Adaptation of a Web-Based, Open Source Electronic Medical Record System Platform to Support a Large Study of Tuberculosis Epidemiology

Background: In 2006, we were funded by the US National Institutes of Health to implement a study of tuberculosis epidemiology in Peru. The study required a secure information system to manage data from a target goal of 16,000 subjects who needed to be followed for at least one year. With previous experience in the development and deployment of web-based medical record systems for TB treatment in Peru, we chose to use the OpenMRS open source electronic medical record system platform to develop the study information system. Supported by a core technical and management team and a large and growing worldwide community, OpenMRS is now being used in more than 40 developing countries. We adapted the OpenMRS platform to better support foreign languages. We added a new module to support double data entry, linkage to an existing laboratory information system, automatic upload of GPS data from handheld devices, and better security and auditing of data changes. We added new reports for study managers, and developed data extraction tools for research staff and statisticians. Further adaptation to handle direct entry of laboratory data occurred after the study was launched. Results: Data collection in the OpenMRS system began in September 2009. By August 2011 a total of 9,256 participants had been enrolled, 102,274 forms and 13,829 laboratory results had been entered, and there were 208 users. The system is now entirely supported by the Peruvian study staff and programmers. Conclusions: The information system served the study objectives well despite requiring some significant adaptations mid-stream. OpenMRS has more tools and capabilities than it did in 2008, and requires less adaptations for future projects. OpenMRS can be an effective research data system in resource poor environments, especially for organizations using or considering it for clinical care as well as research

Artificial Intelligence for Global Health: Learning From a Decade of Digital Transformation in Health Care

The health needs of those living in resource-limited settings are a vastly overlooked and understudied area in the intersection of machine learning (ML) and health care. While the use of ML in health care is more recently popularized over the last few years from the advancement of deep learning, low-and-middle income countries (LMICs) have already been undergoing a digital transformation of their own in health care over the last decade, leapfrogging milestones due to the adoption of mobile health (mHealth). With the introduction of new technologies, it is common to start afresh with a top-down approach, and implement these technologies in isolation, leading to lack of use and a waste of resources. In this paper, we outline the necessary considerations both from the perspective of current gaps in research, as well as from the lived experiences of health care professionals in resource-limited settings. We also outline briefly several key components of successful implementation and deployment of technologies within health systems in LMICs, including technical and cultural considerations in the development process relevant to the building of machine learning solutions. We then draw on these experiences to address where key opportunities for impact exist in resource-limited settings, and where AI/ML can provide the most benefit.Comment: Accepted Paper at ICLR 2020 Workshop on Practical ML for Developing Countrie

Synchronization of patient data among health facilities through electronic medical records system: a case study of Kabgayi District Hospital

Background: The use of modern technology in healthcare system aims to increase the reliability, accessibility and productivity of delivered services. In most developing countries, particularly in sub-Saharan Africa, Electronic Medical Records (EMRs) has been dominated by paper-based system. In Rwanda, EMRs started in 2011 with a baseline of 8% and reached 50% in 2017 within 516 health facilities, but patient data synchronization among health facilities is still a problem. The aim of this research was to identify factors hindering EMRs implementation and propose applied solutions.Methods: A cross-sectional descriptive study design with qualitative and quantitative approach was used. A purposive method to select the research participants among the target population was also used.Results: It was found that, despite the improvement of hospitals’ management and healthcare efficiency via EMRs system, factors affecting synchronization of patients’ data among health facilities still persist. The study also revealed the need for the interoperability in the integration of EMRs system among health facilities.Conclusion: The OpenMRS EMR-based data synchronization can reduce gaps in HIV care. It avoids a duplication of patient identification number (PID) at the same health facility for more than one visit and missing data among health facilities. As part of implementable solutions for effective service delivery, cloud-based server and patient identification were suggested as solutions for much more success in Open MRS EMRs system.Keywords: Electronic Medical Record, Data synchronization, Cloud computing technolog

Development and Deployment of the OpenMRS-Ebola Electronic Health Record System for an Ebola Treatment Center in Sierra Leone.

