Position: Ongoing Recruitment- STTA Junior Nation: Research Manager (Clinical)

Palladium Pakistan (Pvt.) Limited

Job Location: Lahore

Country: Pakistan

Positions: 1

Job Type: Consultancy

Department / Job Category: STTA-Junior National

Last Date: 30th July 2025

TA Title: EMR and HMIS Linkage & Interoperability, and Development of HMIS Manual and SOPs for Patient Referral Management System

Programme

Evidence for Health (E4H) is a Foreign, Commonwealth & Development Office (FCDO)-funded programme aimed at strengthening Pakistan's healthcare system, thereby decreasing the burden of illness and saving lives. E4H provides technical assistance (TA) to the Federal, Khyber Pakhtunkhwa (KP), and Punjab governments, and is being implemented by Palladium along with Oxford Policy Management (OPM).

Through its flexible, embedded, and demand-driven model, E4H supports the government to achieve a resilient health system that is prepared for health emergencies, responsive to the latest evidence, and delivers equitable, quality, and efficient healthcare services. Specifically, E4H delivers TA across three outputs:

Output 1: Strengthened integrated health security, with a focus on preparing and responding to health emergencies, including pandemics.

Output 2: Strengthened evidence-based decision-making to drive health sector performance and accountability.

Output 3: Improved implementation of Universal Health Coverage, with a focus on ending preventable deaths.

Background and Problem Statement

Punjab Is undergoing huge transition In health system where primary health facilities are being outsourced to private entities. The project Is ongoing and by next year, It Is assumed more than half of the primary facilities may be run by the private contractors. Therefore, role of data systems Is of utmost Importance and concern, to be kept Intact.

One of the key reform efforts includes the transition toward a more integrated, digitized Hospital Management Information System (HMIS). This transition aims to enable evidence-based decision-making, improve patient tracking, and foster accountability across primary and secondary levels of care.

The DHIS-II, Is existing In parallel to these 2 systems, and by now, almost all the districts have been trained and are regularly reporting data on DHIS-II. The partners emphasizing DHIS-II , are solely working and supporting through MIS cell In the directorate general health services, while EMR and HMIS are sole Initiatives of HISDU by the H&PD. This data reporting dichotomy makes health facilities representatives overburdened and leads to data quality, completeness, validity and accuracy Issues with a lot of overlapping Information across system. Despite the deployment of Electronic Medical Records (EMRs) and HMIS in Basic Health Units (BHUs), Rural Health Centers (RHCs), Tehsil Headquarter Hospitals (THQs), and District Headquarter Hospitals (DHQs), several operational gaps remain. These include inconsistent data entry practices, a lack of unified standards across different tiers of the health system, and limited capacity among staff to navigate and use the digital tools effectively. Moreover, the two systems do not communicate with each other and one of the most persistent challenges is the absence of standardized guidelines and documented workflows for managing patient referrals across facilities. As a result, referrals are frequently ad hoc, untracked, and misaligned with care protocols, leading to delays, duplication of services, and fragmented patient journeys. This lack of coordinated referral tracking compromises continuity of care, as patients often fall through the cracks between service levels or facilities. Critical clinical information may be lost or omitted, increasing the risk of misdiagnosis, inappropriate interventions, or medication errors. Moreover, the absence of systematic oversight diminishes accountability and undermines patient safety, particularly for those with complex or chronic conditions requiring timely and integrated management.

Health facility staff—including HMIS operators, healthcare providers, and administrative focal points—often rely on informal practices in the absence of standardized operating procedures. This limits the system’s ability to deliver continuity of care, complicates supervision, and dilutes the integrity of health data needed for planning and performance monitoring. 

To address these systemic gaps, E4H will support the linkage and interoperability of the EMR and HMIS and work closely with HISDU to develop a user-focused HMIS Manual along with a set of Standard Operating Protocols (SOPs) for inter-facility patient referrals. This work is not only critical for systematizing current HMIS use, but also for embedding standardized referral pathways that are operationally feasible, digitally integrated, and institutionally anchored.

By defining clear roles, user flows, and escalation protocols, the TA will facilitate more consistent data practices, reinforce digital governance, and lay the groundwork for a more interoperable and patient-centred health system. It is anticipated that the outputs of this assignment will serve as a blueprint for broader scale-up and will inform future reforms aimed at strengthening health system responsiveness, efficiency, and quality of care across Punjab.

Strategic Approach in alignment with other E4H ongoing initiatives

• This support was a direct request from the Deputy Director HISDU during an engagement meeting held with HISDU. 

• HISDU will be requested to share the operational framework of each of the systems e.g; EMR, HMIS and DHIS-II (If they have a role in DHIS-II). DHIS-II system Is being used In split format across the overall health information system. 

• At the sectoral level, the assignment contributes to the Health System Building Block of Health Information Systems (HIS) by improving data integrity, interoperability, and the institutionalization of digital workflows.

• The work that will be done in this TA is envisioned to yield far-reaching benefits. With a unified and interoperable system, the Department of Health and Population gains access to high-quality, real-time data that serves as the backbone for evidence-based decision-making. This, in turn, will bolster the department’s ability to plan, allocate resources, and respond effectively to emerging public health issues. 

• The interoperability will do more than just connect two systems; it fundamentally aims to transform the functionality of the entire health data ecosystem. First, by enforcing standardized data entry practices and uniform guidelines, the system will minimise the inconsistencies and ad hoc practices currently seen in patient referral tracking and record keeping. Such harmonization is key to improving diagnostic accuracy and treatment continuity because patient journeys become better documented and more easily traceable across primary and secondary care levels. Furthermore, establishing clear user flows and detailed operating procedures will build capacity among health facility staff, ensuring that everyone—from HMIS operators to frontline healthcare providers—has the necessary tools and knowledge to operate within a digitally integrated framework.

