OpenMRS/KenyaEMR is an open source medical records system platform and reference application that is customized for use in Kenya through additional modules. KenyaEMR covers areas like HIV/TB care, mother/child health, and plans to expand to primary health care and data integration. It is developed by a small team in Kenya and implemented across several regions, with successes like many active users but also challenges like unreliable power and coordination of stakeholders. Opportunities exist for developers, implementers, trainers and community managers to further support and expand OpenMRS/KenyaEMR.

1. OpenMRS/KenyaEMR
Successes, Challenges, Opportunities...

2. Contents
Introduction to OpenMRS
Introduction to KenyaEMR
Development
Implementation
Successes
Challenges
Lessons
Opportunities
Communities and Associations

3. OpenMRS
Domain: Medical Records System
Open source software platform (API)
Reference application (Web App)
Based on a concept dictionary
Designed to be extended via modules/plug-ins
Written mainly in Java (Spring/Hibernate)
Web technologies (JSP/HTML/CSS/JS e.t.c.)
Code hosted on github.com

4. OpenMRS Architecture

5. KenyaEMR
Suite of modules to customize/extend OpenMRS
Build specifically for Kenya to
comply with the MOH EMR standards and
Development lead by I-TECH Kenya
Currently covers (Mainly):
HIV and TB care
Mother Child Health (including PMTCT)
Future plans:
Primary Health Care (PHC)
DHIS/PIS/LIS interoperability
Billing... e.t.c.

6. Development
Development
3 developers in total
Requirements mainly generated by MOH
All code is open source and is hosted on github.com
Development, test and demo servers available
Testing mostly done by I-TECH, MOH and volunteers
3-month release cycle (ideally, might change in future)

7. Implementation
Implementation
4 regions with 1 coordinator in each region
Enlist support of MOH and other partners on the ground
Enlist local capacity for network and infrastructural upgrades and installations
Training conducted to users from multiple facilities at a time
System support provided through an escalation stack beginning with facility champions right u

8. Successes
Nearly 150 active implementations
Managed to keep hardware costs low by using N-Computing
Growing OpenMRS-Kenya community
Well covered development road map in spite of the small size of our team
Contributed code to OpenMRS core
Empowering students through a programming boot camp held in 2013
Supported a fairly successful DHIS2-KenyaEMR interoperability pilot implementation

9. Challenges
Inefficiencies in requirements gathering
Reliance on OpenMRS core development milestones
Reliance on a concept dictionary not managed locally
Young open source culture (gradually maturing)
Multiplicity of stakeholders: difficult to coordinate
Streamlining deployment process (Manual → VM → Scripts → Fully fledged installers)
Unreliable power
Low computer skills
Extraneous (Terrain, security, strikes e.t.c.)

10. Lessons
Distribution management: Need to ensure all implementations run the same KenyaEMR distro
Active communication: Publicize our work and stay abreast with what others are doing
Foster close end-user/client involvement
Eliminate/reduce training-to-use lead time
Important to mirror existing tools (low computer skills)
Test/research unexpected deployment technology interactions (e.g. VirtualBox + VSpace)
Important to strengthen local capacity

11. Opportunities - Developers
Design and develop health systems that support interoperability “out of the box”
Invest in skills to work within the OpenMRS/KenyaEMR ecosystem
Submit code to OpenMRS/KenyaEMR (Open Source Spirit)
Innovate to create OpenMRS modules to address unique challenges

12. Opportunities - Implementers
Free to deploy OpenMRS/KenyaEMR anywhere (FOSS)
Innovative/entrepreneurial solutions to unique implementation problems
Unreliable power (solar PCs?)
Expensive hardware (N-computing?)
Ease of deployment (Virtual machines?)
Disaster recovery (Off-site backups/data centers?)
Affordable and reliable Internet (interoperability, centralized upgrades, capacity building)
Participate in testing the system and making feature requests and bug reports

13. Opportunities - Trainers
Adopt/expand existing curriculum and provide certification
Diversify to reach out to different target groups
Developers
Implementers
Concept curators/experts
End users

14. Opportunities – Comm. Managers
Mobilize stakeholders towards common goals: Significant EMR features? Convergent developmen
Manage mailing lists and community meetings
Organize capacity building events: Hackathons? Showcases? Mentorship?

15. Communities and Associations
OpenMRS Global
Mailing lists
IRC
Categories (Development, Implementation e.t.c.)
Annual implementers' conference
OpenMRS-Kenya
Mailing list
Face-to-face meetings
KeHIA (www.kehia.org)
Membership association
Professional networking

16. Thank you.
Questions?