Conferencia saptarshi purkayastha_hit_workshop_2016

1. Saptarshi Purkayastha, PhD
Assistant Professor of Health Informatics
Indiana University – Purdue University Indianapolis
July 25th, 2016 – Medellin, Colombia
OpenMRS Introduction,
History and Motivation
An Open Source Medical Record System Framework and
Community That Promotes Local Ownership

2. “Information is Care”
A world-wide recognized fact that clinicians provide best treatment to
patients, when medical history of the patient is available
Hospitals can provide best patient care & maintain highest efficiency
when it can allocate resources to places where patients need it the most

3. What is OpenMRS?

4. 1. Open-source
Free to use, modify and redistribute. Free as in freedom.
➔ More secure
Since more people look and review code
➔ More adaptable
Since people from different contexts and background
contribute to build the product
➔ More shareable
Since everyone contributes, the license allows for
knowledge sharing

5. 2. Patient-centric
Patient-centric medical records systems
➔ Limited administrative functionality
Like billing, insurance, logistics
➔ Focus is on continuity of care
Since people from different contexts and background contribute
to build the product
➔ More shareable
Patient records are shareable since they are architected in a
way to keep them separate from administrative information
➔ Use as a shared health record
Patient data is integrated from multiple clinical applications

6. 3. Platform
OpenMRS is a platform to build your own Electronic Medical Records system
➔ Modular architecture
Modules provide installable features to extend the functionality of the EMR
➔ Customizable
Starts with a blank shell and can build different forms, workflows, disease
programs
➔ Multiple identifiers
Patient identifiers can be generated for the system, or external identifiers
like SSN, passport no., health identifier etc can be used
➔ Distributions for specific use-cases
Different disease specific like WHO express or MDR-TB or for hospital
system like Bahmni or OpenHMIS have been created by community
members

7. 4. Standards based
Many years of research on EMR has been included in
OpenMRS
➔ HL7 import/export
Flexible configuration of HL7 v2 messages
➔ Customizable concept dictionary
Global dictionaries like SNOMED-CT, LOINC have been
mapped and shared by the community in dictionaries like
CIEL

8. OpenMRS implementations around the world

9. Top 10 OpenMRS Features
1. Central Concept Dictionary: Definitions of all data
(both questions and answers) are defined in a centralized
dictionary, allowing for robust, coded data which can be
mapped to multiple reference terminologies like ICD-10,
SNOMED, LOINC, RxNorm etc.
2. Security: User authentication with complex password
support. Support for roles, privileges to separate what user can
and cannot do
3. Patient Repository: Creation and maintenance of
patient data, including demographics, clinical observations,
encounter data, orders, etc.

10. Top 10 Features Continued (2)
4. Multiple identifiers per patient: A single patient
may have single or multiple identifier numbers like passport
number, national id, medical record number etc.
5. Flexible Data entry: With the FormEntry module, clients
with InfoPath (included in Microsoft Office 2003 and later) can
design and enter data using flexible, electronic forms. With the
HTML FormEntry module, forms can be created with
customized HTML and run directly within the web application.
With XForms module, users have a drag-drop interface to
design forms that can then be filled online in a web page.
6. Data export: Data can be exported into a spreadsheet
format for use in other tools (Excel, Access, etc.), including
aggregation HMIS systems like DHIS2.

11. Top 10 Features Continued (3)
7. Modular architecture: An OpenMRS Module can extend
and add any type of functionality to the existing API and web
application. 200+ available modules.
8. Support for complex data: Radiology images, sound
files, etc. can be stored as “complex” observations
9. Cohort management: The cohort builder allows you to
create groups of patients that match a “criteria” for data
exports, reporting, analysis etc.
10.Localization / internationalization:Multiple
language support and the possibility to extend to other
languages with full UTF-8 support.

12. The Community

13. OpenMRS History

19. Medical
Record
Keeping in
Eldoret
circa 2004

20. Starting OpenMRS
 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

22. It started with a
mission

23. Mission Statement
``The mission of OpenMRS is to
improve health care delivery in
resource-constrained environments
by coordinating a global community
that creates a robust, scalable, user-
driven open-source medical record
system platform.``

24. 24
Regenstrief Institute, Inc.

25. Values
User-Centered:
Design decisions are driven by real, not
perceived needs
Our software works in the most challenging
health care delivery environments
We create a platform that is adaptable to the
unique needs of our users around the world

26. Values (2)
Open
We are open, honest and transparent in both
our processes and software
Our software serves as a platform that
empowers users and implementers to
innovate
We publicly document and actively share our
knowledge, skills, experiences, and failures

27. Values (3)
Community-Driven
We believe the best ideas come from people
with different backgrounds and talents, and we
create a community where these people can
come together and create
We believe in harnessing the wisdom of our
software development community by creating a
safe place to raise concerns, discuss failures,
improve existing ideas and solve problems.

28. 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

29. 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

30. https://www.youtube.com/watch?v=Fvc__rmS7lk
OpenMRS: history of 10 years

34. People are using the
OpenMRS platform for all
sorts of things.

42. Disease-specific EMR (MDR-TB)
Credit: WHO-TB and PIH

43. Inpatient Care
Credit: Andrey Kozhushkov,
Ghislain Kouematchoua (Göttingen)

44. Registration Module Screenshot

46. Research Data Coordination
Credit:
Dave Thomas

47. Adaptive Turnaround Documents
Credit: Vibha Anand, Paul Biondich (Regenstrief)

48. Eligibility Across Institutions
Credit: Monica Waggoner

49. Google Maps Integration
Credit: Owais Ahmed, Aamir Khan

50. ID Cards and Barcodes
Credit: Brian Mckown (AMPATH)

51. “Mateme” Touchscreen Registration
Credit: Jeff Rafter (Baobab), Evan Waters (PIH)

52. iPhone App
Credit: Rowan Seymour

53. Notifiable Condition Detector
Credit: Shaun Grannis, Regenstrief Institute

54. Health Data Exchange
Credit:
Odysseas Pentakalos

55. What have we learnt from
EMR implementations
around the world

56. Avoid imagined
needs

57. There's a
difference
between knowing
the Path and
walking the Path.
-The Wachoskis, authors
of “The Matrix”

58. Re-use, don’t
re-invent

59. Obviously, the
highest type of
efficiency is that
which can utilize
existing material to
the best advantage
– Jawaharlal Nehru

60. Flexible,
standards-based
foundation

61. As they say on my own Cape Cod, a
rising tide lifts all the boats…
-John F. Kennedy

62. Follow thought
with action

63. You’ll never plow a field by turning
it over in your mind
-Irish Proverb

64. Where Does OpenMRS fit best?
• OpenMRS is a patient-centric application. Your main
information needs should also focus on direct patient care
provided.
• If you primarily intend to capture data about something
other than the patient (for example, about lab specimens or
medical inventory), you should consider other alternatives.
• OpenMRS does fit with other related health care tools like
Lab Information Systems, Billing Systems, Inventory
systems etc. All of these can be integrated together to build
a patient-centric Hospital Information System.

65. Where Does OpenMRS fit best? (2)
• OpenMRS is designed to manage patient data
longitudinally, linking multiple interactions over time into a
single patient chart.
• Having this complete patient history available empowers
clinicians to make more informed decisions about care,
while also enabling a deeper analysis of patient health in
order to draw more meaningful conclusions on improving
outcomes.
• If you only care about individual patient visits, and not about
linking those together into a longitudinal patient record, then
OpenMRS may not be the right tool for you.