Australian Medical Council Limited, profile picture
Uploaded byAustralian Medical Council Limited
PPT, PDF716 views

UNSW from OCIS to OpenMRS

The document discusses the implementation and success of e-health systems in resource-poor economies, particularly in Kenya, highlighting the evolution of clinical information systems and their impact on healthcare management. It emphasizes the significance of data management in improving patient care, especially in the context of HIV/AIDS, and showcases collaborative efforts in establishing health information systems. Additionally, it outlines the benefits of electronic medical records in enhancing clinical outcomes and resource utilization.

Embed presentation

Downloaded 20 times
Demonstrating the success of the e-health in resource poor (and developed) economies. Making it work. AIHI, UNSW 28th June 2012. DR TERRY J HANNAN MBBS;FRACP;FACHI;FACHI HEALTH INFORMATICIAN July 9, 2012
Schema for presentation. •The journey to Kenya •POWH-OCIS to CCCIS-lessons learnt •AMIA November 1999 •Eldoret January 2000 •MMRS to AMPATH to OpenMRS •AMIA 2007 •Update on status of OpenMRS project •3 x short movies (~3-4mins each) • Questions July 9, 2012
1982-1984 Non clinical evaluation 1984-1986 physician involvement and evaluation 1984-1987 ABSTRACT[SUMMARISATION] modification and implementation (Continuing evolution) 1986-1987 Modification of program / dictionaries /screen displays / reports / units of measurement 1986 MANUAL data entry of laboratory data 1987 MANUAL data entry by NURSING STAFF of clinical / protocol / chemotherapy data 1988-1989 AUTOMATED LABORATORY DATA TRANSFER 1989 REPORT GENERATOR functions(FLOWS &PLOTS) • DRG diagnostic data electronically collated for administration [2nd art to CLINICAL DATA]. CLINICAL TRAILS module implemented 1990-1992 Protocol generated care plans tested and evaluated 10 years Hannan, T., International transfer of the Johns Hopkins Oncology Center clinical information system. MD Comput, 1994. 11(2): p. 92-9.
“Bibles of Health Informatics” July 9, 2012
ACKNOWLEDGEMENTS FOR AMPATH/OPENMRS INFORMATION W. Tierney Andrew S Kanter, Hamish SF Fraser, Christopher J. Seebregts, Paul Biondich, Burke Mamlin, Sylvester Kimaiyo, Charles Safran, Joaquin Blaya Dave Thomas Joe Mamlin Sylvester Kimaiyo OpenMRS consortium participants www.openmrs.org July 9, 2012
Collaborators and Funders  Partners In Health  Regenstrief institute  Medical Research Council, South Africa  World Health Organization  US Centers for Disease Control  Brigham and Women hospital  Harvard Medical School  University of KwaZulu-Natal  Millennium Villages Project  International Development Research Centre, Ottawa  Rockefeller Foundation  Fogarty International Center, NIH  Boston Consulting Group July 9, 2012  Google Inc  PEPFAR
Health care is an information business Information is not a necessary adjunct to care, it is care, and effective patient management requires effective management of patients’ clinical data. Donald M. Berwick President and CEO, Institute for Healthcare Improvement There is no health without management, and there is no management without information. Gonzalo Vecina Neto, head of the Brazilian National Health Regulatory Agency July 9, 2012
TECHNOLOGY IS NOT THE PROBLEM [30 years EMR experience and research] Retrieval times-Fast (blink times) Data and information-Comprehensive Data storage- Long-term-lifelong Data applications-Introspective of total database Data storage- 200 million coded observations By products of the care process 3.25 million narrative reports RESEARCH-accuracy / $ 15 million prescriptions EPIDEMIOLOGY 212,000 ECG tracings ADMIN SUPPORT More than 1.3 million patients “Record once use many times” Access- 1300 medical nurses 1000 physicians 220 medical students Across health care institutions (16) Data access more than 628,000 / month C.J. McDonald, et al, The Regenstrief Medical Record System: A quarter century experience. Int J July 9, 2012Inform 54 (1999), 225‑ 253.) Med
CCDSS TOOLS IN CLINICAL MEDICINE-REQUIREMENTS 1.ALERTING 2. REMINDING 3. INTERPRETATION 4.ASSISTING 5.CRITIQUING 6.DIAGNOSING 7.MANAGING 8. KNOWLEDGE ACCESS /COUPLING [“Medicine in Denial.” L.Weed,L.Weed.2011] Pryor TA, Clayton PD. Decision support systems for clinical medicine. July 9, 2012 9 Tutorial 11.15th SCAMC.Nov. 17. 1991.
SUMMARISATION 1. Communication of health care is maintained using a Summary patient format in the ambulatory setting. Fries. J. Alternatives in medical record formats. Medical care. 1984;12:871-881 6. Summary patient record - information accessible four times faster - contains up to four times more information - Tabulated results allow physicians to better predict future trends in results Whiting-O’Keefe QW,Simborg DW,Epstein WV,Medical Care 1980;18:842-852
USING PHYSICIAN INPATIENT ORDER WRITING ON MICROCOMPUTER WORKSTATIONS. REDUCTION IN HEALTH CARE RESOURCE UTILISATION $3 million per year savings-(USA $65b) 0 -2 -4 TOTAL BED -6 TEST -8 DRUG -10.5 -10 OTHER -12.7 -11.9 -12.5 LOS -12 -14 -15.3 -15.2 -16 Physician inpatient order writing on microcomputer workstations-effects on resource July 9, 2012 utilisation. WM Tierney and others. JAMA 1993;269:379-383
Intermountain Health Care, Salt Lake City, Utah, USA STUDY DESIGN • Computer-based EMR system • Patients discharged January 1, 1988 to December 31, 1994 • 162,196 patients •Goal: to determine clinical and financial outcomes of the • antibiotic practice guidelines implemented through the • computer system Pestotnik, S. L. Classen, D. C. Evans, R. S. Burke, J. P. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes. Ann Intern Med 1996 May 15 July 9, 2012
Intermountain Health Care, Salt Lake City, Utah, USA Overall antibiotic use: decreased 22.8% Mortality rates: decreased from 3.65% to 2.65% Antibiotic-associated ADE: decreased 30% Antibiotic resistance: remained STABLE Appropriately timed preoperative a/biotics: 40% to 99.1% Antibiotic costs per treated patient: decreased $122.66 to $51.90 Acquisition costs for antibiotics: fell 24.8% to 12.9% ($987,547) to ($612,500) Our Case-Mix index which measures patient acuity levels INCREASED during this period, meaning we were treating sicker and sicker patients while better utilizing the delivery of antibiotics. Pestotnik, S. L. Classen, D. C. Evans, R. S. Burke, J. P. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes.Ann Intern Med 1996 May 15 July 9, 2012
AMIA – November 1999 An invitation from Prof. Bill Tierney To KENYA Jan July 9, 2012
AIDS in Africa The Global AIDS Pandemic at a Glance-2000  Leading infectious cause of adult death in the world  Leading cause of death in adults aged 15–59  First case of AIDS recognized in 1981  40 million persons now living with HIV/AIDS, 50% women  >70% of HIV-infected persons living in Africa  14,000 new infections daily  Sexual transmission responsible for more than 85% of infections  6 million in need of immediate treatment and fewer than 8% receiving it SOURCES: Quinn and Chaisson, 2004; WHO, 2003a,b.
AIDS in Africa In Kenya…  2.5 million persons infected (15% of adults)  4th behind South Africa, India, and Nigeria  1 million AIDS orphans (of 31 million citizens)  life expectancy has dropped 18 years in the past 5 years, from 65 → 47 years
One solution: Academic collaboration  14-year collaboration between IU and MU  1st 11 years → focus=educational exchange  In 2001 Joe Mamlin returned  found >50% of the beds in Moi Hospital were filled with young people dying of AIDS  no ARVs, few antibiotics for opportunistic infections  despair, depression, resignation  Then…Daniel
Limited resources July 9, 2012
July 9, 2012
July 9, 2012
July 9, 2012
July 9, 2012
July 9, 2012
July 9, 2012
July 9, 2012
July 9, 2012
A response to HIV July 9, 2012
30-40 million cases HIV/AIDs Existing systems overburdened July 9, 2012
Assignment: knowing there is a 14% prevalence of HIV/AIDS. What are the health information management needs here? PreMMRS July 9, 2012
July 9, 2012
July 9, 2012
July 9, 2012
July 9, 2012
Assignment: knowing there is a 14% prevalence of HIV/AIDS. What are the health information management needs here? PreMMRS July 9, 2012
MMRS data (2 years) 63,728 visits Diagnoses # Visits Drugs # Visits Malaria 17,495 Paracetamol 24,944 URI 8,479 Fansidar 11,550 Septic wound 1,329 Quinine, injected 8,769 Gastroenteritis 964 Penicillin, injected 8,058 Tonsilitis 938 Quinine, oral 7,851 Wound (unspec.) 791 Penicillin, oral 4,753 Myalgia 700 Amoxicillin 4,725 Amebiasis 629 Depoprovera 4,443 Laceration 618 Piriton 3,766 Worms (unspec.) 544 Brufen 3,323 July 9, 2012
MMRS data (2 years) 63,728 visits T B Malaria Diagnoses # Visits 17,495 Drugs Paracetamol NO # Visits 24,944 URI Septic wound 8,479 1,329 n d Fansidar Quinine, injected 11,550 8,769 Gastroenteritis 964 a Penicillin, injected 8,058 Tonsilitis Wound (unspec.) HIV 938 791 Quinine, oral Penicillin, oral 7,851 4,753 Myalgia Amebiasis N O 700 629 Amoxicillin Depoprovera 4,725 4,443 Laceration 618 Piriton 3,766 Worms (unspec.) 544 Brufen 3,323 July 9, 2012
“We have lit a candle in the darkness of Africa” William Tierney. Kenyan Gov’t: “This record system must be in every clinic in Kenya!” July 9, 2012
July 9, 2012
July 9, 2012
A Year of Growth? July 9, 2012
A Year of Growth… One Year Later July 9, 2012
An innovative home-care programme using hand- held computers is also being piloted in the region. Monica Korir, who is living with HIV and is trained as an outreach worker, interviews Paul Ekorok, 52, at his home in Captarit village and records his answers. WHO/Evelyn Hockstein Outreach workers download completed forms into Mosoriot clinic's data management system daily. Automated alerts flag any alarming new symptoms to the attention of the responsible clinical officer, or when a patient has missed an appointment so that outreach workers can find out what is wrong. July 9, 2012
