures.

Civil Registration and Vital Statistics (CRVS) Integration

Civil Registration and Vital Statistics systems provide another crucial layer of patient identity verification and lifecycle management. These systems maintain authoritative records of births, deaths, marriages, and other vital life events that establish and track individual identities throughout their lives. EMRs should interact with CRVS systems at moments including birth and death to ensure that people have official identities that benefit them throughout all facets of their lives, not just healthcare. The integration of CRVS systems with EMRs like Tamanu creates a comprehensive identity ecosystem where healthcare records are anchored to officially recognized vital events.

Birth registration data helps establish definitive patient identities from the earliest stages of life, providing healthcare systems with authoritative information about patient demographics and family relationships. Death registration integration ensures that deceased patients are appropriately flagged in healthcare systems, preventing inappropriate record creation and supporting accurate population health statistics

OpenCRVS represents a leading example of modern CRVS implementation, working globally to improve the management of vital events and strengthen the foundation of identity management systems. Also a free and open-source platform, OpenCRVS are working in the Indo-Pacific region with partners including BES and agencies such as SPC. When integrated with healthcare systems, CRVS data provides several critical benefits for patient identity management.

Conclusion

Effective patient duplicate management requires a comprehensive, multi-layered approach that addresses both prevention and remediation while integrating with broader identity management ecosystems. Tamanu EMR’s five-strategy framework—PMI integration, ID card systems, real-time detection, merge tools, and database-wide reporting—provides healthcare organizations with robust tools for maintaining clean, accurate patient databases.

By combining Tamanu’s built-in deduplication strategies with thoughtful integration of complementary identification systems, healthcare organizations can achieve the highest levels of patient data integrity. This comprehensive approach ensures that every patient record is unique, accurate, and complete—supporting the delivery of safe, coordinated, and effective healthcare services.

Tamanu EMR’s comprehensive approach to duplicate management provides healthcare organizations with the tools and strategies needed to achieve and maintain this essential data quality standard. Come and chat with us about how our Project Management and Data teams can help your health ecosystem achieve its goals.

Watch our video on the five Tamanu deduplication strategies here:

Health facility assessments in Papua New Guinea have been successfully digitised in Tupaia – a GIS and data intelligence platform built by BES – in June 2025. The project, co-funded by the World Bank Group and the Australian Government’s Department of Foreign Affairs and Trade (DFAT) was implemented by partners, the United Nations Office for Project Services (UNOPS) and BES.

In Papua New Guinea, routine health facility assessments allow the national Department of Health to identify gaps in areas like health service provision, staffing levels, infrastructure and biomedical equipment.  In the past, the process for conducting these assessments was made particularly time consuming thanks partly to the use of PDF forms for data collection and spreadsheets for analysis and reporting. 

In June 2025, the health assessments were fully digitised in Tupaia which means that data reporting is now integrated with data collection with the aim of improving the efficiency, quality and accessibility of health assessments. The digitised tool provides health administrators with valuable information to make decisions about where to allocate resources to improve health services for the people of Papua New Guinea. Improved resource allocation should in turn result in better health outcomes.

Gau Baru, Chief Technical Officer, Health Engineering Services, National Department of Health, piloting Tupaia at 6 Mile Polyclinic, 4 June 2025

The key changes made through digitisation of the health facility assessment tool are the speed with which reports are generated and the quality and accessibility of data contained in the reports. Auditors can now collect data through Tupaia’s offline app, MediTrak, while customised reports built in Tupaia.org update as soon as new data syncs. The reports contain a vast array of data, including comparisons with national standards, which is summarised into dashboards and maps that use colour to visually identify areas of concern. 

The system also includes an inventory management module that uses Tupaia’s QR Code capabilities for maintaining records on biomedical and static equipment.

Infrastructure & Engineering dashboard in Tupaia.org

“The tool is one important element that we have been longing for, and having the condition and status (of a facility) known to us has always been challenging. The tool will provide us with the evidence and data we really need to help with evidence based decision making.”

Ambrose Kwaramb, Head of National Health Services Standards

Between April and June 2025 and in collaboration with UNOPS and NDOH, BES imported into Tupaia NDOH’s six assessment surveys and data for 31 health facilities, built reporting dashboards containing over 200 separate data visuals, and piloted the tool with the National Health Services Standards team at 6 Mile Polyclinic health facility in Port Moresby.

“I find the tool very easy, very reliable and user friendly. Previously we used paper which took a lot of time and some data went missing. With Tupaia we just enter data and the information is straight there on the dashboard”

Roy Matthew, Nursing Officer at 6 mile Polyclinic

BES is proud to have contributed to the digitisation of health facility assessments in PNG.

