2. OpenMRS
OpenMRS (Open Source Medical Record System) is a community-developed, open-source, enterprise electronic medical record system framework intended to aid resource-constrained healthcare environments.
Founded in 2004

3. Founders and Collaborators
OpenMRS is a multi-institution, nonprofit collaborative led by:
Regenstrief Institute, Inc. (
Partners In Health (
South African Medical Research Council (MRC) (

4. Background
Originated by the Regenstrief Institute, University of Indiana and used at the Ampath AIDS clinics in Kenya
Operational Sites
AMPATH Clinic, Eldoret, Kenya
Rwinkwavu Hospital, Rwanda
Richmond Chest Hospital, South Africa
Pilot Implementation Sites
Morogoro Regional Hospital, Tumbi Hospital and Ocean Road Cancer Institute, Tanzania
Makerere University (Uganda)
Millennium Village Project
Cell-Life, South Africa
Support Partnerships: CDC/PEPFAR, WHO, Rockefeller Foundation, IDRC

5. What is OpenMRS?
OpenMRS is an application which enables design of a customized medical records system with no programming knowledge (although medical and systems analysis knowledge is required).
It is a common framework upon which medical informatics efforts in developing countries can be built.
At its core is a concept dictionary which stores all diagnosis, tests, procedures, drugs and other general questions and potential answers.

6. What does OpenMRS cater for?
Aimed at Patient Based Care
Allows for the enrolment of Patients
Easier storage of patient data
Ability to produce accurate reports
Reports are defined by the implementers/developers

7. Key Features Open Source, generic forms-based, web application
Uses Microsoft InfoPath for forms development (XForms-like)
Standards-based, XML structure and processing, HL7 messaging
A basic application can be implemented without significant programming
Build on a generic database model allowing it to be highly configurable.

8. OpenMRS Development Resources
OpenMRS web resources:
OpenMRS Wiki (
OpenMRS open source development project (
Implementers Wiki
OpenMRS List servs
Developers list
Implementers list
Announcements

9. OpenMRS Application Development Process

10. OpenMRS Application Development and Data Entry Process
Involves the following key steps
Define Data and Develop Structured Medical Record Forms
Install and Configure OpenMRS
Define Concepts and Database Elements
Develop Form Schema
Develop Electronic Medical Record Forms
Data Entry
Live demonstration of South African ART/TB application

11. OpenMRS Application Development Process – Step 1
Define Data and Develop Structured Medical Record Forms
Install and Configure OpenMRS
Define Concepts and Database Elements
Develop Form Schema
Develop Electronic Medical Record Forms
Data Entry

12. Define Data and Develop Structured Medical Record Form
Data ideally driven by minimum data set, defined vocabulary, clinical information requirements, monitoring and evaluation and reporting
Forms developed together by informatics, medical and public health professionals

13. OpenMRS Application Development Process – Step 2
Define Data and Develop Structured Medical Record Forms
Install and Configure OpenMRS
Define Concepts and Database Elements
Develop Form Schema
Develop Electronic Medical Record Forms
Data Entry

14. OpenMRS - API Three code layers Hibernate, Spring, AJAX Database Layer
Service Layer
Presentation Layer
Hibernate, Spring, AJAX

15. OpenMRS Implementation Software
Packaged Open Source Software
MySQL (Relational database management system)
Java 2SE (Java runtime environment)
Apache Tomcat (Server engine)
Mozilla Firefox (Web browser)
OpenMRS Software
OpenMRS web application
Commercial Software
Microsoft InfoPath or Microsoft Office 2003 Professional (Forms development)

16. Other Software (not required for implementation)
Useful open source software
DBDesigner (open source database schema design tool)
Commercial
Navicat (graphcal user interface to MySQL)
Developer Software
TortoiseSVN (source code repository manager)
Java Developers Kit (Java development environment)
Eclipse SDK (Java integrated development environment tool)
Apache ANT (Java compile application)
OpenMRS
OpenMRS Source code

