Presentation by Partners in Health (Malawi) given at the 2017 International OpenMRS Implementers' Conference at Bingu International Conference Center in Lilongwe, Malawi.

1. OPENMRS
B A C K G R O U N D O F E L E C T R O N I C M E D I C A L R E C O R D S Y S T E M I N
N E N O D I S T R I C T, M A L AW I
J O J I M A L U N G A , L I M B A N I T H E N G O [ P R E S E N T E R S ]
PA R T N E R S I N H E A LT H ( P I H ) / A B W E N Z I PA Z A U M O Y O ( A P Z U )

2. NENO SITE VIDEO

3. IMPLEMENTING OPENMRS FOR PATIENT
MONITORING IN AN HIV/AIDS CARE AND
TREATMENT AND NON-COMMUNICABLE
DISEASE MANAGEMENT.

4. z
2006 –
MOH invites
PIH to Neno
• 165,000 people
• 1 District Hospital
• 1 Community Hospital
• 12 health centres

5. INTRODUCTION OF EMR IN NENO
• In 2007 Neno District started developing electronic medical records system for HIV
program
• Open Medical Record System (OpenMRS) became the most suitable candidate for a
system to provide long term growth in supporting a range of health services, as well as
facilitate eventual needs to support health services research
• Over the past 10 years the system has been developed with direct objective to improve
health care by making clinical data available and useful
• Today OpenMRS covers our Integrated Chronic Care Clinic (IC3) across 14 health
centres
– IC3 provides integrated care for clients with Chronic Conditions (HIV and NCDs)

6. MAPS ON NEXT FEW SLIDES SHOW
DECENTRALIZATION OF CARE OVER TIME
AND EXPANSION OF OPENMRS THAT
ACCOMPANIED THIS PROCESS

7. 2006
219
HIV PATIENTS
active in care
219
FACILITIES
supported by OpenMRS
0

8. 2007
HIV PATIENTS
active in care
398
FACILITY
supported by OpenMRS
1

9. 2008
HIV PATIENTS
active in care
1,584
FACILITIES
supported by OpenMRS
2

10. 2009
HIV PATIENTS
active in care
2,596
FACILITIES
supported by OpenMRS
6

11. 2010
HIV PATIENTS
active in care
3,575
FACILITIES
supported by OpenMRS
10

12. 2011
HIV PATIENTS
active in care
4,747
Nkula
FACILITIES
supported by OpenMRS
11

13. 2012
HIV PATIENTS
active in care
5,638
Nkula
FACILITIES
supported by OpenMRS
13

14. 2013
HIV PATIENTS
active in care
FACILITIES
supported by OpenMRS
6,315
13
Nkula

15. 2014
HIV PATIENTS
active in care
6,779
Nkula
FACILITIES
supported by OpenMRS
13

16. STARTED INTEGRATED CHRONIC CARE
CLINIC (DECENTRALIZED NCD CARE)
IC
3
Integrated
Chronic
Care
Clinic
IC3
2015

17. 2015
7,332 884
IC
3
Integrated
Chronic
Care
Clinic
IC3
HIV PATIENTS
active in care
NCD PATIENTS
active in care
FACILITIES
supported by OpenMRS
13

18. IC
3
Integrated
Chronic
Care
Clinic
2017 - TODAY
HIV PATIENTS
active in care
8,188
NCD PATIENTS
active in care
2,803
FACILITIES
supported by OpenMRS
14
IC
3
Integrated
Chronic
Care
Clinic
IC3

19. EXISTING PAPER-BASED SYSTEM
 MOH has comprehensive
paper based patient
monitoring system for HIV,
with similar system being
developed (and piloted in
Neno) for NCDs.
 Paper system includes facility
register and a patient based
paper chart (“Master card”)

20. OPENMRS OVERVIEW

21. CUSTOMIZING THE OPENMRS
FRAMEWORK

22. CURRENT EMR DATA FLOW
• Two teams based at two
hospitals
• Centralized teams from hospitals
travel to health centres to
provide Integrated Chronic Care
Clinic
• Data technicians accompany
clinical team with their laptops
containing child servers
• All data is entered on-site on that
clinic day
Data technician Charles Goliath entering patient
information

23. EMR DATA USE
• Continually seeking ways for
data use (beyond research
and reporting) and here are
some recent innovations to
share

24. EMR DATA USE: INTEGRATED
APPOINTMENT REPORT

25. EMR DATA USE: INWARD SUMMARY
• One-page summary of history
– Visit history, Medications, weight trend etc.
– EMR team prints on routine basis (triggered by HTC counselors who do inward
testing and notify us of known clients in care)
• Exists for clients living with HIV
– Launching NCD Inward summary later this year