Ezekiel Muruli transports charts daily from Mosoriot to Eldoret, about 25 kms away, where data from paper records are entered into a central electronic system. Direct electronic data transfer is not feasible because Mosoriot does not have high-speed Internet access. WHO/Evelyn Hockstein In Eldoret, Erika Muthoni Kigotho supervises 17 data entry specialists who have received training on HIV care and in spotting potential errors in record-keeping. Electronically generated paper charts, along with reminders for appropriate tests and treatment, are returned to Mosoriot within 48 hours of receipt. July 9, 2012
Early PHRS July 9, 2012
Salina- “Rattling bones syndrome” Starvation! July 9, 2012
Salina on anti-retroviral therapy July 9, 2012
HIV is a treatable disease, but treating millions requires information management. July 9, 2012
AMPATH clinical and support programs capturing electronic data. ALL DISEASE STATES NOT JUST HIV/AIDS Adult HIV/AIDS clinics Oncology clinics Social worker assessments Pediatric HIV/AIDS clinics Mental health clinics Outreach – patient follow-up Primary care – rural health Diabetes clinics Drug adherence assessments clinics Tuberculosis clinics Primary care – urban well-child Clinic pharmacies Nutrition assessments clinics Clinical laboratories Food supplement distribution Antenatal and postnatal clinics Microfinance program Mother-baby register AMPATH maintenance cost only $175/patient/year in 2007 and is now less than $100/patient/year in 2009 July 9, 2012
July 9, 2012
July 9, 2012
Birth of OpenMRS Collaboration-Regenstrief/PIH MEDINFO San Francisco 2007 Prof. Paul Biondich A/Prof. Hamish Fraser A/Prof. Burke Mamlin July 9, 2012
The plural of anecdote is not data. “we must remove ourselves from the ‘unscientific, non data driven personal recommendations’ for care”. Dr. M. Smith CHCF AMIA 2009
0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 2 1N 00 OV DEC 2 1JA 00 N 16,000 F B E MR A APR MY A JUN 2 2JU 00 L AUG SEP OCT NO V DEC 2 3JA 00 N F B E MR A APR MY A JUN 2 3JU 00 L AUG S P E OCT NO V DEC 2 4JA 00 N FEB MR A APR MY A JUN 2 4JU 00 L AUG S P E OCT NO V DEC 2 5JA 00 N F B E MR A APR MY A JUN 2 5JU 00 L AUG SE P OCT NO V DEC 2 6JA 00 N 1 0 / 2/2006 1 0 / 3/2006 1 0 / 4/2006 1 0 / 5/2006 1 0 / 6/2006 1 0 / 7/2006 1 0 / 8/2006 1 0 / 9/2006 1 1 / 0/2006 1 1 / 1/2006 1 1 / 2/2006 1 0 / 1/2007 1 0 / 2/2007 1 0 / 3/2007 1 0 / 4/2007 1 0 / 5/2007 1 0 / 6/2007 1 0 / 7/2007 1 0 / 8/2007 1 0 / 9/2007 1 1 / 0/2007 1 1 / 1/2007 1 1 / 2/2007 1 0 / 1/2008 1 0 / 2/2008 1 0 / 3/2008 1 0 / 4/2008 1 0 / 5/2008 1 0 / 6/2008 1 0 / 7/2008 1 0 / 8/2008 1 0 / 9/2008 1 1 / 0/2008 1 1 / 1/2008 1 1 / 2/2008 1 0 / 1/2009 1 0 / 2/2009 1 0 / 3/2009 1 0 / 4/2009 1 0 / 5/2009 1 0 / 6/2009 1 0 / 7/2009 1 0 / 8/2009 1 0 / 9/2009 1 1 / 0/2009 1 1 / 1/2009 1 1 / 2/2009 1 0 / 1/2010 1 0 / 2/2010 1 0 / 3/2010 1 0 / 4/2010 1 0 / 5/2010 1 0 / 6/2010 Patients Enrolled by Month: Nov ’01 – Jan ‘12 1 0 / 7/2010 1 0 / 8/2010 1 0 / 9/2010 1 1 / 0/2010 1 1 / 1/2010 1 1 / 2/2010 1 0 / 1/2011 1 0 / 2/2011 1 0 / 3/2011 1 0 / 4/2011 1 0 / 5/2011 1 0 / 6/2011 1 0 / 7/2011 1 0 / 8/2011 1 0 / 9/2011 1 1 / 0/2011 1 1 / 1/2011 1 1 / 2/2011 1 0 / 1/2012
450,000 400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000 0 Cumulative Patients Enrolled: Nov ’01 – Jan ‘12
70,000 65,000 60,000 55,000 50,000 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 Patient Visits By Month: Nov ’01 – Jan ‘12
3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 0 Cumulative Patient Visits: Nov ’01 – Jan ‘12
3,000,000 2,800,000 2,600,000 2,400,000 2,200,000 2,000,000 1,800,000 1,600,000 1,400,000 1,200,000 1,000,000 800,000 600,000 400,000 200,000 0 AMRS Observations By Month: Mar ’06 – Jan ‘12
120,000,000 110,000,000 100,000,000 90,000,000 80,000,000 70,000,000 60,000,000 50,000,000 40,000,000 30,000,000 20,000,000 10,000,000 0 Cumulative AMRS Observations By Month: Mar ’06 – Jan ‘12
To improve care, you have to measure it. Not possible using current paper-based medical record systems. W.Tierney, Regenstrief Institute, Indiana. The foundation for quality patient care is information – Comprehensive, Accurate, Up-to-the-minute clinical Information. Information management is care- E. Shortliffe, Stanford. AMPATH PEER REVIEWED PUBLICATIONS SINCE 2000 ~160 ALL GRANTS AND CONTRACTS CURRENTLY FUNDED TO DATE (N=74) $40,928,084US July 9, 2012
July 9, 2012
GN for AIDS MTCT-Plus Women’s & Clinical Program Children’s Trials Health Group Research NHLBI Global Health IeDEA Initiative
OpenMRS A web-based EMR… July 9, 2012
Patient summary and alerts July 9, 2012
OpenMRS is…  An Electronic Medical Record System  A data model  An API  An HIV system … and more.  A TB system  A Primary Care system  A developer community  An implementer community July 9, 2012
Multiple uses July 9, 2012
Kapenguria Kapsakwony Kitale Naitiri Webuye Amukura Turbo Teso Mosoriot Burnt Forest Chulaimbo 50 km
400,000 patients OpenMRS sites - fall 2008 July 9, 2012
600,000 patients OpenMRS sites – Spring 2010 July 9, 2012
July 9, 2012
OpenMRS in Peru March 2006-2007  In total, e-Chasqui will serve a network of institutions providing medical care for over 3.1 million people.  benefits  the test always available during clinical decision making  reducing duplicate tests performed  reducing the time and money spent by staff checking the status of their samples.  The cost to maintain this system is ~US$0.53 per sample or 1% of the National Peruvian TB program's 2006 budget.  Government support to distribute throughout Peru A web-based laboratory information system to improve quality of care of tuberculosis patients in Peru: functional requirements, implementation and usage statistics. Blaya, J.A., et al., BMC Med Inform Decis Mak, 2007. 7: July 9, 2012 p.33
Features of OpenMRS Part 1 Security: User authentication Privilege-based access: User roles and permission system Patient repository: Creation and maintenance of patient data, including demographics, clinical observations, encounter data, orders, etc. Multiple identifiers per patient: A single patient may have multiple medical record numbers Data entry: With the FormEntry module, clients with InfoPath (included in Microsoft Office 2003 and later) can design and enter data using flexible, electronic forms. With the HTML FormEntry module, forms can be created with customized HTML and run directly within the web application. Data export: Data can be exported into a spreadsheet format for use in other tools (Excel, Access, etc.) Standards support: HL7 engine for data import Modular architecture: An OpenMRS Module can extend and add any type July 9, 2012 73 of functionality to the existing API and webapp.
Features of OpenMRS Part 1 Patient workflows: An embedded patient workflow service allows patient to be put into programs (studies, treatment programs, etc.) and tracked through various states. Cohort management: The cohort builder allows you to create groups of patients for data exports, reporting, etc. Relationships: Relationships between any two people (patients, relatives, caretakers, etc.) Patient merging: Merging duplicate patients Localization / internationalization: Multiple language support and the possibility to extend to other languages with full UTF-8 support. Support for complex data: Radiology images, sound files, etc. can be stored as “complex” observations Reporting tools: Flexible reporting tools Person attributes: The attributes of a person can be extended to meet local needs July 9, 2012 74
Lessons learned  Clinical information systems are possible in even the most resource-constrained places  Collaboration with established informatics programs is a must  Primary goals → sustainability of the EMR, independence of the developing country  Start small and build to serve local needs  Anticipate challenges and prepare for them  Maintain hope and enthusiasm
AMPATH 2012 July 9, Medical Record System (AMRS): Collaborating Toward An EMR for Developing Countries Burke W. Mamlin, M.D. and Paul G. Biondich, M.D., M.S. Regenstrief Institute, Inc. and Indiana University School of Medicine, Indianapolis, IN
WHAT OTHERS SAY ABOUT THE INDIANA-KENYA PARTNERSHIP Nominated for the 2007 Nobel Peace Prize; featured in The Wall Street Journal “The people working on this program are public health heroes. They are doing things that many people thought could never be done, and it is going to have a huge multiplier effect.” --Dr. Tim Evans, former director of health equity for the Rockefeller Foundation “Much more accurately described as an Academic MIRACLE in response to AIDS.” --Michael E. Ranneberger, U.S. Ambassador to Kenya “The most important and comprehensive HIV/AIDS effort in all of Africa.” - James Morris, former executive director, United Nations World Food Program July 9, 2012
“Now HIV/AIDS programs are not only in place but some of them, including the partnership between the United States Agency for International Development (USAID) and the Academic Model Providing Access to Healthcare (AMPATH) are openly speaking of bringing the pandemic to its knees over the next 5 years through widespread screening and effective treatment and prevention of HIV.” Braitstein, P., et al., "Talkin' about a revolution": How electronic health records can facilitate the scale-up of HIV care and treatment and catalyze primary care in resource-constrained settings. J Acquir Immune Defic Syndr, 2009. 52 Suppl 1: p. S54-7. July 9, 2012
July 9, 2012
July 9, 2012
July 9, 2012

