The last few weeks we have been working to keep the momentum from Hamish’s visit to Malawi in early February going by laying the groundwork for a rollout of the touchscreen-based Patient Registration / Patient Diagnosis Module.

Work had already begun in late 2007 as I travelled up to Lilongwe to work with Mike McKay and the team at Baobab to build the Patient Registration component of the system. We took the basic structure of Baobab’s existing registration module, which was integrated into their ART system and based on Version 1.0 of the OpenMRS datamodel, and rebuilt it as a standalone module writing directly to OpenMRS Version 1.1. We were able to make this application work side-by-side with our current implementation of the PIH EMR in Malawi. Since then we have been using it for creating the patients in our backlog of ART data, taking advantage of the unique National ID number that the application generates. Baobab has already issued id numbers for more than 500,000 patients in Malawi, or roughly 4% of the country’s 13 million people.

Going forward our intention is to fix a few remaining bugs in Patient Registration so that it is ready for real-time use at Neno Rural Hospital, and add the Patient Diagnosis component to capture the primary and secondary diagnosis, treatment prescribed and clinician comments. In the existing workflow at the hospital, clinicians record the diagnosis in the patient’s medical passport, a data clerk transcribes the information into the ‘Outpatient Register’, one of the many medical registries issued by the Ministry of Health, and the patient proceeds to the Pharmacy. To create a smooth transition, we intend to add the Patient Registration / Patient Diagnosis module as an intermediate step between the clinical visit and the paper registry. Once the hospital staff grows accustomed to the new electronic systems, we hope to modify the workflow slightly so that clinicians can record the diagnosis information directly during the consultation.

Our next steps include:

1.) Demonstration of the existing Patient Registration module to Ministry of Health staff working at Neno Rural Hospital

2.) Generating a list of diagnoses and prescriptions common to Neno

2.) Working with Baobab Developers to write the remaining code for the Patient Diagnosis module

3.) Interior and exterior renovations at the hospital to create the Patient Registration area

4.) Creating a wireless network link between the hospital, our offices at the Neno District Assembly, other offices, and our warehouse in Neno

The final details of our plans for Patient Registration / Patient Diagnosis are falling into place, and we are excited about the prospect of having the system up and running at Neno Rural Hospital sometime in the next few months. In the meantime we are also busy entering the existing data for ART patients at Neno Rural Hospital, and planning for a more robust integration of Baobab’s Ruby on Rails interface within OpenMRS.

Patients queue to have their diagnoses recorded in the Outpatient Register at Neno Rural Hospital

A room adjacent to the existing registration area will be converted to allow data clerks to register patients and record diagnoses using the new Patient Registration / Patient Diagnoses module.

A pharmacy technician fills prescriptions at Neno Rural Hospital. The Patient Diagnoses module will allow clinicians to print labels for prescriptions during the consultation, eventually this could be linked to a wharehouse/pharmacy stock management system.

Patients queue at the Outpatient Register; construction of the new Neno District Hospital is visible in the background. Neno District Hospital is scheduled to open midyear, dramatically improving access to inpatient care for residents of Neno District.