1. Bahmni Open Source EHR System -Ranjan Sakalley (Lead Developer) Simple. Affordable. Scalable

2. Bahmni - Focus on all aspects of patient care 2

3. Bahmni Implementations 3 Possible - Accham, Nepal JSS Hospital, Ganiyari(Bilaspur), India SEARCH Hospital, Gadchiroli, India The Banyan Mental Health Clinic - Chennai, India Union Health Clinic - Kaligonj, Bangladesh (pilot primary health care centre for national rollout) Coming soon – Bahmni Offline - Community Health Workers for Dhaka division of Bangladesh Bahmni for large TB program for 3 global NGOs in 16 countries

4. Learnings from implementations 4 Extremely low to reasonably low computer literacy levels in staff Cannot depend on Internet for hosting, in most places (remote hospitals) Requires physical presence for technical tasks (Extremely busy clinical and non-clinical staff) Disruption cost is quite high, esp. in case of system problems. Low risk appetite. Service delivery context differs vastly, leading to unique data requirements

5. Bahmni – design principles and guidelines 5 Design for resource constrained settings - no internet required Simplicity of use - easier to learn and use with minimal supervision Adaptable - use on variety of devices - tablets/computers Configurable - location specific user interface changes, languages (internationalization) Modular - choose parts from a super-set Build for Integrations - allow others to integrate easily Use Open Source Software – affordable and customizable

6. Bahmni – a union of well-built OSS tools 6 OpenMRS OpenERP/Odoo OpenELIS DCM4CHEE (Oviyam2) New EMR UI for OpenMRS Leveraging – Domain expertise built over years of development and support Vibrant communities that are progressively adding features and integrations Customizable Open Source code

7. OpenMRS Well known Open Source Medical Record System Patient Management Concept Dictionary – Diagnosis – Tests – Procedures – Drugs, and more Heart of the Bahmni system Very friendly and encouraging community

8. OpenERP/Odoo Well known Open Source Resource Management System Billing and inventory management Extremely flexible, wide community of contributors and implementers

9. OpenELIS Open Source Lab Management System Contributions from the Bahmni team towards new API additions and more

10. DCM4Chee – Oviyam2 Open Source Library – robust implementation of DICOM standard Oviyam2 – web based DICOM viewer to make investigation orders which are sent to digital radiology devices. sends patient and the investigation details to the radiology technician. Bahmni also allows you to view the radiology results (DICOM images) from within Bahmni.

11. Bahmni User Interface

12. Focus on simplicity and intuitive user interface Responsive - use on different devices Pre-built dashboards that can be customised Pre-built library of EMR reports that can be customised Offline applications for android and chrome coming soon Open Source, driven by the ThoughtWorks team

13. Integrations and Interoperability All bahmni components communicate with each other using standard Atom feeds over Http Protocol (authorized clients can easily program to listen) Each Bahmni component publishes a log of relevant events happening - other subcomponents can listen to this feed using standard libraries New components (for e.g. an offline android application) may make use of the same mechanism Bahmni provides rich data interface over standard REST API - this means that given the right credentials, components can pull and push data updates directly

14. Integrations and Interoperability Bahmni can be enhanced at multiple levels to add new integrations. - Adding custom OpenMRS module to integrate with other systems (eg. Bangladesh SHR) - Adding custom OpenERP modules - Adding/Importing new standard definitions in OpenMRS - Adding new components based on standards - HL7 standard for Radiology Order built for PACS(Picture Archiving and Communication System) integration Bahmni is modular - new components (like a new lab management system) can be plugged in and old ones removed (in this case OpenELIS)

15. Standards Bahmni supports various international standards – DICOM for communicating digital medical images Bangladesh SHR system communicates using standard HL7 (FHIR) data formats – an enhancement to Bahmni and OpenMRS

16. Engineering Standards Standard Communication – HTTP / REST/ Atom feeds Web standards for our apps Standard and predictable data formats for communications based on OpenMRS Most Stable and Free OS supported – Centos 6 Proven free open-source engines – MySQL, PostGreSQL Extensibility using well known OpenMRS / OpenERP module systems

17. Bahmni as part of a Shared Health Record System 17 Central Registries – Terminology – Personnel/Providers – Locations – Patients (MCI) –[ National Health ID ] – Encounters Centralised Reporting (DHIS2)

18. Bahmni as part of a Shared Health Record System 18 Bahmni on facility (primary clinic to multi-specialty hospital) Works just like any other Bahmni instance, and more. New Bahmni OpenMRS module to regularly sync reference data – terminology, locations, personnel etc. Sync patient and encounter data – FHIR HL7 format Push data recorded at facility for national integration Operational reports for the hospital Ability to import patients in the central registry Sync on demand – no need to be online all the time

19. Bahmni as part of a Shared Health Record System 19 Bahmni Offline for Community Health Workers (CHWs) Publicly Hosted Bahmni server for CHWs Not tied down to a physical facility Offline usage Integrated with SHR system using the same OpenMRS module

20. THANK YOU For questions or suggestions Contact rsakalle@thoughtworks.comrsakalle@thoughtworks.com @rnjn @BahmniOrg https://www.bahmni.org For questions or suggestions Contact rsakalle@thoughtworks.comrsakalle@thoughtworks.com @rnjn @BahmniOrg https://www.bahmni.org