More Related Content

PPTX
2014 icbo courtot_meddra
byMelanie Courtot
 
PDF
American Journal of Anesthesia & Clinical Research
bySciRes Literature LLC. | Open Access Journals
 
PPTX
Multi-Disciplinary Renal Clinic Presentation to Exec Leadership
byTJ O'Neil
 
PDF
Final ppahs notre dame presentation
byMike Wong
 
PDF
From Bits to Bedside: Translating Big Data into Precision Medicine and Digita...
byDexter Hadley
 
PDF
New sources of big data for precision medicine: are we ready?
byHealth and Biomedical Informatics Centre @ The University of Melbourne
 
PDF
인공지능은 의료를 어떻게 혁신하는가 (2019년 7월) (하)
byYoon Sup Choi
 
PDF
Manual ultrasound
byCesar Rosenberg González
 
2014 icbo courtot_meddra
byMelanie Courtot
 
American Journal of Anesthesia & Clinical Research
bySciRes Literature LLC. | Open Access Journals
 
Multi-Disciplinary Renal Clinic Presentation to Exec Leadership
byTJ O'Neil
 
Final ppahs notre dame presentation
byMike Wong
 
From Bits to Bedside: Translating Big Data into Precision Medicine and Digita...
byDexter Hadley
 
New sources of big data for precision medicine: are we ready?
byHealth and Biomedical Informatics Centre @ The University of Melbourne
 
인공지능은 의료를 어떻게 혁신하는가 (2019년 7월) (하)
byYoon Sup Choi
 
Manual ultrasound
byCesar Rosenberg González
 

What's hot

PDF
Balderman2019 thoracic outlet syndrome
byNistaraSinghChawla
 
PPTX
Gpt buchman
bySamantha Haas
 
PPTX
Exploring the Currents of Telemedicine
bydescartin
 
PDF
Acr 2 buscado en fama
bysarciemad
 
PDF
Turning Big Data into Precision Medicine
byMatthieu Schapranow
 
PPT
Presentatie svin deneckere_itineraevent
byItinera Institute
 
PDF
Medical Students in Global Neurosurgery: Rationale and Role
byAhmad Ozair
 
PDF
doi: 10.1101/2021.05.28.21258012
byMattisHallsteinVolla
 
PDF
Austin Aging Research
byAustin Publishing Group
 
PDF
PGD Decolonisation to Reduce Spinal Infection Rates
byAnnesha Archyangelio MSc BSc RN ILM PhD Student
 
PDF
What's New in the Treatment of Gliomas: A Neuro-Oncologist's Perspective
byCanadian Cancer Survivor Network
 
PDF
Remote quality of life assessment: ‘What is always speaking silently is the b...
byKatarzyna Wac & The QoL Lab
 
PPT
UCSF Informatics Day 2014 - Keith R. Yamamoto, "Precision Medicine"
byCTSI at UCSF
 
PPT
Milano (06 02 09) Final
byjescarra
 
PPTX
AANN 2016, Neurocritical Care Without Limits- An Alternative nCCU Model
byTroy Gideon RN, BSN, MBA
 
PDF
Integrating Genomic Medicine into Patient Care with Trish Brown, MS, CGC
byAsia Pacific Medical Technology Association (APACMed)
 
PDF
Autralian journal advance nursing (ajan) (2)
byWayan Rastiti
 
PDF
Cmt newsletter-winter-2015
bySean Ekins
 
PDF
EuroBioForum2014_speaker_Manolio
byEuroBioForum
 
PDF
Always Events, Turning Never Events Into A Smile
byPicker Institute, Inc.
 
Balderman2019 thoracic outlet syndrome
byNistaraSinghChawla
 
Gpt buchman
bySamantha Haas
 
Exploring the Currents of Telemedicine
bydescartin
 
Acr 2 buscado en fama
bysarciemad
 
Turning Big Data into Precision Medicine
byMatthieu Schapranow
 
Presentatie svin deneckere_itineraevent
byItinera Institute
 
Medical Students in Global Neurosurgery: Rationale and Role
byAhmad Ozair
 
doi: 10.1101/2021.05.28.21258012
byMattisHallsteinVolla
 
Austin Aging Research
byAustin Publishing Group
 
PGD Decolonisation to Reduce Spinal Infection Rates
byAnnesha Archyangelio MSc BSc RN ILM PhD Student
 
What's New in the Treatment of Gliomas: A Neuro-Oncologist's Perspective
byCanadian Cancer Survivor Network
 
Remote quality of life assessment: ‘What is always speaking silently is the b...
byKatarzyna Wac & The QoL Lab
 
UCSF Informatics Day 2014 - Keith R. Yamamoto, "Precision Medicine"
byCTSI at UCSF
 
Milano (06 02 09) Final
byjescarra
 
AANN 2016, Neurocritical Care Without Limits- An Alternative nCCU Model
byTroy Gideon RN, BSN, MBA
 
Integrating Genomic Medicine into Patient Care with Trish Brown, MS, CGC
byAsia Pacific Medical Technology Association (APACMed)
 
Autralian journal advance nursing (ajan) (2)
byWayan Rastiti
 
Cmt newsletter-winter-2015
bySean Ekins
 
EuroBioForum2014_speaker_Manolio
byEuroBioForum
 
Always Events, Turning Never Events Into A Smile
byPicker Institute, Inc.
 

Similar to UNSW from OCIS to OpenMRS

PPTX
Menzies final hobart 29 feb13
byAustralian Medical Council Limited
 
PPT
Worldwide Lessons in Healthcare IT
bySocial Media Today
 
PPTX
CIS Innovations in Healthcare
bySBUgroup5
 
PPTX
2009 Partners In Hope
bybobjay
 
PPT
What Is Medical Informatics?
bySanjoy Sanyal
 
PPT
Informatics for librarians: the core of the onion
byJacqueline Leskovec
 
PPTX
Taking Transformational Change To Scale.Doebbeling.3.9.10.Final
byBrad Doebbeling
 
PPT
Pavia wsp october 2011
byAustralian Medical Council Limited
 
PPT
iHT2 Health IT Summit San Francisco 2013 - Christopher Chute, Division of Bio...
byHealth IT Conference – iHT2
 
PPTX
Healthcare-associated Infections Winnable Battle presentation
byPublicHealthFoundation
 
PPT
Classic Papers in Medical Informatics
byMike Hogarth, MD, FACMI, FACP
 
PPT
Day 1 track_5_taffel
bybatrapagal
 
PPTX
iHT² Health IT Summit in Beverly Hills 2012 - Raymond Lowe Case Study “Dignit...
byHealth IT Conference – iHT2
 
PPTX
Health info
byNguyễn Nhật Anh
 
PPTX
Health informatics
byamynicole1219
 
PPTX
Health informatics
byamynicole1219
 
PPSX
Health informatics
byamynicole1219
 
PDF
2011 CMIO Summit | Abha Agrawal
byTriMed Media Group
 
PPTX
iHT2 Health IT Summit San Francisco 2013 - Davin Lundquist, MD, CMIO, Dignity...
byHealth IT Conference – iHT2
 
DOCX
The Application of Data to Problem-SolvingIn the modern era, the.docx
bytodd801
 
Menzies final hobart 29 feb13
byAustralian Medical Council Limited
 
Worldwide Lessons in Healthcare IT
bySocial Media Today
 
CIS Innovations in Healthcare
bySBUgroup5
 
2009 Partners In Hope
bybobjay
 
What Is Medical Informatics?
bySanjoy Sanyal
 
Informatics for librarians: the core of the onion
byJacqueline Leskovec
 
Taking Transformational Change To Scale.Doebbeling.3.9.10.Final
byBrad Doebbeling
 
Pavia wsp october 2011
byAustralian Medical Council Limited
 
iHT2 Health IT Summit San Francisco 2013 - Christopher Chute, Division of Bio...
byHealth IT Conference – iHT2
 