Every day, digital health systems built by BES help visualise thousands of data points across the Pacific and beyond. But data isn’t useful just because it exists. It has to be structured, validated, and presented in a way that helps people make real-world decisions. That’s the job of our data team.

In this post, we share a bit about how that happens – the people behind it, the processes that keep it running, and the work we do to turn raw data into something that matters. Our data team spans Melbourne, Sydney and Canberra, and brings together a mix of backgrounds across analytics, software engineering, and biomedical research.

From point of care to point of impact

Data in Tupaia comes from many sources. Our own data collection tools — MediTrak on Android and DataTrak in the browser — are widely used, especially for surveys and field reporting. But we also pull data from other systems including Tamanu, DHIS2, mSupply, Kobo, and Google Drive, among others. These integrations are designed to be flexible: we can ingest data through APIs, database exports, backups, or spreadsheets, depending on the context.

But just ingesting data isn’t enough. Once we have it, we need to make sure it’s clean, consistent, and safe to report on. That’s where our processing pipelines come in.

Built-in checks and balances

Our data pipelines process over 30 million data points every single day. For that to work reliably, we use automated checks to detect issues in real time, before they impact reports.

When new data arrives, it goes through a series of steps that automatically:

• Remove any deleted, outdated, or otherwise unneeded records
• Check for issues like missing values, data integrity failures, etc.
• Flag inconsistencies for our team to review

If something looks off, it doesn’t just sit there quietly. A validation error is raised and the team is notified. These early alerts are often what allow us to catch issues before they make it into a report or dashboard. It also means we can go back to the original data source, and make sure it doesn’t happen again – whether that’s through user training, or requesting a bug fix in the source system.

Making it easy to report on what matters

As data is ingested, validated, and cleaned, we simultaneously structure it into reporting-friendly database views. We also apply standard calculations at this database view layer, so that metrics are consistent from one visualisation to another. This helps ensure dashboards are fast and reliable, while also keeping the reporting logic clear and easy to follow. Tamanu reports use straightforward queries on these views, and the data from them flows through the rest of our data pipelines. Once in Tupaia’s Viz Builder, they can be combined, filtered, and visualised however needed.

A real-world example: forecasting medication shortages

In September 2023, the Samoan Ministry of Health carried out a mass drug administration for lymphatic filariasis and scabies. Doses were weight-based, and recorded each evening in Tamanu. These were visualised immediately in Tupaia.

After a few days, the dashboards showed something unexpected: stock levels were dropping faster than anticipated. Because of how we model and visualise data, the Ministry was able to quickly spot the trend and take action — placing an emergency order for more medication to ensure the campaign could continue.

That’s the kind of impact we want our data systems to have: helping people see the issue early, and act on it.

To read more about this case study and others like it, visit Data for decision making case studies from the Pacific.

Why it matters

Whether it’s a national outbreak dashboard, a forecasting tool, or a facility-level report, our goal is always the same: to make health data useful. Only then can it be used to improve patient safety, make better policy decisions, or strengthen public health programming.

It takes a solid system, a clear process, and a good team to get there. Fortunately, we have all three.

We’re excited to announce the Spring 2025 super release of Tamanu, our Electronic Medical Record. Officially launching August 14^th, this release represents our most significant leap forward in clinical efficiency, data integrity, and user experience since the release of Tamanu 2.0. Built on extensive feedback from our healthcare partners, these six major enhancements address real-world challenges that clinicians and administrators face daily in our partner countries while maintaining the robust, reliable foundation that Tamanu users have come to trust.

Our latest super release – the first in 18 months – contains six major new features (as well as dozens of minor features and optimisations):

Enhanced medication module

Patient charting

Intelligent duplicate patient detection

Floating encounter notes

Enhanced auditability

Enhanced program registries

1.     Enhanced Medication Module: Comprehensive medication management

Medication management is a cornerstone of patient safety and clinical care, and our enhanced medication module delivers significant improvements to how healthcare teams track, administer, and monitor patient medications.

Medication Administration Record (MAR)

The introduction of the Medication Administration Record represents a major advancement in medication safety and documentation. This feature provides a centralized system for tracking when medications are administered, by whom, and under what circumstances. Healthcare providers can now maintain accurate, real-time records of medication administration, reducing the risk of medication errors and improving compliance with safety protocols.

The MAR system supports complex medication regimens, including scheduled medications, PRN (as-needed) administrations, and one-time doses. This comprehensive approach ensures that all members of the healthcare team have immediate access to current medication status, supporting seamless care transitions and reducing the potential for adverse drug events.

Patient-level ongoing medication tracking

Beyond individual administrations, the enhanced module now provides robust tracking of ongoing medications at the patient level. This longitudinal view allows clinicians to monitor medication histories, and make informed decisions about new prescriptions or medication changes. Ongoing medications can be brought into each encounter with a single click, saving huge amounts of time, and reducing transcription errors.

