OpenMRS is a collaborative project initiated by Indiana University and Moi University to address the HIV/AIDS epidemic in Kenya through an electronic medical record (EMR) system. It focuses on community-based development, active transparency, and the reuse of existing technologies to improve healthcare delivery. The project emphasizes the importance of patient-centered care and iterative development, resulting in scalable implementations across multiple sites.

1. OpenMRS Using Information Technology to Unleash the Transformational Power of Communities Paul, Burke, and the OpenMRS Community

2. Paul Paul is a pediatrician

3. Burke Burke is an internist

4. And we’re both geeks

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. … then lots of people started dying from HIV/AIDS.

7. 40,000,000 95% 5% Developed World Developing World HIV/AIDS Burden Developing countries have most of the burden of HIV/AIDS.

8. In the mid-1990s, Kenya wasn’t prepared.

9. Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH) The IU-Kenya Program responded with AMPATH, a comprehensive program for HIV/AIDS.

10. Starting from two clinics, by 2001 they needed a new building to handle the number of patients

11. And as they grew, their information management needs grew too

12. 45000 2001 2007 2004 In 2004, AMPATH had 3000 patients and was scaling to 30,000+ over 1-2 years

13. Our Introduction February 2004 Asked to be “consultants” One week trip to Eldoret, Kenya 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. The current system was overwhelmed

15. We saw the need…

16. … and what medicines could do.

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. 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. 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. Understanding the Environment Reporting-driven Top down Vertical systems Acute care Proprietary and predatory The existing culture was very top-down.

21. Active transparency Community-based development and ownership Freely available Capacity through apprenticeship Patients are first, others follow Avoid imagined needs Re-use, don’t re-invent Flexible, standards-based foundation Follow thought with action Our values…

22. We started with a robust, scalable data model

23. We built an API around the data model, and then a web application atop the API.

24. We started with a patient-centered system

25. We took paper encounter forms…

26. … and made them electronic for data entry.

27. We’ve built tools to help with data quality

28. And we have a clinical summary sheet for providers

29. With basic info, problem lists, …

30. longitudinal data…

31. … and early decision support.

32. We also have tools for querying the system. We prototype and iterate on the tooling.

33. Regenstrief was working in Kenya; PIH in Rwanda

34. Funding organization asked us to speak about our work, opening the dialogue for a bigger vision.

35. So from a couple sites…

36. … now implementations are popping up everywhere

37. Chris Seebregts created opportunities for community development

38. The community is growing rapidly

39. Google has helped us tremendously through their Summer of Code.

40. Google Summer of Code made us aware of how communities can be sustained through internet technologies. We worked hard on our website.

41. We use technology like RSS to make conversations and changes more transparent and to enhance communication & scalability

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. Being distressed by a problem Deciding something must be done “ Getting to maybe” Understanding the system which led to discontent Encountering “powerful strangers” Rapid growth by “finding flow” Threatened powers fight back Connecting with much larger forces So far the book is dead on. Unfortunately, step #7 is next!

44. What got us this far? So, we reflect on the values that got us this far

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. It’s amazing how profitable it can be to give something away. -OpenMRS

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. The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires. – William Ward

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. Open Source Community how we underestimated the larger open source community 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. 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. Not by age but by capacity is wisdom acquired. -Titus Maccius Plautus

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. Care will lead the way. – Joe Mamlin

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. There's a difference between knowing the Path and walking the Path. -The Wachoskis, authors of “The Matrix”

57. Re-use, don’t re-invent We’ve achieved significant efficiencies through re-use. OpenMRS uses libraries from several open source projects.

58. Obviously, the highest type of efficiency is that which can utilize existing material to the best advantage – Jawaharlal Nehru

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. As they say on my own Cape Cod, a rising tide lifts all the boats… -John F. Kennedy

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. You’ll never plow a field by turning it over in your mind -Irish Proverb

63. Acknowledgements The OpenMRS collaborative The AMPATH team William Tierney Marc Overhage NIH, WHO, PEPFAR, CDC, IDRC Google

64. Regenstrief Institute, Inc.