OpenMRS in Rwanda Hamish Fraser Director of Informatics and Telemedicine, Partners In Health Assistant Prof. Harvard Medical School Co-founder, OpenMRS Collaborative

Overview Rwanda Health Care System OpenMRS sites Training Rrogram Rwanda National OpenMRS Rollout National eHealth Architecture

Rwanda health indicators A small central African country: Population 9 M people Highest population density in Africa, 85% rural Achieved rapid economic growth since genocide in 1994, but still has very poor health outcomes: Life expectancy 38-44 years Infant mortality 152/1000 Maternal mortality 1071/100K Medium income $230 HIV prevalence 3% Malaria prevalence 46%

OpenMRS origins First OpenMRS site Second site Third site Eldoret, Kenya February 2006 Second site Rwinkwavu, Rwanda August 2006 Third site Richmond Hospital, South Africa September/October 2006

OpenMRS Sites in Rwanda Clinics run by Ministry of Health Supported by Partners In Health The TRAC clinic Large HIV clinic run by the MOH Town of Mayange Millennium Villages project National Tuberculosis program OpenMRS-TB

Rwanda

OpenMRS at PIH sites in Rwanda Currently used in 12 PIH – supported health centers 8 sites have own server 6 remote sites have synchronized copy of entire database Registration, encounter and lab data TB, HIV, and now heart failure patients Over 10,000 patients tracked (Sep. 2009) Team of Rwandan data officers trained to enter data, ensure quality & produce reports Clinicians use electronic patient summaries Many new research and clinical applications

OpenMRS dashboard - HIV Care

Physician looking up ARV patient

OpenMRS-TB, bacteriology data Bacteriology management tools include a customizable timeline of smears, cultures, treatment status dates, culture conversion dates, and other clinical observations.

Report of MDR-TB cases BIRT report

National OpenMRS rollout MOH and PIH are augmenting OpenMRS for roll out in hundreds of clinics in Rwanda One month ago we were asked to move ahead with the HIV clinics supported by the GFATM We are developing a new version for primary care

Proposed primary care version of OpenMRS for Rwanda 2 4 Clinical Diagnostics Laboratory testing 1 Patient Registration 3 5 Prescription Drugs Mutuelles de Santé <insert relevant illustration>

Patient registration system (prototype) 1 Patient registration system (prototype) Patient Identification Patient Registration Patient Summary Barcode affixed to patient’s health passport provides a unique identifier to each person Can be used at any clinic or hospital May move to 2 D barcodes Contents stored include: name, age, gender, phone #, insurance, address Time saved for clinics – no need to reenter patient’s personal information every visit Check for duplicate records / names Progression of vitals (i.e. height, weight, blood pressure) Serious allergies and/or drug reactions Current prescriptions Current treatment program Next appointment / appointment history Assists nurse or physician’s assistant in quickly assessing status

Kigali Developer training There is a shortage of Java programmers who can work on eHealth systems like OpenMRS A year ago we set up a training program for computer science graduates to learn these skills The students graduated last week and are working on modules for the OpenMRS rollout for HIV

eHealth Architecture Project Rwanda has embarked on a plan to create national eHealth architecture This will define the functions of each components and interoperability standards for each A meeting was hosted by WHO last week in Kigali. Over 100 people from Rwanda, other African countries and the developed world worked on these specifications and interoperability profiles

Open standards and interoperability To be sustainable information systems need to be designed with compliance with open standards Leverage the expertise and experience of groups in each area: Laboratory, Pharmacy, EMR, Reporting and surveillance Business as usual is hundreds of incompatible systems with limited functionality and high cost

Registration and insurance Radiology / telemedicine Potential components of integrated national eHealth architecture in Rwanda Supply chain systems Camerwa National reporting system TRACNet IXF/SDMX EMR System OpenMRS Pharmacy system PIH Laboratory System PIH-Lab-system HL7 HL7 Dicom HL7 HL7? HL7 Registration and insurance Mutuelle Mobile health systems OpenROSA Radiology / telemedicine system

Challenges for OpenMRS Deployments Equipment, power supplies and networks Data management and quality control Evaluation Sustainability Training Programmers IT staff Data entry staff and managers Users

Conclusions OpenMRS is now heading for widespread use in Rwanda There are studies showing benefits from OpenMRS in process and delivery of care as well as reporting Open standards for data exchange are essential in scaling information systems and reducing costs. Open source software allow the creation of better, more flexible and sustainable tools and allow local communities to build and modify them

Collaborators and Funders Partners In Health Regenstrief institute Medical Research Council, South Africa World Health Organization US Centers for Disease Control Brigham and Women hospital Harvard Medical School University of KwaZulu-Natal Millennium Villages Project International Development Research Centre, Ottawa Rockefeller Foundation Fogarty International Center, NIH Boston Consulting Group Google Inc 22

Question? People in the web conference please hold your questions until the panel at 11 am