• A robust interoperability framework sets the stage for long-term reform and scalability. The development of a standardized HMIS Manual and referral SOPs will improve policy coherence and reinforce accountability mechanisms at both facility and system levels. The TA also supports HISDU by ensuring procedural, and technical alignment with existing health information architecture.

Objective

To support the Health & Population Department in institutionalizing a coherent, interoperable digital health information infrastructure by standardizing referral management protocols and HMIS workflows. This transformation aims to enable an integrated, data-driven ecosystem across primary and secondary healthcare facilities, enhancing continuity of care, patient safety, and system accountability.

Specific Objectives

1. Establish a Digitally Enabled Referral System:
   Develop and validate SOPs for patient referral management that are technically integrated with EMR systems, ensuring referrals are coherent, traceable, and aligned with institutional standards across facility levels.

2. Standardize Health Information Workflows:
   Create an HMIS Manual that defines digital workflows, user roles, and data standards across BHUs, RHCs, THQs, and DHQs, enabling consistent and efficient data capture and utilization within an interconnected system.

Scope of Work and Methodology

The technical assistance (TA) will be delivered through a structured approach over a period of eight months (July 2025 – February 2026), covering planning, development, validation, and rollout support. This approach emphasizes not only the standardization of digital health processes but also the seamless interoperability between the EMR and HMIS systems.  The methodology will ensure stakeholder engagement, contextual alignment and operational feasibility at each stage.

Phase 1: Inception and Planning

• Engage Stakeholders: Convene an inception meeting with key stakeholders—including H&PD, HISDU, SHC&MED and facility teams—to define the scope, clarify roles, and establish coordination mechanisms with a focus on both standalone digital processes and the integration of EMR and HMIS functionalities.

• Develop a Detailed Plan: Create a comprehensive work plan and engagement strategy that outlines key milestones, timelines, and specific interoperability requirements.

• Output: An Inception Slide Deck that details the overall methodology, integration roadmap, linkage, Interoperability plan, timelines, and coordination plan..

Phase 2: Situational Assessment and Gap Analysis

• Review Current Systems: Conduct a thorough review of existing HMIS and EMR tools, workflows, referral protocols, and associated documentation to identify where interoperability gaps exist using standardised tool.

• Conduct Consultations: Engage with staff across BHUs, RHCs, THQs, and DHQs in selected pilot districts to understand current digital practices, challenges, and interoperability readiness.

• Map Workflows in close collaboration with HISDU: Develop a referral workflow map that highlights bottlenecks and gaps in both data exchange and system integration between the EMR and HMIS.

• Output: A comprehensive Gap Analysis Report and Referral Workflow Map that emphasize interoperability challenges and opportunities.

Phase 3: Tool Development

• Draft the HMIS Manual: Develop a modular, digital and user-friendly HMIS User Manual tailored to different facility types. This manual will detail system access procedures, user roles, data standards, and digital workflow protocols that ensure consistent and interoperable operations with EMR systems.

• Develop Integrated SOPs: Create Standard Operating Procedures (SOPs) for referral workflows, including clear flowcharts, decision trees and escalation procedures. These SOPs will explicitly outline how data should be exchanged between the HMIS and EMR systems to maintain a seamless referral process.

• Output: Draft HMIS Manual and Referral SOPs (Version 1) that incorporate the interoperability and linkage aspects between EMR and HMIS.

Phase 4: Validation and Pilot Testing

• Pilot Testing in Select Facilities: Implement the draft manuals and SOPs in selected pilot facilities to test both the standalone processes and the integration between EMR and HMIS.

• Feedback Collection: Use structured tools and focus groups to gather user feedback on the effectiveness, clarity, and interoperability of the drafted tools.

• Output: A Pilot Evaluation Report along with a Finalized HMIS Manual and Patient Referral SOPs that fully integrate EMR and HMIS linkage.

Phase 5: Capacity Building and Rollout Preparation

• Orientation and Training: Conduct Training of Trainers (ToT) workshops and orientation sessions for facility-level staff to build competencies in using the integrated digital systems, emphasizing interoperability protocols.

• Develop Support Materials: Create comprehensive training materials, visual job aids, and a monitoring checklist that include guidelines for both EMR and HMIS interoperability.

• Output: An Orientation Package and Implementation Toolkit that support the scale-up of an interoperable, integrated digital health system across the province linked with overarching Sustainable Training System and institutionalization in PHDC.

By following this structured and participatory methodology, the TA will produce actionable, user-tested tools that are embedded while considering the health system transition In Punjab, and change In governance mechanisms.

Timeline and LOE

The level of effort for the role is 126 working days, from August 2025 - February 2026

Requirements:

Technical Expertise

• MD/MBBS with degree in health sciences or public health.

• At least 5 years of Overall experience

• Experience in synthesizing clinical SOPs and referral workflows.

• Experience coordinating activities at the facility level is an asset.

Competencies

• Strong analysis and synthesis of clinical information.
• High-quality documentation and reporting skills.
• Effective coordination with healthcare providers.
• Ability to contribute to collaborative teams.

Deliverables/KPIs

1. Inception Slide Deck
2. EMR-HMIS Interoperability Blueprint/ Framework
3. HMIS User Manual
4. Patient Referral Management SOPs
5. Pilot Evaluation Report
6. Orientation Package