On December 17th 2022, Palau’s National Hospital held an official launch event for ‘Project Olangch,’ celebrating a comprehensive digitisation of their health information system and a truly transformative moment for healthcare in the country.

Some very special guests helped to mark the occasion, including Palau President Surangel Whipps Jr, Palau Minister for Health Gaafar J. Uherbelau, and Australian Foreign Affairs Minister Penny Wong.

L-R: Minister of State Gustav Aitaro, Australian Ambassador to Palau Richelle Turner, Shadow FM Simon Birmingham, Australian Foreign Affairs Minister Penny Wong, Palau President Surangel Whipps Jr., Health Minister Gaafar J. Uherbelau, Delegate Warren Umetaro, Senator Stevenson J. Kuartei.

Minister for Health Gaafar J. Uherbelau described Project Olangch as a “large leap” for Palau’s health sector. “In establishing Tamanu, Tupaia, and mSupply,” he said, “not only are we adapting and implementing newer and greener health information technology that will further streamline hospital operations, improve security, access, archiving and sharing of patient data and health information, more importantly, this initiative will allow us to provide more efficient care and services to patients and clients, not just here at The Belau National Hospital, but across the health sector to private clinics and healthcare providers.”

Senator Penny Wong also spoke warmly about the project, describing it in her speech as “a demonstration of practical co-operation…on things that matter.” 

One of the biggest highlights of the launch was receiving glowing feedback from many of the hospital staff, who praised the increased ease and efficiency of their workflow as well as an ability to make better-informed decisions regarding patient care.

From L-R: BES Project Officer Ming Ong, Hospital Administration Director Darnelle Worswick, Hospital Services Director Ngirachisau Mekoll, Global Health Administrator Omengkar Wally, Project Managers Rodney Miller and Georgia Lack, ICT administrator Smau Erungel.

About the Project

Project Olangch was initiated in 2020, when the Australian Embassy had a conversation with the Palau Ministry of Health and Human Services (PMHHS) as COVID-19 struck. The Palau MHHS partnered with Beyond Essential in 2021, with support from the Department of Foreign Affairs and Trade, to deploy our three platforms – Tamanu, Tupaia, and mSupply.

These three applications working in concert provide a comprehensive replacement for the paper-based system previously in use at Belau National Hospital. Here’s a quick introduction to the integrated digital health ecosystem:

-With Tamanu, staff now have digital tools at the patient bedside, offering medical history, data capture, and clinical decision support to help them work more quickly and safely.

-Aggregated health data is then visualised in Tupaia to assist with automated disease surveillance and public health reporting.

-When a patient presents at the pharmacy, their medication record can be managed in mSupply and their medicine can be safely dispensed.

The ecosystem improves efficiencies, reduces waste and costs, and improves access to critical health data, resulting in better health outcomes for all.

Dr. Maribeth Caguingin, Emergency Room Physician at BNH.

A Note on ‘Olangch’

Olangch is an important Palauan word meaning ‘a sign, distinguishing mark, indicator, or anything functioning to give directions.’ Olangch was selected by the ministry to describe a pivotal point in Palau’s healthcare journey, as well as to describe the tools the project implemented, which organise data to provide clearer directions for health professionals.

As COVID cases rise across the Pacific, Tamanu is being used to help manage the COVID-19 testing programs in Fiji and Palau. Tamanu is a free, open-source EMR designed specifically for low-resource and remote settings in the Indo-Pacific region.

Using both the Mobile and Desktop versions of Tamanu, staff are recording COVID-19 tests, along with lab results and disseminating this information quickly to contact tracing teams. The system also allows patients to get their results instantly, as soon as they are published by labs. In Fiji, over 50,000 tests have been entered via the system over the last 6 months, whilst in Palau they are one week in and already entering hundreds of tests each day.

As COVID-19 outbreaks spread in countries that were previously COVID free, the system is providing a hugely valuable tool for secure information management. Its ability to collect data offline (syncing when internet becomes available across desktop and mobile) makes it perfectly suited for the Pacific setting.

Our analytics shows that there have been over 60,000 visits to our online results checking tool in Fiji alone, which has therefore saved over 60,000 calls to the national call centre from people trying to find their COVID-19 test result.

The online test results widget in Fiji has been accessed more than 60,000 times

Features of Tamanu for COVID-19 testing:

• Swab teams can record the results of RDTs (rapid tests) using their mobile devices even when offline
• Swab teams can request PCR tests and capture all the details on patient swab forms using their mobile devices, even when offline
• Any laboratory in the country can receive a lab request once it is synced up and enter results using Tamanu Desktop – even if the laboratory loses internet after receiving the request. Results can include all details, including swab type, test type, technician, verification data, status, date/time and additional notes
• Patients can receive their results via a Certificate that is automatically generated
• Patients can check their results or verify it to external parties by using our online widget tool and entering a unique code they are given when being tested
• We can push results via an API to external systems or encode the data in Visible Digital Seals (QR Codes) in accordance with international standards

Like all Tamanu modules, the system is completely free and open-source, with funding support from DFAT’s Indo-Pacific Centre for Health Security. Tamanu can also be used to manage active COVID-19 patients across inpatient and home settings, collect contact tracing information and has a complete immunization module to record COVID-19 vaccines.

Please contact us for a demo or to join upcoming webinars.

This project is proudly supported by the Australian Government.

This is the current experience for healthcare workers in many countries like Palau, who often are forced to work across siloed technology to manage their health systems. Whilst they often have great individual systems for specific tasks, coordinating them is difficult. Regardless of these worker’s skills and capabilities, this spread-out structure causes avoidable inefficiencies.

Recent health crises, most obviously COVID-19, have highlighted the importance of maintaining efficient, functional and integrated eHealth systems to support health workers and improve health systems. This is why Beyond Essential Systems are excited to announce our partnership with the Palau Ministry of Health to help redesign their health information systems. Together, we will combine four key platforms under a single, fully integrated eHealth ecosystem. In doing so, we will be streamlining and optimising the capture of public health information, facility monitoring, disease surveillance and the distribution of essential medical supplies. We are excited about the opportunity to make a lasting, positive impact on the lives of everyday citizens, as well as health workers and decision makers.

Palau’s new system will combine DHIS2, mSupply, Tupaia MediTrak and the Tupaia platform. One of our key focuses will be ensuring information is automatically shared between these platforms, reducing double ups and miscommunications and allowing for efficient, real-time decision making. This focus on software will be combined with a focus on people, as we recognise that the individuals who work with these systems will be the real driving force for change. Through a variety of strategies, including long-term staff development and improved data governance mechanisms, we aim to ensure we build a system that works for users and supports the specific needs of communities in Palau.

We are particularly excited to work with software developers within the Palau Ministry of Health, who will be able to take advantage of the open-source architecture across the systems we are implementing.

Our passionate team are looking forward to sharing our experiences in this area – but we will definitely learn even more ourselves. Palau has a rich history and unique culture and we look forward to getting to know both, working alongside local partners to deliver a useful, effective solution to an important problem.

www.medqualityassurance.org