OpenMRS is a 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. In Rwanda, the program has developed tools in general primary care and chronic disease management, such as heart failure. It also allows non-programmers to report outcomes and other important data for HIV/AIDS, TB and other diseases. 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.
It has records on over 25,000 patients, almost 7,500 of whom have started or completed treatment for MDR-TB. The system is designed to collect baseline data on patient assessment, bacteriology test results, drug regimens and patient outcomes.
In addition, we have also created a system using Personal Digital Assistants (PDAs) to enter information into the PIH-EMR. PDAs are used to track over 3,500 monthly laboratory results from more than 120 health establishments throughout Peru.
The data collection team travels to the health center or laboratory and enters information into the PDA. They then synchronize the PDAs with the computers in the home office, transferring the data into the PIH-EMR. This method of data collection has reduced delays in data entry and has increased efficiency in data entry by 40 percent and reduced data entry errors.
This system provides direct web access to critical laboratory data in Peru, the PIH-EMR now includes a component that permits web-based entry of tuberculosis laboratory results at all regional and central laboratories performing these tests. The component, termed “e-Chasqui,” includes applications that assess quality control, generate aggregate reports, notify health centers of new results or contaminated samples by e-mail, track enrolled patients, and follow the status of pending laboratory tests.
This system was initially deployed in the national TB laboratory, two regional laboratories and twelve health centers. Because of high user satisfaction and heavy use, e-Chasqui is now being used in two district laboratories and 34 health centers. Staff at an additional 25 health centers will be trained on e-Chasqui in May 2008. To date more than 65,000 laboratory samples have been entered and tracked in the system. e-Chasqui will eventually serve a network of institutions providing medical care for over 3.1 million people. An impact evaluation is currently being performed on the system.
e-Chasqui benefits include:
Connection of laboratories and health centers by email
Constant access to laboratory information for health center staff
Tools for data quality improvement
Reporting functions for laboratory personnel
Clinician alerts for high risk patients
In 2002 the PIH-EMR was modified to support the treatment of HIV in rural Haiti. The HIV-EMR is now used in nine clinics in rural Haiti and collects data on patients’ clinical histories and examinations, drug regimens, laboratory tests (including CD4 counts), follow-up data including opportunistic infections, and medication side effects. Data for over 10,800 HIV patients are now stored in the EMR. We have recently added a patient tracking system that will reveal whether patients are missing follow-up visits or if their medication has not been picked up. The HIV-EMR also includes a web-based pharmacy system that tracks all medications and supplies for the clinics, including non-HIV drugs.
The HIV-EMR is accessed by satellite internet in each of the clinics where it is used. It both generates reports on patient treatment and detects patients whose treatment may be delayed or incorrect. Given Haiti's erratic power supply, the HIV-EMR allows staff to enter data while disconnected from the internet. It is then synchronized when the internet is re-connected.