Beyond the day-to-day obstacles of paper-based records and fragmented patient information, MSF faced fundamental architectural challenges in their approach to digital health systems:

• Lack of Portability: Previous EMR implementations were tightly coupled to specific environments, making it difficult to deploy the same solution across different MSF missions with unique infrastructural constraints - and complicating the long-term maintenance of the systems.
  
  
• Limited Adaptability: Systems often required extensive reconfiguration or custom development for each new deployment, increasing costs and delaying implementation.
  
  
• Poor Interoperability: Siloed systems hampered effective information exchange between different components of the healthcare ecosystem, limiting the value of collected data within and outside facilities - such as external lab tests for example. 

These challenges directly impacted MSF's ability to scale digital health solutions across their global operations. With each new mission typically requiring its own custom implementation, MSF faced unsustainable costs and inconsistent user experiences across different contexts.

After a comprehensive feasibility study, MSF partnered with Madiro to begin implementing OpenMRS 3 and Ozone HIS as the foundation for their LIME project. This collaboration directly addressed MSF's three critical success criteria:

• Portable Architecture: Ozone's approach leverages containerization and orchestration to create an agnostic architecture that can function across diverse infrastructure environments, from well-connected hospitals to remote field clinics.
  
  
• Modular Configuration: The implementation utilizes Ozone's content and configuration management capabilities that separate core functionality from site-specific settings, enabling easy updates without modifying the underlying system and inheritance of configurations, which is key to reusability across projects.
  
  
• Interoperable Design: Ozone allowed MSF to easily add an interoperability layer like OpenFN to enable data exchange between OpenMRS 3 and DHIS2, saving hours of manual data entry and increasing the quality of data. 

The implementation at Mosul Hospital began in 2024 and serves as a proof of concept for this modular approach. The system is designed to be replicable across other MSF missions with minimal reconfiguration, and also allows for an iterative digitalization, one department at a time. 

"The modular approach of Ozone means that the same configuration that works in Iraq can be deployed in other countries and projects with minimal changes, dramatically reducing the time and cost of bringing digital health to projects in the field." - Michael Bontyes, Technical Lead at MSF.

Even at this early stage, the MSF experience in Iraq offers valuable insights into building truly reusable digital health solutions:

• Containerization and orchestration are essential for creating portable systems that can function across diverse infrastructure environments.
• Separating configuration from core functionality enables rapid adaptation to new contexts without requiring custom development.
• The modular approach significantly reduces the total cost of ownership by enabling components to be reused across implementations.

This pioneering implementation exemplifies how Ozone's modular architecture can transform humanitarian healthcare delivery. As the pilot project in Mosul continues to evolve, it will serve as a model for future deployments across MSF's global operations, potentially saving millions in development and maintenance costs while bringing digital health benefits to more projects and patients.

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