Healthcare-associated Infections Winnable Battle presentation
byPublicHealthFoundation
 
Classic Papers in Medical Informatics
byMike Hogarth, MD, FACMI, FACP
 
Day 1 track_5_taffel
bybatrapagal
 
iHT² Health IT Summit in Beverly Hills 2012 - Raymond Lowe Case Study “Dignit...
byHealth IT Conference – iHT2
 
Health info
byNguyễn Nhật Anh
 
Health informatics
byamynicole1219
 
Health informatics
byamynicole1219
 
Health informatics
byamynicole1219
 
2011 CMIO Summit | Abha Agrawal
byTriMed Media Group
 
iHT2 Health IT Summit San Francisco 2013 - Davin Lundquist, MD, CMIO, Dignity...
byHealth IT Conference – iHT2
 
The Application of Data to Problem-SolvingIn the modern era, the.docx
bytodd801
 

Recently uploaded

PDF
Seminario biología molecula - EBV-miR-BART5-3p
bysalvarez1862004
 
PPTX
FEBRUARY 2026 ONCOLOGY CARTOONS BY DR KANHU CHARAN PATRO
byKanhu Charan
 
PPTX
TOMOGRAPHY PRINCIPLE & EQUIPMENTS.pptx..
byMuntasir9
 
PPTX
OXFORD TECHNIQUE ,Zinovieff OXFORD TECHNIQUE
byDrTabassumAzmi1
 
PPTX
Atrial Fibrillation and difference with Atrial flutter
byrashamarei
 
PPTX
Introduction to Geriatric Nursing,Theory
bynabina paneru
 
PPTX
History and Evolution of Microbiology.pptx
byVijayaRengan4
 
PPTX
Cardiovascular Disease ppt. S.Y D-Pharm.
byAkshata Jain
 
PDF
Artículo Biomol Interaction between ZMIZ2 and AR promotes prostate cancer pro...
bySebastianCastrillon10
 
PPTX
Preformulation Studies for new Pharmaceutical substances
byMenaka V
 
PPTX
Fresh Empanelment of Private Hospitals under CGHS 22 Dec 25 Presentation
bybillingkohakadehospi
 
PPTX
Template for presentation of patients at the MDT Meeting
byNasri937947
 
PPTX
SAPIENT3.0 Medi-trivia Quiz (FINALS) | F.A.Q. 2025
byDr. Anindya
 
PPTX
Left Ventricular Assist Devices.(New Gen)
bySyedFaisalAhmed12
 
PPTX
WHEN NOT TO DO TENDOACHILLES TENOTOMY.pptx
byUmeshPrasadChoudhary
 
PPTX
THE STUDY OF MIND content intro and basics.pptx
byLakshmiPrasanthi11
 
PPTX
LOW DOSE RADIATHERAPY (LDRT) IN OSTEOARTHRITIS
byKanhu Charan
 
PPTX
Circulatory System by Dr. Rabia Inam Gandapore.pptx
byDr. Rabia Inam Gandapore
 
PPTX
The Autonomic Nervous System and Visceral Reflexes
bycotomato21
 
PPTX
ANATOMY AND PHYSIOLOGY OF THYROID GLAND / TRIANGLEs RELATED TO THYROID GLAND/...
byDr Sushil Gyawali
 
Seminario biología molecula - EBV-miR-BART5-3p
bysalvarez1862004
 
FEBRUARY 2026 ONCOLOGY CARTOONS BY DR KANHU CHARAN PATRO
byKanhu Charan
 
TOMOGRAPHY PRINCIPLE & EQUIPMENTS.pptx..
byMuntasir9
 
OXFORD TECHNIQUE ,Zinovieff OXFORD TECHNIQUE
byDrTabassumAzmi1
 
Atrial Fibrillation and difference with Atrial flutter
byrashamarei
 
Introduction to Geriatric Nursing,Theory
bynabina paneru
 
History and Evolution of Microbiology.pptx
byVijayaRengan4
 
Cardiovascular Disease ppt. S.Y D-Pharm.
byAkshata Jain
 
Artículo Biomol Interaction between ZMIZ2 and AR promotes prostate cancer pro...
bySebastianCastrillon10
 
Preformulation Studies for new Pharmaceutical substances
byMenaka V
 
Fresh Empanelment of Private Hospitals under CGHS 22 Dec 25 Presentation
bybillingkohakadehospi
 