BACKGROUND: Stringent infection control requirements at Ebola treatment centers (ETCs), which are specialized facilities for isolating and treating Ebola patients, create substantial challenges for recording and reviewing patient information. During the 2014-2016 West African Ebola epidemic, paper-based data collection systems at ETCs compromised the quality, quantity, and confidentiality of patient data. Electronic health record (EHR) systems have the potential to address such problems, with benefits for patient care, surveillance, and research. However, no suitable software was available for deployment when large-scale ETCs opened as the epidemic escalated in 2014. OBJECTIVE: We present our work on rapidly developing and deploying OpenMRS-Ebola, an EHR system for the Kerry Town ETC in Sierra Leone. We describe our experience, lessons learned, and recommendations for future health emergencies. METHODS: We used the OpenMRS platform and Agile software development approaches to build OpenMRS-Ebola. Key features of our work included daily communications between the development team and ground-based operations team, iterative processes, and phased development and implementation. We made design decisions based on the restrictions of the ETC environment and regular user feedback. To evaluate the system, we conducted predeployment user questionnaires and compared the EHR records with duplicate paper records. RESULTS: We successfully built OpenMRS-Ebola, a modular stand-alone EHR system with a tablet-based application for infectious patient wards and a desktop-based application for noninfectious areas. OpenMRS-Ebola supports patient tracking (registration, bed allocation, and discharge); recording of vital signs and symptoms; medication and intravenous fluid ordering and monitoring; laboratory results; clinician notes; and data export. It displays relevant patient information to clinicians in infectious and noninfectious zones. We implemented phase 1 (patient tracking; drug ordering and monitoring) after 2.5 months of full-time development. OpenMRS-Ebola was used for 112 patient registrations, 569 prescription orders, and 971 medication administration recordings. We were unable to fully implement phases 2 and 3 as the ETC closed because of a decrease in new Ebola cases. The phase 1 evaluation suggested that OpenMRS-Ebola worked well in the context of the rollout, and the user feedback was positive. CONCLUSIONS: To our knowledge, OpenMRS-Ebola is the most comprehensive adaptable clinical EHR built for a low-resource setting health emergency. It is designed to address the main challenges of data collection in highly infectious environments that require robust infection prevention and control measures and it is interoperable with other electronic health systems. Although we built and deployed OpenMRS-Ebola more rapidly than typical software, our work highlights the challenges of having to develop an appropriate system during an emergency rather than being able to rapidly adapt an existing one. Lessons learned from this and previous emergencies should be used to ensure that a set of well-designed, easy-to-use, pretested health software is ready for quick deployment in future

Training software developers for electronic medical records in Rwanda

Also published in Studies in health technology and informatics (2010), volume: 160, issue: pt 1, p. 585-589.This paper describes a training program in Rwanda that enables local computer science graduates to play a significant role in the country’s implementation of a national electronic medical record (EMR) system. This training program is unique in the region. The paper discusses the challenges inherent in such an undertaking which produces local software developers familiar with medical informatics. Successful and sustainable eHealth implementations in the developing world will rely on local talent

Implementação do Registo Eletrónico de Saúde em África - uma Análise SWOT

A inovação tecnológica em saúde está a revolucionar significativamente a forma como os cuidados de saúde estão a ser prevenidos, diagnosticados e tratados. Apesar dos muitos benefícios destacados, a implementação de EHR requer um grande investimento, não só em recursos tecnológicos, mas também em recursos humanos qualificados. O objetivo principal do estudo é conhecer as forças, oportunidades, fraquezas e ameaças dos registos eletrónicos em saúde nos países africanos. A metodologia baseou-se na realização de uma revisão sistemática para análise SWOT. Com base nos resultados obtidos, o ponto forte com maior relevância esta relacionado com acesso oportuno e rápido das informações. Já a fraqueza mais evidente é a queda da corrente elétrica seguida da fraca conexão a internet. Ter experiência prévia em EHR é a oportunidade identificada com maior relevância na utilização destes sistemas. Por último, a maior ameaça evidenciada é a inexistência de conhecimento prévio em EHR e em informática. Os sistemas implementados na África. os resultados mostram que o sistema EHR Open source como o mais implementado na África em 83,3% em (10/12) artigos que caracterizaram os tipos de sistemas implementados.Technological innovation in healthcare is significantly revolutionising the way healthcare is being prevented, diagnosed and treated. Despite the many benefits highlighted, EHR implementation requires a major investment, not only in technological resources, but also in qualified human resources. The main objective of the study is to know the strengths, opportunities, weaknesses and threats of electronic health records in African countries. The methodology was based on conducting a systematic review for SWOT analysis. Based on the results obtained, the strong point with the greatest relevance is related to timely and rapid access to information. The most obvious weakness is the power outage followed by poor internet connection. Having previous EHR experience is the most relevant opportunity identified when using these systems. Finally, the greatest threat evidenced is the lack of prior knowledge in EHR and computer science. The systems implemented in África. the results show that the Open source EHR system as the most implemented in África in 83.3% in (10/12)c articles that characterized the types of systems implemented

