Transcript Clinical Information systems as tools to improve quality

OpenMRS in Rwanda
Hamish Fraser
Director of Informatics and Telemedicine,
Partners In Health
Assistant Prof. Harvard Medical School
Co-founder, OpenMRS Collaborative
Overview
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Rwanda Health Care System
OpenMRS sites
Training Rrogram
Rwanda National OpenMRS Rollout
National eHealth Architecture
Rwanda health indicators
• A small central African country:
– Population 9 M people
– Highest population density in Africa, 85% rural
• Achieved rapid economic growth since genocide in
1994, but still has very poor health outcomes:
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Life expectancy 38-44 years
Infant mortality 152/1000
Maternal mortality 1071/100K
Medium income $230
HIV prevalence 3%
Malaria prevalence 46%
OpenMRS origins
• First OpenMRS site
– Eldoret, Kenya February 2006
• Second site
– Rwinkwavu, Rwanda August 2006
• Third site
– Richmond Hospital, South Africa
September/October 2006
OpenMRS Sites in Rwanda
• Clinics run by Ministry of Health
– Supported by Partners In Health
• The TRAC clinic
– Large HIV clinic run by the MOH
• Town of Mayange
– Millennium Villages project
• National Tuberculosis program
– OpenMRS-TB
Rwanda
OpenMRS at PIH
sites in Rwanda
• Currently used in 12 PIH –
supported health centers
• 8 sites have own server
– 6 remote sites have synchronized copy of entire database
• Registration, encounter and lab data
– TB, HIV, and now heart failure patients
– Over 10,000 patients tracked (Sep. 2009)
• Team of Rwandan data officers trained to enter
data, ensure quality & produce reports
• Clinicians use electronic patient summaries
• Many new research and clinical applications
OpenMRS dashboard - HIV Care
Physician looking up ARV patient
OpenMRS-TB, bacteriology data
Bacteriology management tools include a customizable timeline of smears, cultures,
treatment status dates, culture conversion dates, and other clinical observations.
Report of MDR-TB cases
BIRT report
National OpenMRS rollout
• MOH and PIH are augmenting OpenMRS
for roll out in hundreds of clinics in
Rwanda
• One month ago we were asked to move
ahead with the HIV clinics supported by
the GFATM
• We are developing a new version for
primary care
Proposed primary care version of
OpenMRS for Rwanda
Clinical Diagnostics
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Patient Registration
Prescription Drugs
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Laboratory testing
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Mutuelles de Santé
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<insert relevant
illustration>
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Patient registration system (prototype)
Patient
Identification
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Barcode affixed to
patient’s health
passport provides a
unique identifier to
each person
Can be used at any
clinic or hospital
May move to 2 D
barcodes
Patient
Registration
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Contents stored include:
name, age, gender,
phone #, insurance,
address
Time saved for clinics –
no need to reenter
patient’s personal
information every visit
Check for duplicate
records / names
Patient
Summary
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Progression of vitals
(i.e. height, weight,
blood pressure)
Serious allergies and/or
drug reactions
Current prescriptions
Current treatment
program
Next appointment /
appointment history
Assists nurse or
physician’s assistant in
quickly assessing
status
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Kigali Developer training
• There is a shortage of Java programmers who
can work on eHealth systems like OpenMRS
• A year ago we set up a training program for
computer science graduates to learn these
skills
• The students graduated last week and are
working on modules for the OpenMRS rollout
for HIV
eHealth Architecture Project
• Rwanda has embarked on a plan to create
national eHealth architecture
• This will define the functions of each
components and interoperability standards for
each
• A meeting was hosted by WHO last week in
Kigali. Over 100 people from Rwanda, other
African countries and the developed world
worked on these specifications and
interoperability profiles
Open standards and interoperability
• To be sustainable information systems need to
be designed with compliance with open
standards
• Leverage the expertise and experience of
groups in each area:
– Laboratory, Pharmacy, EMR, Reporting and
surveillance
• Business as usual is hundreds of incompatible
systems with limited functionality and high cost
Potential components of integrated national
eHealth architecture in Rwanda
National
reporting system
TRACNet
Supply chain
systems
Camerwa
IXF/SDMX
Pharmacy
system
PIH
HL7
HL7
Registration and
insurance
Mutuelle
EMR System
OpenMRS
HL7?
Mobile health
systems
OpenROSA
HL7
Laboratory
System
PIH-Lab-system
Dicom
HL7
Radiology /
telemedicine
system
Challenges for OpenMRS Deployments
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Equipment, power supplies and networks
Data management and quality control
Evaluation
Sustainability
Training
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Programmers
IT staff
Data entry staff and managers
Users
Conclusions
• OpenMRS is now heading for widespread use in
Rwanda
• There are studies showing benefits from OpenMRS
in process and delivery of care as well as reporting
• Open standards for data exchange are essential in
scaling information systems and reducing costs.
• Open source software allow the creation of better,
more flexible and sustainable tools and allow local
communities to build and modify them
Collaborators and Funders
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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
Google Inc
Question?
People in the web conference
please hold your questions
until the panel at 11 am