Template for presentation of patients at the MDT Meeting
byNasri937947
 
SAPIENT3.0 Medi-trivia Quiz (FINALS) | F.A.Q. 2025
byDr. Anindya
 
Left Ventricular Assist Devices.(New Gen)
bySyedFaisalAhmed12
 
WHEN NOT TO DO TENDOACHILLES TENOTOMY.pptx
byUmeshPrasadChoudhary
 
THE STUDY OF MIND content intro and basics.pptx
byLakshmiPrasanthi11
 
LOW DOSE RADIATHERAPY (LDRT) IN OSTEOARTHRITIS
byKanhu Charan
 
Circulatory System by Dr. Rabia Inam Gandapore.pptx
byDr. Rabia Inam Gandapore
 
The Autonomic Nervous System and Visceral Reflexes
bycotomato21
 
ANATOMY AND PHYSIOLOGY OF THYROID GLAND / TRIANGLEs RELATED TO THYROID GLAND/...
byDr Sushil Gyawali
 

UNSW from OCIS to OpenMRS

  • 1.
    Demonstrating the successof the e-health in resource poor (and developed) economies. Making it work. AIHI, UNSW 28th June 2012. DR TERRY J HANNAN MBBS;FRACP;FACHI;FACHI HEALTH INFORMATICIAN July 9, 2012
  • 2.
    Schema for presentation. •Thejourney to Kenya •POWH-OCIS to CCCIS-lessons learnt •AMIA November 1999 •Eldoret January 2000 •MMRS to AMPATH to OpenMRS •AMIA 2007 •Update on status of OpenMRS project •3 x short movies (~3-4mins each) • Questions July 9, 2012
  • 3.
    1982-1984 Non clinicalevaluation 1984-1986 physician involvement and evaluation 1984-1987 ABSTRACT[SUMMARISATION] modification and implementation (Continuing evolution) 1986-1987 Modification of program / dictionaries /screen displays / reports / units of measurement 1986 MANUAL data entry of laboratory data 1987 MANUAL data entry by NURSING STAFF of clinical / protocol / chemotherapy data 1988-1989 AUTOMATED LABORATORY DATA TRANSFER 1989 REPORT GENERATOR functions(FLOWS &PLOTS) • DRG diagnostic data electronically collated for administration [2nd art to CLINICAL DATA]. CLINICAL TRAILS module implemented 1990-1992 Protocol generated care plans tested and evaluated 10 years Hannan, T., International transfer of the Johns Hopkins Oncology Center clinical information system. MD Comput, 1994. 11(2): p. 92-9.
  • 4.
    “Bibles of HealthInformatics” July 9, 2012
  • 5.
    ACKNOWLEDGEMENTS FOR AMPATH/OPENMRS INFORMATION W. Tierney Andrew S Kanter, Hamish SF Fraser, Christopher J. Seebregts, Paul Biondich, Burke Mamlin, Sylvester Kimaiyo, Charles Safran, Joaquin Blaya Dave Thomas Joe Mamlin Sylvester Kimaiyo OpenMRS consortium participants www.openmrs.org July 9, 2012
  • 6.
    Collaborators and Funders  Partners In Health  Regenstrief institute  Medical Research Council, South Africa  World Health Organization  US Centers for Disease Control  Brigham and Women hospital  Harvard Medical School  University of KwaZulu-Natal  Millennium Villages Project  International Development Research Centre, Ottawa  Rockefeller Foundation  Fogarty International Center, NIH  Boston Consulting Group July 9, 2012  Google Inc  PEPFAR
  • 7.
    Health care isan information business Information is not a necessary adjunct to care, it is care, and effective patient management requires effective management of patients’ clinical data. Donald M. Berwick President and CEO, Institute for Healthcare Improvement There is no health without management, and there is no management without information. Gonzalo Vecina Neto, head of the Brazilian National Health Regulatory Agency July 9, 2012
  • 8.
    TECHNOLOGY IS NOTTHE PROBLEM [30 years EMR experience and research] Retrieval times-Fast (blink times) Data and information-Comprehensive Data storage- Long-term-lifelong Data applications-Introspective of total database Data storage- 200 million coded observations By products of the care process 3.25 million narrative reports RESEARCH-accuracy / $ 15 million prescriptions EPIDEMIOLOGY 212,000 ECG tracings ADMIN SUPPORT More than 1.3 million patients “Record once use many times” Access- 1300 medical nurses 1000 physicians 220 medical students Across health care institutions (16) Data access more than 628,000 / month C.J. McDonald, et al, The Regenstrief Medical Record System: A quarter century experience. Int J July 9, 2012Inform 54 (1999), 225‑ 253.) Med
  • 9.
    CCDSS TOOLS INCLINICAL MEDICINE-REQUIREMENTS 1.ALERTING 2. REMINDING 3. INTERPRETATION 4.ASSISTING 5.CRITIQUING 6.DIAGNOSING 7.MANAGING 8. KNOWLEDGE ACCESS /COUPLING [“Medicine in Denial.” L.Weed,L.Weed.2011] Pryor TA, Clayton PD. Decision support systems for clinical medicine. July 9, 2012 9 Tutorial 11.15th SCAMC.Nov. 17. 1991.
  • 10.
    SUMMARISATION 1. Communication ofhealth care is maintained using a Summary patient format in the ambulatory setting. Fries. J. Alternatives in medical record formats. Medical care. 1984;12:871-881 6. Summary patient record - information accessible four times faster - contains up to four times more information - Tabulated results allow physicians to better predict future trends in results Whiting-O’Keefe QW,Simborg DW,Epstein WV,Medical Care 1980;18:842-852
  • 11.
    USING PHYSICIAN INPATIENTORDER WRITING ON MICROCOMPUTER WORKSTATIONS. REDUCTION IN HEALTH CARE RESOURCE UTILISATION $3 million per year savings-(USA $65b) 0 -2 -4 TOTAL BED -6 TEST -8 DRUG -10.5 -10 OTHER -12.7 -11.9 -12.5 LOS -12 -14 -15.3 -15.2 -16 Physician inpatient order writing on microcomputer workstations-effects on resource July 9, 2012 utilisation. WM Tierney and others. JAMA 1993;269:379-383
  • 12.
    Intermountain Health Care,Salt Lake City, Utah, USA STUDY DESIGN • Computer-based EMR system • Patients discharged January 1, 1988 to December 31, 1994 • 162,196 patients •Goal: to determine clinical and financial outcomes of the • antibiotic practice guidelines implemented through the • computer system Pestotnik, S. L. Classen, D. C. Evans, R. S. Burke, J. P. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes. Ann Intern Med 1996 May 15 July 9, 2012
  • 13.
    Intermountain Health Care,Salt Lake City, Utah, USA Overall antibiotic use: decreased 22.8% Mortality rates: decreased from 3.65% to 2.65% Antibiotic-associated ADE: decreased 30% Antibiotic resistance: remained STABLE Appropriately timed preoperative a/biotics: 40% to 99.1% Antibiotic costs per treated patient: decreased $122.66 to $51.90 Acquisition costs for antibiotics: fell 24.8% to 12.9% ($987,547) to ($612,500) Our Case-Mix index which measures patient acuity levels INCREASED during this period, meaning we were treating sicker and sicker patients while better utilizing the delivery of antibiotics. Pestotnik, S. L. Classen, D. C. Evans, R. S. Burke, J. P. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes.Ann Intern Med 1996 May 15 July 9, 2012