The system maintains a complete record of current and historical medications, including dosage changes, discontinuations, and the clinical reasoning behind medication decisions – it also supports pharmacy notes, allowing the pharmacy team to undertake medication reviews from their desks.

This comprehensive medication profile supports continuity of care and enables more informed clinical decision-making across all patient encounters.

2.     Patient Charting: Longitudinal data capture within and between encounters

Longitudinal clinical care often requires tracking multiple, complex data points over time, and our new Patient Charting feature transforms how clinicians document, monitor, and use this critical patient information.

Comprehensive charting capabilities

The Patient Charting module enables better tracking of longitudinal data both within individual encounters and across multiple patient visits. This capability is particularly valuable for managing complex conditions that require ongoing monitoring and trending of clinical parameters.

Clinicians can now easily chart critical areas including fluid management, pain assessment and management, wound care progression, maternal health monitoring, and partograph documentation. Each of these specialized charting areas is designed to support the specific workflows and documentation requirements that clinicians encounter in their daily practice – and deployments are able to configure their own charts using easy reference data imports – no coding is required.

Strengthening clinical decision support

By providing clear visualization of trends and patterns in patient data, the charting system supports more informed clinical decisions. Healthcare providers can quickly identify concerning trends, evaluate the effectiveness of interventions, and adjust care plans based on comprehensive longitudinal data. It also allows clinicians to more easily track metrics across multiple encounters.

This last feature – the system’s ability to track data across encounters – is particularly valuable for chronic disease management (e.g. diabetes or hypertension), post-operative care, and other situations where long-term monitoring is essential for optimal patient outcomes.

3.     Intelligent duplicate patient detection

Patient misidentification remains a persistent challenge in healthcare, potentially leading to fragmented medical records, medication errors, and compromised patient safety. Our new duplicate patient alert system addresses this challenge with sophisticated detection capabilities.

Advanced fuzzy matching technology

When creating new patient records, Tamanu now automatically checks for existing patients using PostgreSQL’s fuzzy string matching capabilities – and the system can check in real-time, alerting admin users before the record is created. This technology goes beyond simple exact matches to identify potential duplicates even when there are common data entry variations.

The system is designed to catch duplicates despite spelling errors (Jon vs John), phonetic variations (Smith vs Smyth), minor typing mistakes, and even common date formatting errors like swapped days and months in birth dates. This comprehensive approach significantly reduces the risk of creating duplicate records while maintaining system performance.

Flexible and Updatable Detection Logic

The duplicate detection system is built using a PostgreSQL function that can be updated as organizational needs evolve. The function applies a principle called ‘Levenshtein distance’ to determine the likelihood that a newly created record is a duplicate of an existing record.

Intelligently and flexibly, countries can tweak the existing algorithm to suit their needs or use entirely new functions in the future. This flexibility ensures that the system can be fine-tuned based on the specific patient populations and naming conventions relevant to each healthcare organization – and also that the system can evolve as more modern tooling emerges.

While the system is highly effective, we’ve been transparent about current limitations, such as when there are significant phonetic differences in last names and substantial variations in name length. This transparency allows users to understand the system’s capabilities and implement appropriate additional verification procedures where needed. Users retain the ability to produce near-duplicate patients and can be simply prompted to choose the patient record they would like to work with.

4.     Floating encounter notes: A game-changer for clinical documentation

Clinical documentation has always required a delicate balance between thorough record-keeping and efficient patient care. Our new floating encounter notes feature addresses a longstanding user request and represents a significant improvement in clinical workflow design.

“Can we enter patient notes whilst we navigate throughout the rest of patient’s record?” – yes, now you can.

Seamless chart navigation while documenting

The enhanced notes modal now allows users to navigate a patient’s chart while simultaneously recording encounter notes. This seemingly simple improvement addresses a major frustration point for clinicians who previously had to choose between completing their documentation and reviewing relevant patient information.

Clinicians can now reference previous visits, review medication lists, check lab results, and examine imaging reports without interrupting their documentation process. This capability is particularly valuable during complex patient encounters where multiple systems and historical data points need to be considered.

Improved clinical decision-making

By enabling simultaneous chart review and documentation, this feature supports more comprehensive and accurate clinical notes. Clinicians can incorporate relevant historical information, identify patterns across visits, and make more informed decisions about patient care—all while maintaining their documentation workflow.

The reduction in navigation burden translates to decreased frustration and improved job satisfaction for healthcare providers, while also supporting more thorough and accurate patient records.

