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PEOPLE’S EMR
Scaling across multiple countries
THE STORY SO FAR
Our journey
2
Jan Swasthya Sahyog
3
▪ Pro-poor hospital in the most underdeveloped part of
central India
▪ High quality patient care
▪ A...
JSS - EMR
4
▪ Rescue of a year and half old EMR project
▪ Started off as a project (not product)
▪ EMR that meets the need...
Why only JSS?
5
▪ OpenMRS and Odoo provided generic platform
▪ Widespread need for such a system
What is Bahmni
6
o EMR
o Hospital System
o OpenMRS distribution
o Open Source, AGPL
o Multiple Open Source Products
o Deve...
BAHMNI
The tapestry of open source
7
LOW RESOURCE
SETTING
What are the constraints? What are the available resources?
8
9
Bahmni
The Village
BAHMNI
Usability to enable better patient-care is the focus of the product
1
0
Bahmni Goals
1
1
▪ Improve quality of patient care and health of
community
▪ Accessible, easy to use and implement
▪ Build...
BAHMNI AND THOUGHTWORKS
1
2
▪ Committed for the long term
▪ Social mission
▪ Largely funded by ThoughtWorks
▪ Doing implem...
ARCHITECTURE
1
3
Apache Web Server
Bahmni MRS
Frontend
(JavaScript, HTML5,
AngularJS)
OpenMRS Server
(REST API)
Java
OpenMRS DB
(MySQL)
Bro...
Apache Web Server
Bahmni MRS
Frontend
(JavaScript, HTML5,
AngularJS)
OpenMRS Server
(REST API)
Java
OpenMRS DB
(MySQL)
Bro...
16
▪ Choose sub-systems you want
○ sub-systems not chosen are not even
deployed
▪ Choose apps you want
○ applies to EMR
○ ...
17
Medical Device Integration
1
8
DESIGNED FOR DIFFERENT DEVICES
1
9
DESIGN
2
0
Registration
2
1
2
2
Configurable patient dashboard
2
3
2
4
Discharge summary completely via configuration
2
5
Configurable patient dashboard
"sections": {
"patientInformation": {
"title": "Patient Information",
"name": "patientInfor...
Configurable patient dashboard
2
7
Multiple dashboards
2
8
Observation Forms Platform
2
9
3
0
Forms using Configuration, not programming
3
1
Lab, Procedure Orders
3
2
Reports
3
3
Canned and Configurable
3
4
"visitReport" : {
"name": "Visit Report",
"type": "visitReport",
"config": {
"personAttributes...
Laboratory
3
5
3
6
Odoo
3
7
3
8
Bahmni Offline
3
9
▪ Web technologies
▪ AngularJS helps
▪ Crosswalk, Ionic Framework
▪ Service Workers
▪ Sqlite on Android...
Implementations
4
0
IMPLEMENTATIONS
Implemented at 6 hospitals
■ Jan Swasthya Sahyog | Bilaspur, India
■ Society for Education, Action, Resear...
Bahmni (and TW) within OpenMRS community
42
Bahmni Product Team
ThoughtWorks Implementation
Team
(~ 2% Bahmni implementati...
Roadmap Principles
1. Performance, security, technical operational improvements and
general robustness of the software
2. ...
4
4
Bahmni Wiki
4
5
www.bahmni.org
There are many criticisms of
technology, indicating that it can
take away the human element of
health care. ThoughtWorks h...
THANK YOU
For questions or suggestions
Contact Vivek Singh:
vsingh@thoughtworks.com
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Bahmni, Scaling in multiple countries

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Bahmni started from a rural hospital in India three years back and is now being deployed in many countries. In this talk I share our motivation, approach and strategy of making and scaling Bahmni via implementations. I will also cover key technologies, features and roadmap of Bahmni.

Published in: Software
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Bahmni, Scaling in multiple countries