  • 14.
    AMIA – November 1999 Aninvitation from Prof. Bill Tierney To KENYA Jan July 9, 2012
  • 15.
    AIDS in Africa The Global AIDS Pandemic at a Glance-2000  Leading infectious cause of adult death in the world  Leading cause of death in adults aged 15–59  First case of AIDS recognized in 1981  40 million persons now living with HIV/AIDS, 50% women  >70% of HIV-infected persons living in Africa  14,000 new infections daily  Sexual transmission responsible for more than 85% of infections  6 million in need of immediate treatment and fewer than 8% receiving it SOURCES: Quinn and Chaisson, 2004; WHO, 2003a,b.
  • 16.
    AIDS in Africa InKenya…  2.5 million persons infected (15% of adults)  4th behind South Africa, India, and Nigeria  1 million AIDS orphans (of 31 million citizens)  life expectancy has dropped 18 years in the past 5 years, from 65 → 47 years
  • 17.
    One solution: Academic collaboration  14-year collaboration between IU and MU  1st 11 years → focus=educational exchange  In 2001 Joe Mamlin returned  found >50% of the beds in Moi Hospital were filled with young people dying of AIDS  no ARVs, few antibiotics for opportunistic infections  despair, depression, resignation  Then…Daniel
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
    A response toHIV July 9, 2012
  • 29.
    30-40 million cases HIV/AIDs Existing systems overburdened July 9, 2012
  • 30.
    Assignment: knowing thereis a 14% prevalence of HIV/AIDS. What are the health information management needs here? PreMMRS July 9, 2012
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
    Assignment: knowing thereis a 14% prevalence of HIV/AIDS. What are the health information management needs here? PreMMRS July 9, 2012
  • 36.
    MMRS data (2years) 63,728 visits Diagnoses # Visits Drugs # Visits Malaria 17,495 Paracetamol 24,944 URI 8,479 Fansidar 11,550 Septic wound 1,329 Quinine, injected 8,769 Gastroenteritis 964 Penicillin, injected 8,058 Tonsilitis 938 Quinine, oral 7,851 Wound (unspec.) 791 Penicillin, oral 4,753 Myalgia 700 Amoxicillin 4,725 Amebiasis 629 Depoprovera 4,443 Laceration 618 Piriton 3,766 Worms (unspec.) 544 Brufen 3,323 July 9, 2012
  • 37.
    MMRS data (2years) 63,728 visits T B Malaria Diagnoses # Visits 17,495 Drugs Paracetamol NO # Visits 24,944 URI Septic wound 8,479 1,329 n d Fansidar Quinine, injected 11,550 8,769 Gastroenteritis 964 a Penicillin, injected 8,058 Tonsilitis Wound (unspec.) HIV 938 791 Quinine, oral Penicillin, oral 7,851 4,753 Myalgia Amebiasis N O 700 629 Amoxicillin Depoprovera 4,725 4,443 Laceration 618 Piriton 3,766 Worms (unspec.) 544 Brufen 3,323 July 9, 2012
  • 38.
    “We have lita candle in the darkness of Africa” William Tierney. Kenyan Gov’t: “This record system must be in every clinic in Kenya!” July 9, 2012
  • 39.
  • 40.
  • 41.
    A Year ofGrowth? July 9, 2012
  • 42.
    A Year ofGrowth… One Year Later July 9, 2012
  • 43.
    An innovative home-careprogramme using hand- held computers is also being piloted in the region. Monica Korir, who is living with HIV and is trained as an outreach worker, interviews Paul Ekorok, 52, at his home in Captarit village and records his answers. WHO/Evelyn Hockstein Outreach workers download completed forms into Mosoriot clinic's data management system daily. Automated alerts flag any alarming new symptoms to the attention of the responsible clinical officer, or when a patient has missed an appointment so that outreach workers can find out what is wrong. July 9, 2012
  • 44.
    Ezekiel Muruli transportscharts daily from Mosoriot to Eldoret, about 25 kms away, where data from paper records are entered into a central electronic system. Direct electronic data transfer is not feasible because Mosoriot does not have high-speed Internet access. WHO/Evelyn Hockstein In Eldoret, Erika Muthoni Kigotho supervises 17 data entry specialists who have received training on HIV care and in spotting potential errors in record-keeping. Electronically generated paper charts, along with reminders for appropriate tests and treatment, are returned to Mosoriot within 48 hours of receipt. July 9, 2012
  • 45.
  • 46.
    Salina- “Rattling bonessyndrome” Starvation! July 9, 2012
  • 47.
    Salina on anti-retroviraltherapy July 9, 2012
  • 48.
    HIV is atreatable disease, but treating millions requires information management. July 9, 2012
  • 49.
    AMPATH clinical andsupport programs capturing electronic data. ALL DISEASE STATES NOT JUST HIV/AIDS Adult HIV/AIDS clinics Oncology clinics Social worker assessments Pediatric HIV/AIDS clinics Mental health clinics Outreach – patient follow-up Primary care – rural health Diabetes clinics Drug adherence assessments clinics Tuberculosis clinics Primary care – urban well-child Clinic pharmacies Nutrition assessments clinics Clinical laboratories Food supplement distribution Antenatal and postnatal clinics Microfinance program Mother-baby register AMPATH maintenance cost only $175/patient/year in 2007 and is now less than $100/patient/year in 2009 July 9, 2012
  • 50.
  • 51.
  • 52.
    Birth of OpenMRSCollaboration-Regenstrief/PIH MEDINFO San Francisco 2007 Prof. Paul Biondich A/Prof. Hamish Fraser A/Prof. Burke Mamlin July 9, 2012
  • 53.
    The plural ofanecdote is not data. “we must remove ourselves from the ‘unscientific, non data driven personal recommendations’ for care”. Dr. M. Smith CHCF AMIA 2009
  • 54.
    0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 2 1N 00 OV DEC 2 1JA 00 N 16,000 F B E MR A APR MY A JUN 2 2JU 00 L AUG SEP OCT NO V DEC 2 3JA 00 N F B E MR A APR MY A JUN 2 3JU 00 L AUG S P E OCT NO V DEC 2 4JA 00 N FEB MR A APR MY A JUN 2 4JU 00 L AUG S P E OCT NO V DEC 2 5JA 00 N F B E MR A APR MY A JUN 2 5JU 00 L AUG SE P OCT NO V DEC 2 6JA 00 N 1 0 / 2/2006 1 0 / 3/2006 1 0 / 4/2006 1 0 / 5/2006 1 0 / 6/2006 1 0 / 7/2006 1 0 / 8/2006 1 0 / 9/2006 1 1 / 0/2006 1 1 / 1/2006 1 1 / 2/2006 1 0 / 1/2007 1 0 / 2/2007 1 0 / 3/2007 1 0 / 4/2007 1 0 / 5/2007 1 0 / 6/2007 1 0 / 7/2007 1 0 / 8/2007 1 0 / 9/2007 1 1 / 0/2007 1 1 / 1/2007 1 1 / 2/2007 1 0 / 1/2008 1 0 / 2/2008 1 0 / 3/2008 1 0 / 4/2008 1 0 / 5/2008 1 0 / 6/2008 1 0 / 7/2008 1 0 / 8/2008 1 0 / 9/2008 1 1 / 0/2008 1 1 / 1/2008 1 1 / 2/2008 1 0 / 1/2009 1 0 / 2/2009 1 0 / 3/2009 1 0 / 4/2009 1 0 / 5/2009 1 0 / 6/2009 1 0 / 7/2009 1 0 / 8/2009 1 0 / 9/2009 1 1 / 0/2009 1 1 / 1/2009 1 1 / 2/2009 1 0 / 1/2010 1 0 / 2/2010 1 0 / 3/2010 1 0 / 4/2010 1 0 / 5/2010 1 0 / 6/2010 Patients Enrolled by Month: Nov ’01 – Jan ‘12 1 0 / 7/2010 1 0 / 8/2010 1 0 / 9/2010 1 1 / 0/2010 1 1 / 1/2010 1 1 / 2/2010 1 0 / 1/2011 1 0 / 2/2011 1 0 / 3/2011 1 0 / 4/2011 1 0 / 5/2011 1 0 / 6/2011 1 0 / 7/2011 1 0 / 8/2011 1 0 / 9/2011 1 1 / 0/2011 1 1 / 1/2011 1 1 / 2/2011 1 0 / 1/2012