5.     Enhanced auditability: meeting international standards

Recognizing the critical importance of audit trails in healthcare systems, we’ve significantly enhanced Tamanu’s auditability features. These improvements align with ISO27789: Health informatics – Audit trails for electronic health records, ensuring that our audit capabilities meet international standards for healthcare information systems.

Comprehensive audit trail architecture

Our enhanced audit system tracks two distinct types of activities, providing comprehensive visibility into all system interactions:

Access Tracking monitors when logged-in users view patient personal and clinical data. The system intelligently differentiates between different types of access patterns. For instance, when a user searches for a patient by name, this generates a “query access” log entry for the list of results returned. When they subsequently open a specific patient record to view complete information, this creates a “single access” log entry. This granular approach ensures that audit trails capture the full context of how patient information is accessed and used.

Change Tracking captures all modifications made to data within Tamanu, including creates, updates, and deletes. This encompasses both user-initiated changes made as part of clinical workflows and system-generated actions such as automatic patient discharges. The comprehensive nature of this tracking ensures that every data modification has a clear audit trail, supporting accountability and compliance requirements.

Of course, we retain all of our existing front-end edit logs, including for notes, vitals, lab results and more. The enhanced auditability functions are a step up from these tools though to allow fare more comprehensive audit trails.

Supporting healthcare governance

These audit enhancements provide healthcare organizations with the detailed information needed to address various circumstances, from routine quality assurance to regulatory compliance and security investigations. The alignment with ISO27789 standards ensures that Tamanu’s audit capabilities meet the rigorous requirements expected in healthcare environments.

The enhanced audit trails support healthcare organizations in demonstrating compliance with privacy regulations, tracking user activities for security purposes, and maintaining the data integrity that is essential for quality patient care.

6.     Revolutionizing program registry management

The final pillar of this release is our comprehensive enhancement to the Patient Program Registry Module. Healthcare organizations managing cohorts for disease surveillance, chronic condition tracking, and population health programs will find these improvements transformative for their daily operations.

Advanced condition category tracking

One of the most significant improvements is the introduction of condition category tracking with configurable statuses. Clinicians can now track the natural progression of conditions through customizable stages such as “suspected,” “under investigation,” and “confirmed.” This granular approach reflects the reality of clinical practice, where diagnoses often evolve as more information becomes available.

The system maintains a complete audit trail of these status changes, providing healthcare teams with unprecedented visibility into how conditions develop over time. This transparency is crucial for quality assurance, clinical decision-making, and regulatory compliance. Users can see exactly when a condition status changed, who made the change, and what information was available at each stage of the diagnostic process.

Streamlined registry management workflows

We’ve consolidated registry management into a unified interface that allows clinicians to update both registry status and multiple related conditions simultaneously. This workflow optimization eliminates the need to navigate between different screens and reduces the time required to maintain accurate patient records. For busy healthcare environments, this efficiency gain translates to more time available for direct patient care.

Enhanced data model architecture

Behind the scenes, we’ve restructured the program registry data model to support improved auditing and condition tracking. A critical improvement is that conditions are now directly linked to specific registrations rather than patients. This architectural change prevents conditions from automatically carrying over between registry enrolments and allows the same condition to be recorded multiple times when clinically appropriate (for example, across multiple diagnoses of dengue or malaria).

This enhancement ensures data integrity while providing accurate historical tracking. Healthcare organizations can now maintain precise records of when patients were enrolled in specific programs, what conditions were relevant during each enrolment period, and how those conditions evolved over time.

The updated patient-level dashboard now displays condition categories clearly, giving clinicians immediate insight into a patient’s current status across all relevant programs. The improved registry activation process preserves condition history, ensuring that valuable clinical information is never lost during transitions between programs.

Looking forward

The Spring 2025 super release represents our commitment to continuous improvement based on real-world healthcare needs. These six major enhancements—from sophisticated program registry management and intelligent duplicate detection to seamless clinical documentation, comprehensive medication management, advanced patient charting, and robust audit trails—work together to create a more efficient, accurate, and compliant healthcare information system.

As healthcare continues to evolve, Tamanu remains dedicated to providing the tools and capabilities that enable healthcare organizations to deliver exceptional patient care while maintaining the highest standards of data integrity, clinical efficiency, and regulatory compliance.

Later in 2025? Look out for our new patient portal, launching in Q4, 2025. The patienr portal will give patients greater access to their healthcare record as they move throughout the systems and across their lives. We will also be introducing our new AI tool, ‘Atamai’, which will allow users to query data using plain language requests. Keep your eyes out – it’s going to be incredible.

We encourage all users to explore these new features and provide feedback as we continue to refine and enhance the Tamanu platform. Your insights and experiences are invaluable in shaping the future of healthcare information management in our region.