Final Technical Report - Open Architectures, Standards and Information Systems (OASIS II) – Developing Capacity, Sharing Knowledge and Good Principles across eHealth in Africa

The OASIS II project aimed to build on aspects of the Open Architectures, Standards and Information Systems for Healthcare in Africa (OASIS) project, previously funded by IDRC through the South African Medical Research Council. The objectives of the project included over-arching, network-wide objectives and individual project objectives. In addition, OASIS II aimed to investigate a shared research purpose and combine existing methods between one existing and four new projects and partners to: 1) elaborate a network-wide OASIS II research methodology, 2) establish an open enterprise architectural framework for eHealth in developing countries and 3) create a collaborative framework for sharing new evidence regarding the impact of eHealth solutions in resource-poor settings

Evaluating eHealth: Undertaking Robust International Cross-Cultural eHealth Research

David Bates and Adam Wright discuss the opportunities and challenges of undertaking international collaborations in eHealth evaluation research, and make recommendations for moving forward

Architectural Design of the National Health Information System for Rwanda

The use of information technology in healthcare services can improve the quality of care. The large amount of research has demonstrated the role of the use of Information and communication technology (ICT) solutions to overcome the challenges in patient information management. One of the challenges is the healthcare information sharing between providers. In high income countries, the challenge of exchanging information is almost solved. Nearly all high income countries have implemented a national healthcare network which connects healthcare providers in the whole country. Furthermore, European Union (EU) aims at the point of cross-border healthcare information exchange which supports the mobility of EU citizens. However, in developing countries, they are not yet ready to take the full advantage of ICT in their healthcare systems. The main objective of the thesis was to design the architecture of a national health information system for Rwanda, which is a developing country with limited resources. The research was based on three main issues: One was to determine existing health IT solutions in the healthcare system of Rwanda. The second one was to explore how other countries have developed their national health information systems (NHISs). The third was to find out how open source solutions can build a national network for a country. From the research, the components of the architecture have been defined and finally the architecture was designed. The research started by examining the current situation of ICT solutions in the healthcare system of Rwanda. This showed the progress in implementing certain electronic medical record systems in certain health facilities. However, there is no single hospital with a fully functional system. This step was followed by exploring how other countries implemented their NHIS and it showed that the process varies country by country. It was clear that in developing countries, open source solutions got a large market share contrary to developed countries where proprietary systems are the most used. Finally, open source solutions proved the capability to build a NHIS with different examples of robust open source solutions available in health IT nowadays. Although it would have been interesting, the thesis does not estimate the financial resources needed for the implementation of the architecture. It is possible to implement the NHIS for Rwanda by using both proprietary and open source solutions. However, the interoperability issue can be mitigated by minimizing different types of electronic medical records in healthcare facilities

Evaluation of IDRC-supported eHealth projects : final report

This report provides an in-depth account of the evaluation findings and recommendations for the next five years of IDRC’s eHealth programming. The quantitative and qualitative assessment covered 25 projects representing activities in 25 countries in Africa, Asia, and Latin America and the Caribbean (LAC) of which approximately 50% have been completed and 50% remain on-going ranging in scope from $30,000 -$2,422,652. The total dollar value of the projects included in this evaluation is approximately $17 million CAD. To complement the evaluation a targeted literature review of eHealth, a series of Lessons Learned Workshops with grantees and IDRC staff, and key informant interviews with internal and external stakeholders were conducted..