  • 55.
    450,000 400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000 0 Cumulative Patients Enrolled: Nov ’01 – Jan ‘12
  • 56.
  • 57.
    3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 0 Cumulative Patient Visits: Nov ’01 – Jan ‘12
  • 58.
  • 59.
    120,000,000 110,000,000 100,000,000 90,000,000 80,000,000 70,000,000 60,000,000 50,000,000 40,000,000 30,000,000 20,000,000 10,000,000 0 Cumulative AMRS Observations By Month: Mar ’06 – Jan ‘12
  • 60.
    To improve care,you have to measure it. Not possible using current paper-based medical record systems. W.Tierney, Regenstrief Institute, Indiana. The foundation for quality patient care is information – Comprehensive, Accurate, Up-to-the-minute clinical Information. Information management is care- E. Shortliffe, Stanford. AMPATH PEER REVIEWED PUBLICATIONS SINCE 2000 ~160 ALL GRANTS AND CONTRACTS CURRENTLY FUNDED TO DATE (N=74) $40,928,084US July 9, 2012
  • 61.
  • 62.
    GN for AIDS MTCT-Plus Women’s & Clinical Program Children’s Trials Health Group Research NHLBI Global Health IeDEA Initiative
  • 63.
    OpenMRS A web-based EMR… July 9, 2012
  • 64.
    Patient summary andalerts July 9, 2012
  • 65.
    OpenMRS is…  An Electronic Medical Record System  A data model  An API  An HIV system … and more.  A TB system  A Primary Care system  A developer community  An implementer community July 9, 2012
  • 66.
  • 68.
    Kapenguria Kapsakwony Kitale Naitiri Webuye Amukura Turbo Teso Mosoriot Burnt Forest Chulaimbo 50 km
  • 69.
    400,000 patients OpenMRS sites - fall 2008 July 9, 2012
  • 70.
    600,000 patients OpenMRS sites – Spring 2010 July 9, 2012
  • 71.
  • 72.
    OpenMRS in PeruMarch 2006-2007  In total, e-Chasqui will serve a network of institutions providing medical care for over 3.1 million people.  benefits  the test always available during clinical decision making  reducing duplicate tests performed  reducing the time and money spent by staff checking the status of their samples.  The cost to maintain this system is ~US$0.53 per sample or 1% of the National Peruvian TB program's 2006 budget.  Government support to distribute throughout Peru A web-based laboratory information system to improve quality of care of tuberculosis patients in Peru: functional requirements, implementation and usage statistics. Blaya, J.A., et al., BMC Med Inform Decis Mak, 2007. 7: July 9, 2012 p.33
  • 73.
    Features of OpenMRSPart 1 Security: User authentication Privilege-based access: User roles and permission system Patient repository: Creation and maintenance of patient data, including demographics, clinical observations, encounter data, orders, etc. Multiple identifiers per patient: A single patient may have multiple medical record numbers Data entry: With the FormEntry module, clients with InfoPath (included in Microsoft Office 2003 and later) can design and enter data using flexible, electronic forms. With the HTML FormEntry module, forms can be created with customized HTML and run directly within the web application. Data export: Data can be exported into a spreadsheet format for use in other tools (Excel, Access, etc.) Standards support: HL7 engine for data import Modular architecture: An OpenMRS Module can extend and add any type July 9, 2012 73 of functionality to the existing API and webapp.
  • 74.
    Features of OpenMRSPart 1 Patient workflows: An embedded patient workflow service allows patient to be put into programs (studies, treatment programs, etc.) and tracked through various states. Cohort management: The cohort builder allows you to create groups of patients for data exports, reporting, etc. Relationships: Relationships between any two people (patients, relatives, caretakers, etc.) Patient merging: Merging duplicate patients Localization / internationalization: Multiple language support and the possibility to extend to other languages with full UTF-8 support. Support for complex data: Radiology images, sound files, etc. can be stored as “complex” observations Reporting tools: Flexible reporting tools Person attributes: The attributes of a person can be extended to meet local needs July 9, 2012 74
  • 75.
    Lessons learned  Clinicalinformation systems are possible in even the most resource-constrained places  Collaboration with established informatics programs is a must  Primary goals → sustainability of the EMR, independence of the developing country  Start small and build to serve local needs  Anticipate challenges and prepare for them  Maintain hope and enthusiasm
  • 76.
    AMPATH 2012 July 9, Medical Record System (AMRS): Collaborating Toward An EMR for Developing Countries Burke W. Mamlin, M.D. and Paul G. Biondich, M.D., M.S. Regenstrief Institute, Inc. and Indiana University School of Medicine, Indianapolis, IN
  • 77.
    WHAT OTHERS SAYABOUT THE INDIANA-KENYA PARTNERSHIP Nominated for the 2007 Nobel Peace Prize; featured in The Wall Street Journal “The people working on this program are public health heroes. They are doing things that many people thought could never be done, and it is going to have a huge multiplier effect.” --Dr. Tim Evans, former director of health equity for the Rockefeller Foundation “Much more accurately described as an Academic MIRACLE in response to AIDS.” --Michael E. Ranneberger, U.S. Ambassador to Kenya “The most important and comprehensive HIV/AIDS effort in all of Africa.” - James Morris, former executive director, United Nations World Food Program July 9, 2012
  • 78.
    “Now HIV/AIDS programsare not only in place but some of them, including the partnership between the United States Agency for International Development (USAID) and the Academic Model Providing Access to Healthcare (AMPATH) are openly speaking of bringing the pandemic to its knees over the next 5 years through widespread screening and effective treatment and prevention of HIV.” Braitstein, P., et al., "Talkin' about a revolution": How electronic health records can facilitate the scale-up of HIV care and treatment and catalyze primary care in resource-constrained settings. J Acquir Immune Defic Syndr, 2009. 52 Suppl 1: p. S54-7. July 9, 2012
  • 79.
  • 80.
  • 81.

