OpenMRS in Rwanda Hamish SF Fraser Partners In Health Division of Global Health Equity, BWH Harvard medical School
OpenMRS:  open source, modular EMR system <ul><li>Developed as a collaboration of PIH, the Regenstrief Institute and South...
OpenMRS sites - fall 2008
Rwanda
Rwanda health indicators <ul><li>A small central African country: </li></ul><ul><ul><li>Population 9 M people  </li></ul><...
Accompagnateur, Haiti
OpenMRS at PIH  sites in Rwanda <ul><li>Currently used for 12 PIH – supported health centers </li></ul><ul><li>8 sites hav...
OpenMRS dashboard - HIV Care
 
Patient  summary and alerts
Physician looking up ARV patient
Cohort builder Not actual names
Government of Rwanda EMR roll out <ul><li>The Government of Rwanda is committed to having a strong national EMR program </...
Potential components of integrated national  eHealth architecture in Rwanda  EMR System OpenMRS National  reporting system...
Connecting sites with limited internet <ul><li>Potential solutions? </li></ul><ul><ul><li>#1: Collect Data on paper and sh...
Synchronization <ul><li>We created a new component to allow bi-directional synchronization between OpenMRS instances </li>...
 
Data Synchronization: Vision
Challenges for OpenMRS deployments <ul><li>Reliability and support for equipment, power supplies and software   </li></ul>...
Collaborators and Funders  <ul><li>Partners In Health </li></ul><ul><li>Regenstrief institute </li></ul><ul><li>Medical Re...
 
Acknowledgements Darius Jazayeri, Joaquin Blaya,   Sharon Choi, Patrice Nevil, Christian Allen, Paul Biondich, Burke Mamli...
Tracking HIV patients  <ul><li>Patient data collection and project evaluation are core components of improving quality of ...
OpenMRS – Pharmacy System integration <ul><li>The prototype integration project is being  developed in South Africa for us...
Rwinkwavu-administration page
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Open M R S Boston Meeting

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  • Open M R S Boston Meeting

