OpenMRS in Rwanda Hamish SF Fraser Partners In Health Division of Global Health Equity, BWH Harvard medical School

OpenMRS: open source, modular EMR system Developed as a collaboration of PIH, the Regenstrief Institute and South African MRC Uses concept dictionary for data storage Modular design simplifies adding new functions and linking to other systems Supports multiple languages Released with open source license (April 2007) Core of paid programmers with growing community support www.openmrs.org Partners In Health Regenstrief Institute Medical reseach council SA

Developed as a collaboration of PIH, the Regenstrief Institute and South African MRC

Uses concept dictionary for data storage

Modular design simplifies adding new functions and linking to other systems

Supports multiple languages

Released with open source license (April 2007)

Core of paid programmers with growing community support

www.openmrs.org

OpenMRS sites - fall 2008

Rwanda

Rwanda health indicators A small central African country: Population 9 M people Highest population density in Africa, 85% rural Achieved rapid economic growth since genocide in 1994, but still has very poor health outcomes: Life expectancy 38-44 years Infant mortality 152/1000 Maternal mortality 1071/100K Medium income $230 HIV prevalence 3% Malaria prevalence 46%

A small central African country:

Population 9 M people

Highest population density in Africa, 85% rural

Achieved rapid economic growth since genocide in 1994, but still has very poor health outcomes:

Life expectancy 38-44 years

Infant mortality 152/1000

Maternal mortality 1071/100K

Medium income $230

HIV prevalence 3%

Malaria prevalence 46%

Accompagnateur, Haiti

OpenMRS at PIH sites in Rwanda Currently used for 12 PIH – supported health centers 8 sites have their own server, 6 remote sites maintain a synchronized copy of the entire database Registration, encounter and lab data for patients with HIV, TB and now heart failure Over 8000 patients tracked (Feb. 2009) Team of Rwandan data officers trained to enter data, ensure quality & produce reports Clinicians lookup of electronic patient summaries Many new research and clinical applications

Currently used for 12 PIH – supported health centers

8 sites have their own server, 6 remote sites maintain a synchronized copy of the entire database

Registration, encounter and lab data for patients with HIV, TB and now heart failure

Over 8000 patients tracked (Feb. 2009)

Team of Rwandan data officers trained to enter data, ensure quality & produce reports

Clinicians lookup of electronic patient summaries

Many new research and clinical applications

OpenMRS dashboard - HIV Care

Patient summary and alerts

Physician looking up ARV patient

Cohort builder Not actual names

Government of Rwanda EMR roll out The Government of Rwanda is committed to having a strong national EMR program MoH has stated that OpenMRS will be used for the national roll out to health centers and small hospitals MoH wants a non-disease specific system which: Can assist in the management of all outpatients Will also continue to be used for HIV management

The Government of Rwanda is committed to having a strong national EMR program

MoH has stated that OpenMRS will be used for the national roll out to health centers and small hospitals

MoH wants a non-disease specific system which:

Can assist in the management of all outpatients

Will also continue to be used for HIV management

Potential components of integrated national eHealth architecture in Rwanda EMR System OpenMRS National reporting system TRACNet Pharmacy system PIH Registration and insurance Mutuelle Mobile health systems OpenROSA Radiology / telemedicine system Laboratory System PIH-Lab-system IXF HL7 HL7 HL7? HL7 Dicom HL7 Supply chain systems Camerwa

Connecting sites with limited internet Potential solutions? #1: Collect Data on paper and ship it back to central location Pros vs. Cons ? Eldoret #2: OpenMRS ‘Lite’ Make light-weight copy of OpenMRS that support minimal functionality and distribute it to remote areas Pros vs. Cons ? #3: Separate Desktop Application Make completely separate application that works in disconnected mode –e.g Offline EMR, Haiti Pros vs. Cons ? #4: Connected installs of OpenMRS with data synchronization Pros vs. Cons ?

Potential solutions?

#1: Collect Data on paper and ship it back to central location

Pros vs. Cons ? Eldoret

#2: OpenMRS ‘Lite’

Make light-weight copy of OpenMRS that support minimal functionality and distribute it to remote areas

Pros vs. Cons ?

#3: Separate Desktop Application

Make completely separate application that works in disconnected mode –e.g Offline EMR, Haiti

Pros vs. Cons ?

#4: Connected installs of OpenMRS with data synchronization

Pros vs. Cons ?

Synchronization We created a new component to allow bi-directional synchronization between OpenMRS instances Uses limited internet capability, soon to be usable with USB memory stick 6 sites in Rwanda are now synchronizing Working on a general version, requires modification to the data model

We created a new component to allow bi-directional synchronization between OpenMRS instances

Uses limited internet capability, soon to be usable with USB memory stick

6 sites in Rwanda are now synchronizing

Working on a general version, requires modification to the data model

Data Synchronization: Vision

Challenges for OpenMRS deployments Reliability and support for equipment, power supplies and software Training Data management and quality control Evaluation Sustainability

Reliability and support for equipment, power supplies and software

Training

Data management and quality control

Evaluation

Sustainability

Collaborators and Funders Partners In Health Regenstrief institute Medical Research Council, South Africa World Health Organization US Centers for Disease Control Brigham and Women hospital Harvard Medical School University of KwaZulu-Natal Millennium Villages Project International Development Research Centre, Ottawa Rockefeller Foundation Fogarty International Center, NIH Boston Consulting Group Google Inc

Partners In Health

Regenstrief institute

Medical Research Council, South Africa

World Health Organization

US Centers for Disease Control

Brigham and Women hospital

Harvard Medical School

University of KwaZulu-Natal

Millennium Villages Project

International Development Research Centre, Ottawa

Rockefeller Foundation

Fogarty International Center, NIH

Boston Consulting Group

Google Inc

Acknowledgements Darius Jazayeri, Joaquin Blaya, Sharon Choi, Patrice Nevil, Christian Allen, Paul Biondich, Burke Mamlin, Justin Miranda, Ben Wolfe, Mark Mosely, Paul Farmer http://www.pih.org http://www.openmrs.org

Tracking HIV patients Patient data collection and project evaluation are core components of improving quality of care Accurate analysis requires patient level data EMR systems can implement guidelines and support best practice Allow real time tracking of patients to ensure they are followed up and taking ARVs, complementing work of accompagnateurs Green bar: Recent clinic visit and ARV pick-up. Red Bar: Neither event has occurred. Yellow bars: Only one tracking event has occurred

Patient data collection and project evaluation are core components of improving quality of care

Accurate analysis requires patient level data

EMR systems can implement guidelines and support best practice

Allow real time tracking of patients to ensure they are followed up and taking ARVs, complementing work of accompagnateurs

OpenMRS – Pharmacy System integration The prototype integration project is being developed in South Africa for use in a major public hospital in Pretoria. Uses MIRTH developed by a US based medical information integration company Webreach This work is being done by Ryan Crichton

The prototype integration project is being developed in South Africa for use in a major public hospital in Pretoria.

Uses MIRTH developed by a US based medical information integration company Webreach

This work is being done by Ryan Crichton

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