open standard EHR with open source based web development
Study on Electronic Health Record System Suited For
Developing Countries Environment
Case Study: A Private Emergency Medical Service in
Yunan Mahastra Satria
Global InformaLon and TelecommunicaLon Studies
Supervisor : Prof. Sadahiko Kano
Background of the Study
• Developing countries have neither ﬁnancial nor
• BeSer medical care is provided by private hospitals which
are expensive. They are equipped with proprietary
Electronic Health Records (EHRs) which is extremely costly.
• Emergency Medical Service (EMS) is provided by public
agency (government), but it is not meeLng the demands of
people. Therefore, private EMS is emerging in Indonesia
which uses currently paper based health records (word
ObjecLve and Scope of Study
• The objecLve of this study is to ﬁnd out a most appropriate
soluLon for Electronic Health Record (EHR) to be uLlized for
private Emergency Medical Service (EMS) in Indonesia in
order to replace the current paper based health record.
• Therefore, I have chosen the use of free open source based
soware (FOSS) to develop web‐based soware applicaLon
EHR in order to replace the current paper‐based health
record and to solve the lack of ﬁnancial resources issue of
Sharing of data among diﬀerent exper2se in EMS opera2on
Pre arrival InstrucLon
Wireless Internet Access to paramedics using
To Receive Analog Radio
Pa2ent Call Alarm Call Center PaLent Health Info CommunicaLon
Telecommunicator SMO* Dispatcher
*SMO: Senior Medical Oﬃcer
Urgent Care Point
Facility Web Hos2ng Server 4
• To look and study at the open standard for electronic health
record (e.g openEHR) and open‐source based development
soware (e.g. Java Development Tools) in order to develop
an EHR system to be used by private EMS in Indonesia.
• To evaluate the developed EHR system from the view point
of its applicability in developing countries in general.
• To take the openEHR standard as a basis because:
– It is open.
– It is ISO standard (ISO 13606)
– It clearly separates medical experLse and soware
experLse. Therefore, the EHR system can be
developed by IT experts eﬃciently.
• To use the Java Development Tools as a set of
soware tools because:
– They are free open source soware
– They are developed by volunteer internaLonal “Java
Community”. Therefore, advices are freely given by
members of the community.
OpenEHR Implementa2on Architecture
on Java MVC (Manage, View and Control) Model
Main Clinic for Urgent Care Facility
Alarm Call Center/ OpenEHR Data
Request data in
other Clinics MySQL Database
PC User (web
Data will be viewed
in HTML Format
(HTTP‐DYNDNS) Produce data in
HTML Format JAVA Server Page
XML XML Data
Mobile Client Tomcat‐Apache
User (web XSLT
Web Server App
Paramedics Open Standard EHR Server Applica2on
on Java Environment
Simple Use Case Diagram
<User Log in>
User ID JAVA
<User Search Client> <User Input Data>
Java Servlet Java Servlet
Transfer to JSP Transfer to JSP
Result of the Study
• Out of 214 archetypes, I have used 7 of them to create an EHR
for emergency medical service.
1. Blood Matching 2. Blood Pressure
3. Body Weight 4. Body Height
5. Body Temperature 6. Heart Rate Pulse;
• DuraLon of this study
Result of the Study
EHR Applica2on on Mobile Environment
• The EHR applicaLon has been tested in a server‐mobile client environment using
both iPod‐Touch whereas the mobile client is connected to the network via Wi‐Fi
(Wireless Fidelity) Network and Blackberry via GSM‐GPRS Cellular Network.
EHR applica2on on Ipod Touch (Wi‐Fi) EHR applica2on on Blackberry (GSM‐GPRS)
Source: Author Source: Author
Result of the Study
Mobile EHR applica2on tested by EMS Doctor and Paramedic in Jakarta
• The ﬁnal tesLng of this simulaLon was actually done directly
by the end‐users (i.e. an EMS doctor and emergency
paramedics in Jakarta, Indonesia).
Emobile HSDPA Telkom GSM‐GPRS
My PC as Server
Web Hos2ng in
EMS Doctor and Paramedics
Feedback of the end‐user point of view from EMS doctor and paramedics
• EHR applicaLon had been evaluated by both an EMS doctor (Dyah
GusLnar Savitri, my sister who is in charge of EMS doctors) and EMS
paramedic (Jim Crouch, paramedics team leader who is an experienced
and licensed medical emergency paramedics from Australian Red Cross).
• “The access Menu is prac/cal, relevant and frequently used informa/on by
doctors and paramedics on medical emergency and hospitals/clinics. This
informa/on that you provide are easy to update and to be reviewed. You
can update and retrieve your medical informa/on record any/me and
anywhere through your mobile handheld device. This data is helpful and
crucial for all doctors, nurses or hospitals taking care of you. And it could
even save your life during a medical emergency.”
• The importance of openEHR standardizaLon in EHR applicaLon was
– I could develop and test this EHR applicaLon in 8 months period.
• The advantage of Free Open‐Source Soware (in this case is Java)
– My EHR applicaLon can be run on various compuLng environment
such as, PC, Ipod‐Touch and Blackberry mobile handsets.
• The beneﬁt of web‐based EHR applicaLon was proven.
– Sharing of health informaLon among diﬀerent medical experts is
– More eﬃcient work sharing can be accomplished compared with
paper‐based health records.
– CompaLbility issue across diﬀerent plakorm of device interface can be
resolved due to the web‐based soware technology.
• The Free Open‐Source Soware based EHR
applicaLon can solve the lack of ﬁnancial and
knowledge issue in developing countries in
• Further future study is needed to develop the
XML database format for the health
informaLon as a standard format for
possibility to convert the data to other