    1. 1. OpenMRS in Rwanda Hamish SF Fraser Partners In Health Division of Global Health Equity, BWH Harvard medical School
    2. 2. OpenMRS: open source, modular EMR system <ul><li>Developed as a collaboration of PIH, the Regenstrief Institute and South African MRC </li></ul><ul><li>Uses concept dictionary for data storage </li></ul><ul><li>Modular design simplifies adding new functions and linking to other systems </li></ul><ul><li>Supports multiple languages </li></ul><ul><li>Released with open source license (April 2007) </li></ul><ul><li>Core of paid programmers with growing community support </li></ul><ul><li>www.openmrs.org </li></ul>Partners In Health Regenstrief Institute Medical reseach council SA
    3. 3. OpenMRS sites - fall 2008
    4. 4. Rwanda
    5. 5. Rwanda health indicators <ul><li>A small central African country: </li></ul><ul><ul><li>Population 9 M people </li></ul></ul><ul><ul><li>Highest population density in Africa, 85% rural </li></ul></ul><ul><li>Achieved rapid economic growth since genocide in 1994, but still has very poor health outcomes: </li></ul><ul><ul><li>Life expectancy 38-44 years </li></ul></ul><ul><ul><li>Infant mortality 152/1000 </li></ul></ul><ul><ul><li>Maternal mortality 1071/100K </li></ul></ul><ul><ul><li>Medium income $230 </li></ul></ul><ul><ul><li>HIV prevalence 3% </li></ul></ul><ul><ul><li>Malaria prevalence 46% </li></ul></ul>
    6. 6. Accompagnateur, Haiti
    7. 7. OpenMRS at PIH sites in Rwanda <ul><li>Currently used for 12 PIH – supported health centers </li></ul><ul><li>8 sites have their own server, 6 remote sites maintain a synchronized copy of the entire database </li></ul><ul><li>Registration, encounter and lab data for patients with HIV, TB and now heart failure </li></ul><ul><li>Over 8000 patients tracked (Feb. 2009) </li></ul><ul><li>Team of Rwandan data officers trained to enter data, ensure quality & produce reports </li></ul><ul><li>Clinicians lookup of electronic patient summaries </li></ul><ul><li>Many new research and clinical applications </li></ul>
    8. 8. OpenMRS dashboard - HIV Care
    9. 10. Patient summary and alerts
    10. 11. Physician looking up ARV patient
    11. 12. Cohort builder Not actual names
    12. 13. Government of Rwanda EMR roll out <ul><li>The Government of Rwanda is committed to having a strong national EMR program </li></ul><ul><li>MoH has stated that OpenMRS will be used for the national roll out to health centers and small hospitals </li></ul><ul><li>MoH wants a non-disease specific system which: </li></ul><ul><ul><li>Can assist in the management of all outpatients </li></ul></ul><ul><ul><li>Will also continue to be used for HIV management </li></ul></ul>
    13. 14. 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
    14. 15. Connecting sites with limited internet <ul><li>Potential solutions? </li></ul><ul><ul><li>#1: Collect Data on paper and ship it back to central location </li></ul></ul><ul><ul><ul><ul><li>Pros vs. Cons ? Eldoret </li></ul></ul></ul></ul><ul><ul><li>#2: OpenMRS ‘Lite’ </li></ul></ul><ul><ul><ul><li>Make light-weight copy of OpenMRS that support minimal functionality and distribute it to remote areas </li></ul></ul></ul><ul><ul><ul><ul><li>Pros vs. Cons ? </li></ul></ul></ul></ul><ul><ul><li>#3: Separate Desktop Application </li></ul></ul><ul><ul><ul><li>Make completely separate application that works in disconnected mode –e.g Offline EMR, Haiti </li></ul></ul></ul><ul><ul><ul><ul><li>Pros vs. Cons ? </li></ul></ul></ul></ul><ul><ul><li>#4: Connected installs of OpenMRS with data synchronization </li></ul></ul><ul><ul><ul><ul><li>Pros vs. Cons ? </li></ul></ul></ul></ul>
    15. 16. Synchronization <ul><li>We created a new component to allow bi-directional synchronization between OpenMRS instances </li></ul><ul><li>Uses limited internet capability, soon to be usable with USB memory stick </li></ul><ul><li>6 sites in Rwanda are now synchronizing </li></ul><ul><li>Working on a general version, requires modification to the data model </li></ul>
    16. 18. Data Synchronization: Vision
    17. 19. Challenges for OpenMRS deployments <ul><li>Reliability and support for equipment, power supplies and software   </li></ul><ul><li>Training </li></ul><ul><li>Data management and quality control   </li></ul><ul><li>Evaluation </li></ul><ul><li>Sustainability </li></ul>
    18. 20. Collaborators and Funders <ul><li>Partners In Health </li></ul><ul><li>Regenstrief institute </li></ul><ul><li>Medical Research Council, South Africa </li></ul><ul><li>World Health Organization </li></ul><ul><li>US Centers for Disease Control </li></ul><ul><li>Brigham and Women hospital </li></ul><ul><li>Harvard Medical School </li></ul><ul><li>University of KwaZulu-Natal </li></ul><ul><li>Millennium Villages Project </li></ul><ul><li>International Development Research Centre, Ottawa </li></ul><ul><li>Rockefeller Foundation </li></ul><ul><li>Fogarty International Center, NIH </li></ul><ul><li>Boston Consulting Group </li></ul><ul><li>Google Inc </li></ul>
    19. 22. 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
    20. 23. Tracking HIV patients <ul><li>Patient data collection and project evaluation are core components of improving quality of care </li></ul><ul><li>Accurate analysis requires patient level data </li></ul><ul><li>EMR systems can implement guidelines and support best practice </li></ul><ul><ul><li>Allow real time tracking of patients to ensure they are followed up and taking ARVs, complementing work of accompagnateurs </li></ul></ul>Green bar: Recent clinic visit and ARV pick-up. Red Bar: Neither event has occurred. Yellow bars: Only one tracking event has occurred
    21. 24. OpenMRS – Pharmacy System integration <ul><li>The prototype integration project is being developed in South Africa for use in a major public hospital in Pretoria. </li></ul><ul><li>Uses MIRTH developed by a US based medical information integration company Webreach </li></ul><ul><li>This work is being done by Ryan Crichton </li></ul>
    22. 25. Rwinkwavu-administration page

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