In the last few weeks the OpenMRS team along with collaborators from the University of Washington have been meeting with members of the OpenELIS team, an open source laboratory information management system (LIMS) that’s been implemented in Minnesota, Kansas, Missouri, and Vietnam. The members of this team are from the Association of Public Health Laboratories (APHL) and from labs in the US. Conversations have focused on how the OpenELIS group can learn from the community building experience of OpenMRS and how the two systems can connect to provide countries with the possibility of implementing both systems.

Our first meeting last month was extremely productive. Dr. Gail Cassell was also present. We’re now coordinating meetings to meet the two goals mentioned above: helping in creating an OpenELIS developer community and connecting both systems.

It’s not time to throw the confetti yet. But maybe we can throw just a little for now.

In November, the EMR Team attempted to rollout an edition of the EMR at the Rwanda Project that included “Synchronization”. Synchronization, for those of you that haven’t heard this little buzzword, is the ability for different machines to automatically communicate data about our patients back and forth with each other. The benefits of this are many. We can have offline entry in at sites with no computers or electricity by bringing a laptop and then have that data copied back to a central database. In sites like Lesotho where there is no internet connectivity at some of the sites, a single roaming data team member can go from site to site collecting data on a flash drive and then have it merge in to a central EMR database back in Maseru. Theoretically, data from all project sites could be accumulated in Boston for high-level analysis.

The rollout of the Synchronization Edition of the EMR was a tricky process for 2 reasons. For one, Synchronization was the single largest change to the system since the creation of the new EMR (EMR 2.0, aka OpenMRS), not to mention the most likely to cause corruption of medical data. Secondly, the rollout had to take place in a relatively short window of time during which a member of the EMR Team was actually in Rwanda. Sadly, on the day of launch the shuttle failed inspection, and Synchronization was held at Cape Canaveral indefinitely, until another window opened.

In Febuary, the skies opened again for the Synchronization Edition of the EMR to launch. This time, with luck and hard work on the part of a few dedicated developers, it passed inspection and the countdown began.

5…4…3…2…1…

On February 7, the button was pushed, and another, identical EMR came online in Kirehe. For the remainder of the day, all changes and entries that were done in Rwinkwavu magically appeared minutes later in Kirehe. Changes made in Kirehe magically appeared minutes later in Rwinkwavu. A team of extremely nerdy people looked on from a control room with anxiety and awe. By 5pm, the data entry teams had gone home for the day, and the shuttle appeared to still fly straight. It was a brief but welcomed victory.

The next day, Synchronization held strong again. And the next day. And the next. By the end of the first week of usage, the team encountered their first minor setback, but the problem was quickly corrected and the launch back on target. Another week went by. Still no problems.

At this point, Synchronization has been running without error, copying all kinds of data back and forth between the distant project sites for almost 4 weeks. To date, it has successfully copied over 75,000 changes between the sites. It is done so automatically and in the background. The entry teams working at the sites don’t even notice that it is happening, but instead can focus on the priorities and daily tasks. The only thing they really notice is that now entry is fast and efficient, since they have their own, local version of the EMR.

Most hospital systems in the Western world are unable to successfully set up systems that provide universal access to patient data, such that a patient can check in to multiple facilities and those facilities have instant (yet secure) access to their patient charts. But we have it in the Eastern Province of Rwanda. And we’ll have it soon at our other sites.

So why no confetti yet? Because we’re not finished. There still remain a growing number of sites in Rwanda that don’t have their server set up yet. Or they have a server that is being tested, but hasn’t been shipped out to the site yet. Also, Synchronization is not yet ready for the greater OpenMRS community - the vast number of people who have started to use our EMR. It still needs a simpler and more intuitive setup process.

No - there will be no confetti and champagne for Hamish, Darius, and their team yet. But maybe, just maybe, we could throw a *little* bit for this one small step for the EMR Team.

Welcome to the PIH-EMR Team Blog! We are a team of 12 people working on medical information systems for Partners In Health (PIH), a health care non-profit that works in developing countries. PIH provides free, high-quality health care in some of the poorest parts of the world including rural Haiti, Rwanda, Lesotho, Malawi and Mexico. We provide primary care, and specialize in the treatment of HIV. We also provide specialized treatment fro drug resistant tuberculosis in Peru and Russia, and now Haiti and Lesotho as well.

The EMR team develops and deploys electronic medical records - EMRs - for patients being treated for HIV or MDR TB who need long-term treatment. The need to closely monitor these patients and track their laboratory data and drug regimens presents a major challenge, especially in the resource-poor areas in which PIH works. All our EMR systems are web-based, starting with the original system for MDR TB patients in Peru in 2000-2001. We are now concentrating most of our effort on developing and deploying the OpenMRS system, a new open source EMR architecture jointly developed by PIH and the Regenstrief Institute in Indiana and the Medical Research Council in South Africa. This is now a growing open source project with developers and collaborators from the US, several African countries, Peru, Haiti and soon India.

In this Blog we will post our updates on the systems, and the progress in setting them up and using them in the 5 current PIH EMR sites. We will talk about the ideas behind the systems, the challenges we face and the progress in hardware software and useful data and some cool results from evaluation studies.

-Hamish Fraser