26.  ART Inward Summary
EMR Data Use: Inward ART Summary

27. John Banda
Demographics:
Age: 55y
Gender: M
Village: Neno
Last Height: 148cm
Last Weight: 10kg
Last BMI: 21
Program Enrollment
• HIV: ART Program, enrolled 1-Jan-2009, last visit 16-Jan-2017 programmatic outcome on date, last visit date or never
enrolled
• Hypertension: programmatic outcome on date or never enrolled
• Diabetes: programmatic outcome on date with Type 1 or Type 2 or never enrolled
• Epilepsy: programmatic outcome on date or never enrolled
• Asthma: programmatic outcome on date with Asthma Severity or never enrolled
• COPD: programmatic outcome on date or never enrolled
• Mental Health: diagnosis on date or never enrolled [Note, list all diagnoses]
Hypertension
Enrolment Date:
Last Visit Date:
Last Blood Pressure:
Current Medications
Medication 1 Name:
Dose:
Frequency:
Start date:
Medication 2 Name:
Dose:
Frequency:
Start Date:
Diabetes
Enrolment Date:
Last Visit Date:
Last Blood Pressure:
Last HbA1c result:
Last Blood sugar result:
FBS or RBS
Date test:
Current Medications
Medication 1 Name:
Dose:
Frequency:
Start date:
Medication 2 Name:
Dose:
Frequency:
Start Date:
Epilepsy
Enrolment Date:
Last Visit Date:
Current Medications
Medication 1 Name:
Dose:
Frequency:
Start date:
Medication 2 Name:
Dose:
Frequency:
Start Date:
Asthma
Enrolment Date:
Last Visit Date:
Current Medications
Medication 1 Name:
Dose:
Frequency:
Start date:
Medication 2 Name:
Dose:
Frequency:
Start Date:
Mental Health
Enrolment Date:
Last Visit Date:
Current Medications
Medication 1 Name:
Dose:
Frequency:
Start date:
Medication 2 Name:
Dose:
Frequency:
Start Date:
Community Health Worker:
Betty Banda
Date Blood Pressure Blood
Sugar(mg/dl)
Systol Diastol FBS RBS
3/3/17 101 89
2/2/17 160 100
9/1/17 140 100
Blood Pressure & Blood Glucose History
Weight Trend
EMR Data Use: Inward NCD
 NCD Inward mockup

28. • Utilize EMR to track HIV and NCD clients who have missed
appointment, have new lab results, or need to get lab test
• EMR generates two different types of reports
– Two weeks Report
– Six weeks Report
EMR DATA USE: TRACKING RETENTION
AND CLIENT ENROLLMENT (TRACE)

29. EMR DATA USE: TRACKING RETENTION
AND CLIENT ENROLLMENT (TRACE)
TWO WEEKS REPORT
CHWs alert HIV and NCD
clients who
• recently missed an
appointment
• have urgent lab results
• need a lab test

30. EMR DATA USE: TRACKING RETENTION
AND CLIENT ENROLLMENT (TRACE)
TWO WEEKS REPORT
CHWs alert HIV and NCD
clients who
• recently missed an
appointment
• have urgent lab results
• need a lab test
SIX WEEKS REPORT
IC3 TRACE team follows
• HIV clients who have not made it
back into care 6w after missed
appointment or urgent lab results
• NCD clients who have been out of
care more than 6 weeks and are high
priority, (e.g. Stage 3 HTN clients or diabetic
client on insulin)

31. TRACE REPORT

32. EMR KEY CHALLENGES
• Keeping system running, accurate, and promoting utility is
hard work
– Maintenance
– Accuracy
• Changing systems, mean routinely updating system
– Constant tailoring, tweaking, and programming

33. EMR KEY SUCCESSES
• OpenMRS supports HIV/NCD care at all 14 facilities across
Neno District
• Utilizing EMR Data, including:
– Identify when clients need routine VL testing; search patients with
high VL
– Supporting stronger inpatient care through clinical support reports
– Recent deep data dive in ART – second line ART care

34. EMR VISION
• Short-term:
• Launching new Community Health Worker module to better connect
CHWs to patients
• Adding palliative care
• Long-term:
• Adding NCD point-of-care system, including modules for capturing vitals
and clinical decision-support
• Interoperability between OpenMRS and Medic Mobile

35. THE PIH MALAWI INFORMATICS TEAM
• Liberty Neba
• Joji Malunga
• Andrew Mahaka
• Harvey Zamatchetcha
• Marie Chamanza
• Charles Goliath
• Shareen Iman
• Limbani Thengo
• Alex Priebe
• Beth Dunbar