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Jun 21, 2012.
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Added on 21 Jun 2012
Authors: By Joaquin Blaya, PhD, Terry Hannan and Marie Connelly
In the last decade, development agencies like the World Bank, USAID, PEPFAR and the Global Fund have spent between $3 and $5 Billion on eHealth projects in low and middle income countries. Many of these expenditures have been on Electronic Medical Record (EMR) projects which in some cases are no longer being used. Health Information Management Systems are complex and optimizing these programs for real world use in both developed and developing countries is an ongoing challenge.
Facing that challenge is the community of OpenMRS users and developers. OpenMRS, an open-source EMR, has been implemented in over 130 sites in 50 countries, including the US, South Africa, Germany, the Philippines, and Chile. Further, both the Rwandan and Kenyan governments have chosen OpenMRS for the implementation of their national eHealth infrastructure.
This Expert Panel centered on the OpenMRS platform and surrounding community of users (Seebregts 2010): their experiences, the challenges they encountered implementing OpenMRS in resource-constrained settings, as well as the benefits they’ve found from using this platform.
Challenges faced in implementation include:
- There were a wide range of reasons for choosing OpenMRS including: cost (free), ease of set-up, its advertised applicability for resource-constrained environments, the fact that it is configurable without programming, was easily extensible, and had functionality specifically needed in low resource settings.
- Members and panelists identified the following benefits of OpenMRS:
- A large and active community willing to help and from which implementers can learn. This community also provides continuous record structure updates and system maintenance via the web.
- EHR data is captured locally and in a manner that permits data usage even where internet connectivity is intermittent.
- All implementations have the same mappings to international standards so that datacan be shared and aggregated across sites e.g. SMOMED-CT, LOINC, HL7.
- There is an offline functionality allowing the use of OpenMRS even when there is no Internet.
- Rapid form generation and ease of reporting provide better support for longitudinal care, and operational research that would have been otherwise almost impossible
- Decreased turnaround time and error reduction for test results (e.g. CD4 test) entered by lab technicians into OpenMRS when compared to returning test results to clinicians on paper (Amoroso 2010)
- Data ownership by the local communities and form generation to meet their needs with data standardizations through the concept dictionary.
- Platform adaptability and extensions allow for data collection via cell phone.
Members and panelists debated whether it was more beneficial to use free text responses in some fields, or “structured data” where answers are codified. It was agreed that, in general, if there is any plan for the computer to re-use information beyond just re-displaying it to humans – e.g., for decision support, reporting, research, etc. – then data collection in a codified format is preferable.
There was also some debate about the benefits of open source software compared to proprietary platforms:
- Hardware, internet, and remote location issues such as slow or no internet, burnt servers due to lighting strikes, and hours of transport between sites.
- A lack of trained personnel in both medical and informatics, though there is evidence that OpenMRS can be a significant educational tool.
- Needing to continually implement newer versions of OpenMRS to access the latest functionality.
- Explaining to colleagues and funders that the system is continuously evolving and requires resources to be maintained.
- Rejection by staff members who may feel threatened by new technology and platforms.
- Terminology. Currently, implementing the international standards requires personnel with experience in the field.
What is critical is that health IT investment be directed to ensuring the software marketplace consists of multiple competing vendors - each with enterprise-grade systems, and not homegrown MS Access databases.
- Ultimately, members and panelists agreed that every project needs to take into account the Total Cost of Ownership (TCO) which includes development required, implementation, training and more, to identify the most cost-effective solution.
- Some felt that a need for local ownership could be a reason why many traditional EMRs have not been adopted in resource poor settings, as open source provides an opportunity for local capacity building, local modification, and local ownership of application and data.
- Others argued that developing countries would be better served building on existing solutions, which are primarily proprietary technologies, rather than spending precious time duplicating efforts.
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