Medical Informatics

Over the past decade, the challenge of making HIV and TB treatment available in poor countries has led to a new emphasis on improving health systems in these countries and utilizing modern technology as a means to improve clinical care and program management. For this reason, Partners In Health designed and deployed its first web-based Electronic Medical Records (EMR) system in 2001 to manage the treatment of patients with multidrug-resistant tuberculosis (MDR-TB) at PIH’s sister organization in Peru, Socios En Salud (SES). Later, the Medical Informatics team adapted this EMR for use in Haiti to support PIH/ZL’s HIV treatment program there. In both countries, the EMR has proved to be a valuable clinical and programmatic tool. With data input from physicians, nurses, and local data entry staff, the EMR captures information that can be used to track patient care and clinical outcomes, analyze aggregate results, manage and forecast drug inventory needs, and generate reports for funding agencies. The system is also designed to function when not connected to a network, using an application that allows data to be entered and viewed when the Internet is unavailable and then synchronizes the data when the connection is restored.

In 2005, with increased attention and support from donors for global health, PIH took advantage of an exciting opportunity to refine its EMR, creating a new open source version that is flexible, scalable and adaptable by other programs. The result is a project called OpenMRS (Open Medical Records System). This was created through collaboration with the Regenstrief Institute at the University of Indiana, the South African Medical Research Council, and many other partners around the world. The PIH Medical Informatics team began the development of OpenMRS in late 2004 and in 2006 deployed the system in Rwinkwavu, Rwanda.

 

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Clinician viewing patient summary in OpenMRS during consultation (Courtesy Rockefeller Foundation).

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Data officers undertook monthly training in software features, medical terminology and new data quality tools.

OpenMRS

OpenMRS is a freely available, flexible architecture for electronic medical records systems in resource-poor settings. It responds to the specific needs of large-scale treatment programs in developing countries and has many distinct differences from other medical information systems. OpenMRS is built with free, open source software, which enables the system to be as widely accessible as possible by sites with limited funding. The system is based on open standards for medical data exchange such as HL7, allowing the exchange of patient data with other medical information systems. OpenMRS has immense flexibility – it can run on Linux, Windows or Mac, and the entire system can be run on a large server or just a laptop computer. Another feature of OpenMRS is that it does not require expert programming to add new forms or to tailor the system to new sites or diseases. Data stored in OpenMRS is coded using a “concept dictionary” that represents all the possible data items that can be collected. This greatly simplifies linking to existing medical coding systems like ICD10 or LOINC and comparing data between projects or sites; it also allows new items to be added to the system by non-programmers, further reducing the need for full-time technical assistance. Finally, like the original PIH-EMR, OpenMRS retains the clear benefits of a web-based system while allowing local area network or offline data entry, and it also provides tools for data analysis, reporting and patient viewing within a single, integrated system.

OpenMRS is now used in over 23 countries in the developing world and has become the foundation of a large international collaboration. An increasing numbers of groups also involved in system development.

Current Projects

Using OpenMRS, the Medical Informatics team made significant progress during 2009 on the development of new form-entry tools in an open source environment and of easy-to-use reporting tools to allow non-programmers to report outcomes and other important data for HIV/AIDS, TB and other diseases. In Rwanda, we also developed tools in primary care and chronic disease management, such as heart failure.

The OpenMRS MDR-TB module to track the treatment of patients with multi-drug resistant tuberculosis is now running in Haiti and Pakistan and has been implemented in Rwanda in partnership with the government. In Lima, Peru, new OpenMRS research data management tools were implemented in 2009 for a large NIH-funded study of MDR-TB transmission.

With support from the Canadian government’s International Development Research Centre (IDRC), the OpenMRS team launched a mentor-driven training course in Kigali, Rwanda for ten Rwandan computer science graduates. The course focuses on training the students in java programming and practical skills in healthcare informatics. In October 2009, the first ten students graduated from the program. In February 2010, a new cohort of 12 students began the course, selected from over 160 applicants. Skilled Rwandan programmers are especially critical in the Government of Rwanda’s plan to implement OpenMRS on a national level and fit into the government’s larger plan to create a strong IT industry.

PIH is working with the Rwandan government on an ambitious plan to roll out OpenMRS to 250 clinics in Rwanda. The system will support HIV treatment, primary care, and other clinical problems.

After the devastating earthquake in Haiti on January 12, the Medical Informatics team is planning an expansion of OpenMRS at the 12 clinics and hospitals run by Zanmi Lasante. This will include a stronger focus on primary care and women’s health as well as the creation of a surgical EMR system. The team will be working with other key organizations in Haiti that have deployed medical information systems and the Haitian government.

Funding

The Medical Informatics team is grateful for the support of the Rockefeller Foundation, the International Development Research Center (IDRC), the World Health Organization (WHO), and the Centers for Disease Control and Prevention (CDC).

Publications

The PIH Medical Informatics team has published 25 peer reviewed papers and given numerous presentations at meetings and conferences around the world. The team are leaders in the evaluation of medical information systems in developing countries and have won several prizes for this work.

Bibliography of Medical Informatics team publications

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