Editor's Notes

  • #9 In a 1999 review of the major EMR systems in the world that are the models for future EMRs, these were the data/information and performance values for the Regenstrief system in Indian. They emphasize that technology is not the problem for EMRs and information retrieval must function at these levels of recall time.
  • #10 Core decision support tools for all E.H.Rs regardless of the complexity of the decision support required.
  • #12 Tierney’s study into the use of of a longitudinal CBPR to reduce resource utilization. (Refer to the Johns and Blum study on costs, resource utilization, and clinical decision making)
  • #13 Slides 114-122 display the results of the above study. It is important to look at this study from many aspects. The size of the study (not possible with a paper-based record-time, costs, data accuracy), the alteration of process, the measurements of outcome, the definition of patient cohorts. This is the only institution that has shown the stabilization of antibiotic resistance – a major problem with antibiotic usage. The study also demonstrates that the rewards from CBPR systems are the result of an INCREMENTAL process with verification of benefits and or failures along the way.
  • #20 At the time, there was a lot of work to be done.
  • #29 OpenMRS was created in response to HIV/AIDS. Indiana University School of Medicine had been collaborating with Moi University Faculty of Health Sciences (Eldoret, Kenya) for over a decade when their focus, by necessity, turned toward the HIV pandemic.
  • #30 And existing systems were overburdened and getting pushed beyond their capacity.
  • #41 He knew the enterprise would be information-intensive, so he pushed me to create the first ambulatory electronic medical record system in sub-Saharan Africa. Because the HIV protocols had been created in the U.S. and Europe, they had little relevance to resource-poor countries. So Joe also pushed me to create and lead a multidisciplinary HIV research program.
  • #49 But patients like Musa, who you’ve already met, showed that HIV was a treatable disease. The problem wasn’t how to treat HIV, but how to scale that up to 100,000 and millions of patients. That kind of scale could only be obtained through effective information management.
  • #64 We’ve built a web-based EMR atop the OpenMRS platform to serve our community’s needs, but that doesn’t prevent other things to be built atop the API.
  • #66 So, OpenMRS is an EMR, a data model (some folks have chosen to simply use our data model and build their own system), an API, an HIV system, a TB system, a Primary Care system, a strong developer community, and a vibrant implementer community. We’re all in this together.
  • #67 And we’ve already seen evidence of the flexibility of a platform approach. Folks in Maryland have wired a different primary care system atop the OpenMRS API, so docs work within another system, but all data are stored within an instance of OpenMRS. Shaun Grannis developed a disease surveillance system using OpenMRS. In Skid Row of Los Angeles, OpenMRS is being used to manage data for homeless patients with TB. And Paul’s pediatric decision support system has been rebuilt and now runs within OpenMRS.
  • #78 Up to 1991there had been accumulating evidence that clinical decision support tools were of benefit to health care delivery. The IOM designed an 18 month study to evaluate the CBPR in health. The title of its report defines this critical focus point in EMR developments and provided the focus for all new and existing EMR developments.