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OpenMRS Transformation


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OpenMRS - Using Information Technology to Unleash the Transformational Power of Communities. Presented by Paul Biondich and Burke Mamlin and the 10th Biennial Regenstrief

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OpenMRS Transformation

  1. 1. OpenMRS Using Information Technology to Unleash the Transformational Power of Communities <ul><li>Paul, Burke, and the OpenMRS Community </li></ul>
  2. 2. <ul><li>Paul </li></ul>Paul is a pediatrician
  3. 3. <ul><li>Burke </li></ul>Burke is an internist
  4. 4. And we’re both geeks
  5. 5. OpenMRS grew out of a partnership between Indiana University School of Medicine and Moi University in Eldoret, Kenya. They had a 10-year collaboration through the 1990s…
  6. 6. … then lots of people started dying from HIV/AIDS.
  7. 7. 40,000,000 95% 5% Developed World Developing World HIV/AIDS Burden Developing countries have most of the burden of HIV/AIDS.
  8. 8. In the mid-1990s, Kenya wasn’t prepared.
  9. 9. <ul><li>Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH) </li></ul>The IU-Kenya Program responded with AMPATH, a comprehensive program for HIV/AIDS.
  10. 10. Starting from two clinics, by 2001 they needed a new building to handle the number of patients
  11. 11. And as they grew, their information management needs grew too
  12. 12. 45000 2001 2007 2004 In 2004, AMPATH had 3000 patients and was scaling to 30,000+ over 1-2 years
  13. 13. Our Introduction <ul><li>February 2004 </li></ul><ul><li>Asked to be “consultants” </li></ul><ul><li>One week trip to Eldoret, Kenya </li></ul>We were brought in for a week to tell them how to scale up their system. MS Access had served them well, but was being stretched beyond capacity.
  14. 14. The current system was overwhelmed
  15. 15. We saw the need…
  16. 16. … and what medicines could do.
  17. 17. But they needed an enterprise electronic medical record (EMR) and two guys building an EMR with 10% of their time…well, it was a herculean task.
  18. 18. We looked to see if others had solved the problem. There were silos of effort, mostly with MS Access-based systems built to meet immediate needs.
  19. 19. Then we met Partners In Health. They were installing their system in Rwanda and wanted to rebuild it. A perfect match for us. The impossible became possible.
  20. 20. Understanding the Environment <ul><li>Reporting-driven </li></ul><ul><li>Top down </li></ul><ul><li>Vertical systems </li></ul><ul><li>Acute care </li></ul><ul><li>Proprietary and predatory </li></ul>The existing culture was very top-down.
  21. 21. <ul><li>Active transparency </li></ul><ul><li>Community-based development and ownership </li></ul><ul><li>Freely available </li></ul><ul><li>Capacity through apprenticeship </li></ul><ul><li>Patients are first, others follow </li></ul><ul><li>Avoid imagined needs </li></ul><ul><li>Re-use, don’t re-invent </li></ul><ul><li>Flexible, standards-based foundation </li></ul><ul><li>Follow thought with action </li></ul>Our values…
  22. 22. We started with a robust, scalable data model
  23. 23. We built an API around the data model, and then a web application atop the API.
  24. 24. We started with a patient-centered system
  25. 25. We took paper encounter forms…
  26. 26. … and made them electronic for data entry.
  27. 27. We’ve built tools to help with data quality
  28. 28. And we have a clinical summary sheet for providers
  29. 29. With basic info, problem lists, …
  30. 30. longitudinal data…
  31. 31. … and early decision support.
  32. 32. We also have tools for querying the system. We prototype and iterate on the tooling.
  33. 33. Regenstrief was working in Kenya; PIH in Rwanda
  34. 34. Funding organization asked us to speak about our work, opening the dialogue for a bigger vision.
  35. 35. So from a couple sites…
  36. 36. … now implementations are popping up everywhere
  37. 37. Chris Seebregts created opportunities for community development
  38. 38. The community is growing rapidly
  39. 39. Google has helped us tremendously through their Summer of Code.
  40. 40. Google Summer of Code made us aware of how communities can be sustained through internet technologies. We worked hard on our website.
  41. 41. We use technology like RSS to make conversations and changes more transparent and to enhance communication & scalability
  42. 42. Getting to Maybe: How the World is Changed Then Tom Inui pointed out this book to us and we learned that OpenMRS is an example of a “social transformation.” We hadn’t realized there was a theoretical framework for what we were doing.
  43. 43. <ul><li>Being distressed by a problem </li></ul><ul><li>Deciding something must be done </li></ul><ul><li>“ Getting to maybe” </li></ul><ul><li>Understanding the system which led to discontent </li></ul><ul><li>Encountering “powerful strangers” </li></ul><ul><li>Rapid growth by “finding flow” </li></ul><ul><li>Threatened powers fight back </li></ul><ul><li>Connecting with much larger forces </li></ul>So far the book is dead on. Unfortunately, step #7 is next!
  44. 44. <ul><li>What got us this far? </li></ul>So, we reflect on the values that got us this far
  45. 45. Freely Available Not only do we serve free food, but we strive to take every ingredient and every recipe made within the kitchen and make it freely available to everyone. Also know as “open source.”
  46. 46. It’s amazing how profitable it can be to give something away. -OpenMRS
  47. 47. “ Active” Transparency We don’t stop there. We actively work at communicating our thought processes to the community and encouraging others to do so as well.
  48. 48. The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires. – William Ward
  49. 49. Community-based development and ownership The community gives us our only chance for a fully realized system. Getting others involved requires us to share ownership of what’s evolving with everyone who takes part.
  50. 50. Open Source Community <ul><li>how we underestimated the larger open source community </li></ul>Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. -Margaret Mead
  51. 51. Capacity Through Apprenticeship We consistently encourage those that we help to then go and help others, so that we may someday be made obsolete.
  52. 52. Not by age but by capacity is wisdom acquired. -Titus Maccius Plautus
  53. 53. Patients are first… others follow In all this, we are physicians. So underlying all the efforts, we must always focus on what’s important.
  54. 54. Care will lead the way. – Joe Mamlin
  55. 55. Avoid imagined needs We started off with the mistaken belief that a big system required a big design. We learned to make decisions based on priority and need instead of attempting to envision what we might need.
  56. 56. There's a difference between knowing the Path and walking the Path. -The Wachoskis, authors of “The Matrix”
  57. 57. Re-use, don’t re-invent We’ve achieved significant efficiencies through re-use. OpenMRS uses libraries from several open source projects.
  58. 58. Obviously, the highest type of efficiency is that which can utilize existing material to the best advantage – Jawaharlal Nehru
  59. 59. Flexible, standards-based foundation Utilizing existing standards, focusing on providing a strong & flexible foundation, and creating opportunities for innovation within that playground has served us immensely well.
  60. 60. As they say on my own Cape Cod, a rising tide lifts all the boats… -John F. Kennedy
  61. 61. Follow thought with action We’re pragmatists by nature. A lot of people come with good ideas, but we’ve found that often those fall through the cracks unless we quickly move to turn that idea into something tangible. Theory is great, but only when followed by action.
  62. 62. You’ll never plow a field by turning it over in your mind -Irish Proverb
  63. 63. Acknowledgements <ul><li>The OpenMRS collaborative </li></ul><ul><li>The AMPATH team </li></ul><ul><li>William Tierney </li></ul><ul><li>Marc Overhage </li></ul><ul><li>NIH, WHO, PEPFAR, CDC, IDRC </li></ul><ul><li>Google </li></ul>
  64. 64. Regenstrief Institute, Inc.