This document summarizes the management and use of an electronic medical record (EMR) system across multiple health districts in Rwanda. It describes the teams responsible for system management, implementation, and maintenance. It also provides an overview of how clinical data from the EMR is currently used for direct patient care, program monitoring, and influencing health policy. Finally, it outlines ongoing efforts between the Ministry of Health and partners to harmonize EMR implementations and terminology to improve data sharing and sustainability.

1. Background

2. Management of the system
• System Management:
– PIH HIS. M&E and Research
– System Development: PIH/IMB Software team
– PIH Business Analyst & HIS Developer Manager–
– PIH Software Developers: Berchmas Ndikubwimana, Neza Guillaine,
Bailley Rurangirwa
• System Implementation:
– Cross site Implementation
• PIH Implementation Manager – Nadine Karema
• PIH Cross site and training coordinator
– District Implementation
• MOH Medical Directors
• PIH District EMR Coordinators
• MOH EMR staff based at health facilities
• PIH District and cross site EMR IT management
• 3 District Hospitalsᵃ and 34 HFsᵇ

3. Current status
• OpenMRS EMR in use in 34 health centers in 3 Districts
• 29 Sites have their own server and maintain a synched
copy of the entire database
• Clinical data systems in use for chronic diseases (~50000
patients):
– HIV
– NCD (asthma, diabetes, hypertension, heart failure)
– Oncology
-> Patient Registration and look-up,
Reporting for patient follow-up , M&E,
Research, and Data Quality

4. Use of Data for Operational Decisions
– Direct Patient Care
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• Paper charts
– Rendezvous forms
– Flow sheets
• Consult sheets
• Patient lists
– Key clinical information
– Medications
– Alerts for care (ex. CD4 decline, late CD4, last
visit, weight decline > 5%)

5. Use of Data for Tactical Decisions –
Patient Tracking & Mentoring
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• Monthly Patient Reports
– Late visits
– Late CD4 counts
– No clinical visit in the last 12 months
– Very low BMI
– High viral load in the last 6 months

6. Use of Data for Tactical Decisions –
Program Monitoring
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• Quarterly Reporting of Key Indicators
– Per location
– By program

7. Use of Data for Strategic Decisions –
Influencing Policy
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• EMR data supports the policy
development, implementation, and
feedback cycle
• Example: measuring viral load, diabetes
testing

8. Current MOH Project: Harmonization
• PIH/MOH capture different contents for
similar programs
• Difficult to exchange tools across systems
• Concepts not standardized to international
terminologies
• Lack of a standard model for managing
metadata

9. Harmonization: Current Status
Objective:
 Avoid discrepancies in EMR data implementations
 Establish concept dictionary with standard terminology
 Simplify exchange of EMR tools across systems
Achievements :
 Build a national metadata server (MDS) to manage
data
 Harmonize our EMRs sites to guarantee sustainability

10. Activities planned 2014/2015
First Phase:
 Implement HIV Flowsheet as a pilot project
 Harmonize and clean MoH/PIH dictionaries
 Create mapping tools for new concepts terminology
 Uses MDS as principal source for partners or
researchers.
Next Phase:
 Implement NCD program with new concept techniques
 Design and develop strategies for metadata
management

11. Murakoze