  1. 1. PEOPLE’S EMR Scaling across multiple countries
  2. 2. THE STORY SO FAR Our journey 2
  3. 3. Jan Swasthya Sahyog 3 ▪ Pro-poor hospital in the most underdeveloped part of central India ▪ High quality patient care ▪ Appropriate technology ▪ We love JSS for their social mission
  4. 4. JSS - EMR 4 ▪ Rescue of a year and half old EMR project ▪ Started off as a project (not product) ▪ EMR that meets the needs of the clinicians
  5. 5. Why only JSS? 5 ▪ OpenMRS and Odoo provided generic platform ▪ Widespread need for such a system
  6. 6. What is Bahmni 6 o EMR o Hospital System o OpenMRS distribution o Open Source, AGPL o Multiple Open Source Products o Developed by ThoughtWorks o For community of implementers
  7. 7. BAHMNI The tapestry of open source 7
  8. 8. LOW RESOURCE SETTING What are the constraints? What are the available resources? 8
  9. 9. 9 Bahmni The Village
  10. 10. BAHMNI Usability to enable better patient-care is the focus of the product 1 0
  11. 11. Bahmni Goals 1 1 ▪ Improve quality of patient care and health of community ▪ Accessible, easy to use and implement ▪ Build community that takes Bahmni places where ThoughtWorks cannot ▪ For the Global South ▪ Community to Tertiary Care
  12. 12. BAHMNI AND THOUGHTWORKS 1 2 ▪ Committed for the long term ▪ Social mission ▪ Largely funded by ThoughtWorks ▪ Doing implementations to learn and develop the right product ▪ Majority of implementations done by the community not by ThoughtWorks
  13. 13. ARCHITECTURE 1 3
  14. 14. Apache Web Server Bahmni MRS Frontend (JavaScript, HTML5, AngularJS) OpenMRS Server (REST API) Java OpenMRS DB (MySQL) Browser Server (Linux) User’s Machine OpenERP Server (XML-WS API) Python OpenERP DB (PostgreSQL) OpenELIS Server (REST API) Java OpenELIS DB (PostgreSQL) Background jobs consuming feeds all communication over http no orchestrator
  15. 15. Apache Web Server Bahmni MRS Frontend (JavaScript, HTML5, AngularJS) OpenMRS Server (REST API) Java OpenMRS DB (MySQL) Browser Server (Linux) User’s MachineBahmni Lite
  16. 16. 16 ▪ Choose sub-systems you want ○ sub-systems not chosen are not even deployed ▪ Choose apps you want ○ applies to EMR ○ applies to ERP ○ apps not chosen are not deployed As lightweight as you want it to be
  17. 17. 17
  18. 18. Medical Device Integration 1 8
  19. 19. DESIGNED FOR DIFFERENT DEVICES 1 9
  20. 20. DESIGN 2 0
  21. 21. Registration 2 1
  22. 22. 2 2
  23. 23. Configurable patient dashboard 2 3
  24. 24. 2 4
  25. 25. Discharge summary completely via configuration 2 5
  26. 26. Configurable patient dashboard "sections": { "patientInformation": { "title": "Patient Information", "name": "patientInformation", "ageLimit": 5, "patientAttributes": [ "smoking", "alcohol", "landHolding", "rationCard", "familyIncome", ], "addressFields": [], "displayOrder": 0 }, "nutritionalValue": { "title": "Nutritional Values", "name": "vitals", "isObservation": true, "dashboardParams": { "conceptNames": [ "Height", "Weight", "BMI Status Data" ], "scope": "latest" }, "displayOrder": 1 2 6 Observation Control Drug Order Control Lab Result Control Diagnosis Control Patient Profile Control Disposition Control Graph Control Graph With Reference Data Control Orders Control Programs Control Pacs Orders Control Flow Sheet Control Custom Control Navigation Links Control Obs To Obs Flow Sheet Chronic Treatment Chart Drug Order Details Control
  27. 27. Configurable patient dashboard 2 7
  28. 28. Multiple dashboards 2 8
  29. 29. Observation Forms Platform 2 9
  30. 30. 3 0
  31. 31. Forms using Configuration, not programming 3 1
  32. 32. Lab, Procedure Orders 3 2
  33. 33. Reports 3 3
  34. 34. Canned and Configurable 3 4 "visitReport" : { "name": "Visit Report", "type": "visitReport", "config": { "personAttributes": ["caste", "class", "education", "occupation", "primaryContact"], "visitAttributes": ["Visit Status"] } ● Configurable for your needs ● Performance optimised SQL ● Presentation based on excel
  35. 35. Laboratory 3 5
  36. 36. 3 6
  37. 37. Odoo 3 7
  38. 38. 3 8
  39. 39. Bahmni Offline 3 9 ▪ Web technologies ▪ AngularJS helps ▪ Crosswalk, Ionic Framework ▪ Service Workers ▪ Sqlite on Android; Indexeddb + Lovefield elsewhere ▪ Same user interface, some features
  40. 40. Implementations 4 0
  41. 41. IMPLEMENTATIONS Implemented at 6 hospitals ■ Jan Swasthya Sahyog | Bilaspur, India ■ Society for Education, Action, Research in Community Health | Gadchiroli, India ■ Lok Biradari Prakalp | Gadchiroli, India ■ Bayalpata Hospital, Possible Health | Accham, Nepal ■ The Banyan | Chennai, India ■ Kaliganj (sub-district) hospital, Bangladesh Over 25 implementations underway across the world, mostly outside the Indian subcontinent 4 1
  42. 42. Bahmni (and TW) within OpenMRS community 42 Bahmni Product Team ThoughtWorks Implementation Team (~ 2% Bahmni implementations) OpenMRS Platform Bahmni TW Clients Rest of the world OpenMRS Core Team Community Implementations (98% of Bahmni implementations) non-Bahmni OpenMRS Implementations
  43. 43. Roadmap Principles 1. Performance, security, technical operational improvements and general robustness of the software 2. Strengthen outpatient clinic, secondary care hospitals and vertical programs i. Features that improve patient care ii. Improve implementers user experience 3. Offline i. basic clinical features 4. Tertiary Care (may be)
  44. 44. 4 4 Bahmni Wiki
  45. 45. 4 5 www.bahmni.org
  46. 46. There are many criticisms of technology, indicating that it can take away the human element of health care. ThoughtWorks has shown us how technology can help, and still remain very human. - Dr. Yogesh Jain, JSS 4 6
  47. 47. THANK YOU For questions or suggestions Contact Vivek Singh: vsingh@thoughtworks.com

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