OpenMRS in Rwanda

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OpenMRS in Rwanda Hamish Fraser Director of Informatics and Telemedicine, Partners In Health Assistant Prof. Harvard Medical School Co-founder, OpenMRS Collaborative

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Transcript of OpenMRS in Rwanda

Page 1: OpenMRS in Rwanda

OpenMRS in Rwanda

Hamish FraserDirector of Informatics and Telemedicine,

Partners In Health

Assistant Prof. Harvard Medical School

Co-founder, OpenMRS Collaborative

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Overview

• Rwanda Health Care System

• OpenMRS sites

• Training Rrogram

• Rwanda National OpenMRS Rollout

• National eHealth Architecture

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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:– Life expectancy 38-44 years– Infant mortality 152/1000– Maternal mortality 1071/100K– Medium income $230– HIV prevalence 3%– Malaria prevalence 46%

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OpenMRS origins

• First OpenMRS site – Eldoret, Kenya February 2006

• Second site – Rwinkwavu, Rwanda August 2006

• Third site– Richmond Hospital, South Africa

September/October 2006

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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

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Rwanda

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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

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OpenMRS dashboard - HIV Care

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Physician looking up ARV patient

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OpenMRS-TB, bacteriology dataBacteriology management tools include a customizable timeline of smears, cultures,

treatment status dates, culture conversion dates, and other clinical observations.

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Report of MDR-TB cases

BIRT report

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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

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Proposed primary care version of OpenMRS for Rwanda

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Patient RegistrationPatient Registration

Clinical DiagnosticsClinical Diagnostics

Prescription DrugsPrescription Drugs Mutuelles de SantéMutuelles de Santé

1

2

3 5

Laboratory testingLaboratory testing 4

<insert relevant illustration>

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Patient registration system (prototype)

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Patient Identification

Patient Registration

Patient Summary

• 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

• 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

• 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

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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

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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

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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

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Potential components of integrated national eHealth architecture in Rwanda

EMR SystemOpenMRS

National reporting system

TRACNet

Pharmacy system

PIH

Registration and insuranceMutuelle

Mobile health systems

OpenROSA

Radiology /telemedicine

system

Laboratory System

PIH-Lab-system

IXF/SDMX

HL7HL7

HL7?HL7

DicomHL7

Supply chain systems

Camerwa

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Challenges for OpenMRS Deployments

• Equipment, power supplies and networks• Data management and quality control• Evaluation• Sustainability• Training

– Programmers– IT staff– Data entry staff and managers– Users

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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

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Collaborators and Funders • 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

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Question?

People in the web conference

please hold your questions

until the panel at 11 am