Implementing Electronic Medical Record Systems in Rural Haiti
- 1. Implementing Electronic Medical Record Systems in Rural Haiti Ellen Ball & Michael Seaton Partners In Health Medical Informatics Boston, Massachusetts USA LibrePlanet March 22, 2015
- 7. Why technology? 7 Information systems are a key component in PIH’s model of care. To replicate the model of care, it is fundamental that open, scalable, maintainable, and high-quality information systems are available that meet the unique challenges found in resource poor settings
- 8. Why technology? 8 Clinical Decision Support View trends that would be difficult or impossible to see otherwise Alert clinicians to potentially dangerous situations (allergies, contraindications)
- 10. Why technology? 10 Monitoring, Evaluation, and Quality Improvement Analyze cohorts of patients. Find patient groups in need of follow-up or further analysis. Identify areas of improvement (in what percentage of patient visits was a weight recorded) Perform routine reporting to health ministries, funders, and program managers
- 11. Why technology? 11 Support Advanced Treatment
- 13. 13 Challenges: Human resources Few trained staff High patient volume.
- 14. 14 Challenges: Funding No cost recovery from facilities Low eHealth budgets
- 15. 15 2000 PIH and Harvard Medical School win $44.7 million Gates Foundation grant to fight drug-resistant TB in Peru. In Haiti, Zanmi Lasante's HIV Equity Initiative is one of the first in the world to provide antiretroviral therapy in resource-poor settings.
- 16. 16 2001 PIH creates drug- resistant TB EMR for Peru and HIV EMR for Haiti.
- 17. 17 2005 PIH expands to sub- Saharan Africa, bringing community-based HIV treatment and primary care to two districts in rural Rwanda.
- 18. 18 2005: Why OpenMRS? PIH begins collaboration with Regenstrief Institute to create OpenMRS. • global health community • free & open • collaboration • replication • cost benefits
- 19. 19 Why OpenMRS? Free and open Client (Browser, Integrated Applications) Server OS: Flexible MySQL PostgreSQL Database OpenMRS JVM (OpenJDK, Oracle JDK) MariaDB Web Container (Tomcat, Jetty, JBoss…) Hibernate Liquibase OpenMRS Platform Spring MVC REST API Modules Configuration and Content H T T P
- 20. 20 OpenMRS Core Why OpenMRS? Modular REST Web Services Framework idgen emrapi metadata deploy paper record app html form entry app framework metadata sharing registration app name phonetics address hierarchy reporting framework core apps radiology app allergy api atom feed appointment scheduling dispensing provider mgmt ui library ui commons style guide ui framework Shared Dictionary REST client apps calculation allergy api event messaging Distributions Configuration Content Integrations
- 21. 21 Why OpenMRS? Flexible Name Weight Height John Doe 150 65 Flat Model New data points require new columns Name Weight Height Temp John Doe 150 65 99 Concept Units Weight lbs Height in EAV Model New data points require new rows. Metadata dictionary enables associating more information describing each data point (eg. units, value ranges) Name Concept Value John Doe Weight 150 John Doe Height 150 Concept Units Weight lbs Height in Temp f Name Concept Value John Doe Weight 150 John Doe Height 150 John Doe Temp 99
- 22. 22 Why OpenMRS? Configurable Configurable and shareable metadata, including forms Configurable components via editable settings Customizable functionality, including overriding core pages, styles, logos via modules
- 23. 23 Why OpenMRS? Community Active forums #OpenMRS on irc.freenode.net Developers list: dev@openmrs.org https://talk.openmrs.org/ https://wiki.openmrs.org Many contributors with broad expertise Regular (un)conferences Building the movement ● Not reliant on any one organization ● Evolving regional communities ● Supports scaling and replicating
- 24. 24 2006 AMPATH starts using OpenMRS in Kenya. PIH Rwanda begins using OpenMRS in Rwanda.
- 25. 25 2007 PIH begins work in Lesotho and Malawi, launching testing and treatment programs for HIV and TB. PIH Lesotho and Malawi uses OpenMRS.
- 26. 26 2009 PIH develops OpenMRS MDRTB module for many countries and organization including Haiti, Pakistan, Nepal, and South Africa.
- 27. 27 2009 PIH trains computer science graduates in Java and OpenMRS in Rwanda. 34 graduates in 3 years.
- 28. 28 2010 PIH responds to a 7.0 earthquake in Haiti with lifesaving emergency care and a plan to strengthen Haiti's public health system. PIH provides treatment and vaccination in response to cholera outbreak.
- 29. 29
- 30. 30 2013 Clinical care Point of care Registration Appointments Vitals Medications Surgery
- 31. 31 2013 PIH develops OpenMRS for University Hospital which becomes the basis of the OpenMRS 2.0 Reference Application.
- 32. 32 2013
- 33. 2015: HUM by the numbers 33 Since March 2013: 150K unique patients 480K visits 1.3M encounters 6.7M observations 400+ users
- 34. 34 2015 PIH continues ebola response work in Sierra Leone and Liberia, but transitioning to health care strengthening.
- 35. Where next? 35
- 37. 37 ● Partners In Health (pih.org) ○ Medical Informatics positions ■ Boston ■ Lesotho ■ Malawi ○ http://www.pih.org/pages/employment ○ PIH Engage ○ Donate ● OpenMRS community ○ Sprints / Bug fixes / Documentation ○ Google Summer of Code Opportunities