Implementing OpenMRS Medical Record System in an AIDS treatment program in Uganda Daniel Kayiwa
OpenMRS – A Community Developed, Open Source Medical Record System for Developing Countries
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Transcript of OpenMRS – A Community Developed, Open Source Medical Record System for Developing Countries
Regenstrief Institute, Inc.
OpenMRS – A Community Developed, Open Source Medical
Record System for Developing Countries
Paul Biondich, MD MSBurke Mamlin, MD
…and the OpenMRS collaborative
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Overview Our start What OpenMRS is Our progress to date Where we hope to go Guiding principles
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Introduction Regenstrief Institute / IU – 30+ year of
clinical informatics development in US, building large scale clinical information systems
February 2004: Asked to be “consultants”: give advice about how pre-existing HIV data repository (Access-based) could be extended / given more functionality -> supposed one week trip to Eldoret, Kenya
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40,000,00095%5%
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February, 2004• AMPATH: example of successful HIV
comprehensive care system in developing country… huge information needs
• Significant growth ahead: rapid ramp up to 20+ geographically disparate sites
• Immediate Observations:• No “quick fix” or “retro-fit” of old system• We were “hooked” and became very
engaged after visiting Eldoret
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Silos
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Existing Efforts• Multiple “silos” of disparate efforts• Focus on user interface• Minimal opportunity for collaboration
or interface• Non-coded, unstructured data• Lack of standards• Aren’t directly helping clinicians
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Design Dogma• Follow the lead of the 30+ year
experience of our mentors• Graceful evolution towards enterprise-
worthy systems• We must enforce deep structure in the
database to improve data integrity / quality
• Use of informatics standards throughout
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OpenMRS - API• Three code
layers• Database Layer• Service Layer• Presentation
Layer• Hibernate,
Spring, AJAX
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OpenMRS – Data Model• In continuous development for 3+ years• It simultaneously defines and directly
stores clinical data• Robustly defined concept vocabulary• Form hierarchies
• Versioning system, public debate/input• Data Repository vs. “Business” tables
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OpenMRS - Standards• HL7: Method of bulk data input/output
and reporting to national centers• Local vocabulary can and will be
mapped to ICD10, LOINC, and SNOMED where applicable
• Arden Syntax: logical constructs• Liberal use of open source
programming paradigms/standards
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AMPATH Medical Record System (AMRS)
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Model-view-
controller based data entry
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Concept Statistics
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Building Enterprise EMRs Difficult (if not impossible) to fully sustain
internally within our environment Grant/contract money for development limited Difficult local hiring climate Inconsistent with priority of academic culture
Human resource needs only scale over time (everyone wants a new feature)
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Open Source Communities – A Solution?
Open Source Instruction code made freely available to public Nurture environment that encourages outside
developers to work with your code Open source licensing ensures that those who
add to your core code must also give it away Community
Give everyone stake in decision making process Make it fun/easy to participate
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Open Source License in Place
• License formalized• Essentially Mozilla Public License 1.1 with
extra clause related to medical liability• Main ideas:
• Core vs. Modules: all core will adhere to base license, modules are encouraged to do so
• Core managed by OpenMRS Management Group (Paul, Burke, Hamish, Chris)
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Types of Participants Large HIV programs throughout the world
Partners-in-Health Medical Research Council Millennium Village Project Family AIDS Care and Services (FACES) Clinton Foundation
Programmers with philanthropic leanings CS students Professionals with spare cycles Other large FOSS communities
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What this community “costs” us
Time Initial education on our design Building web portal / information
content Constant fielding of questions Guiding the design towards the right
direction Slower progress on our own work
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What this community gives us
Development scale Cohort builder example
Fresh sets of eyes to strengthen design Daniel Kawiya from Uganda
Implementation “cushion” Chris Seebregts and implementation group
Sponsor “gravitational pull”
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Where we want to go…• Evolution of core development group into
mentorship “team” – scaling development, educate in medical informatics, FOSS
• Continue to foster OpenMRS Implementation Group (Chris)
• Fundamental additions to OpenMRS (team)• “deep” decision support functionality• completion of research query tools / reports• encourage tools that facilitate clinical care• synchronization between OpenMRS instantiations
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OpenMRS Principles• Serve care providers/patients first, reuse
data• Develop based on active implementations• Be transparent• Reduce redundancy• Collaborate broadly• Apprenticeship – Learning by doing
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It’s amazing how profitable it can be to give something away.