17. Installing and Configuring OpenMRS
Desktop Installation
Install required packaged and set environmental variables
Configure database (SQL scripts)
Deploy OpenMRS web application
Client Server Installation
Establish standalone server installation
Establish network
Define user permissions
Set global variables
Web Installation
Establish remote access using Terminal Services, InfoPath, OR;
Establish Internet access and configure Tomcat to use SSL

18. OpenMRS Application Development Process – Step 3
Define Data and Develop Structured Medical Record Forms
Install and Configure OpenMRS
Define Concepts and Database Elements
Develop Form Schema
Develop Electronic Medical Record Forms
Data Entry

19. Database
OpenMRS database model makes use of a generic database model which has many advantages which are useful in the realm of health especially coming to the dynamic changes and need for longitudinal data for care.
This is best explained through means of an example:

20. Flat Data Set (Analytic Conceptualization)
Pat ID
Name
Visit Date
Hgb
CD4
SGPT
SaO2
WHO Stage
1234-5
Doe Jane
12May05 13 95 39 93 2
1234-5
Doe Jane
1Oct05
12.5
200 60 98 3
8888-3
Doe Sam
4June95 16 78 90 3
1234-5
Doe Jane
23Jan06 14 23 95 3
Each Row: One Patient, or One Patient Encounter
(Table Grows Wider)

21. Stacked Data Set (Application Conceptualization)
Pt ID
Visit Date
Obs. ID
Value
Units
Nl Range
Place
Provider
1234-5
12-May-05
Hgb 13
mg/dl
Mosoriot
Dr. Smith
Doe J
12-May-05
CD4 95
cells/mm3
Mosoriot
Dr. Smith
Doe J
12-May-05
SGPT 39
IU/L
80-140
Mosoriot
Dr. Smith
Doe J
12-May-05
SaO2 93 %
80-140
Mosoriot
Dr. Smith
Doe J
13-May-05
WHO Stage 2
1-4
Mosoriot
Dr. Smith
Doe J
1-Oct-05
Hgb
12.5
mg/dl
Mosoriot
Dr. Jones
Each Row: One Clinical Observation
(Table Grows Longer)

22. OpenMRS Data Model v1.00

23. AMRS Data Model v0.70

24. Encounter User Patient Form Concept Obs Order Business
AMRS Data Model v0.70

25. Encounter User Patient Form Concept Obs Order Business Concept:
“Dictionary” of all medical concepts (terms) within our system..
Concepts exist for both questions (urine ketone level?) and answers (large).
Class (Drug) and Datatype (Numeric)
Synonyms (Hgb)
Sets (CBC)
Encounter
User
Patient
Form
Concept
Obs
Order
Business
AMRS Data Model v0.70

26. Encounter User Patient Form Concept Obs Order Business
Patient (The “Who”):
Comprehensive list of all known patient demographics.. matching!
Tribe -> Coded Equivalent of Ethnicity
Archive of all addresses (patient_address)
Archive of all patient names (patient_name)
Archive of all identifying IDs: MRNs, national IDs, etc. (patient_identifier)
User
Patient
Form
Concept
Obs
Order
Business
AMRS Data Model v0.70

27. Encounter User Patient Form Concept Obs Order Business
Observation (The “What”):
All things clinically measured or observed
Weight
Platelet Count
Cardiac Exam Findings
Alcoholic Drinks / day
Value Groups (complex answers)
Obs Groups (complex questions)
Complex Data?
User
Patient
Form
Concept
Obs
Order
Business
AMRS Data Model v0.70

28. Encounter User Patient Form Concept Obs Order Business
Encounter (The “Where”):
Tables that describe “places” within the healthcare setting, each observation or order is labeled with one of these.
Encounter: describes a health care provider <-> patient interaction
Encounter Type: describes various types of encounters (inpatient, outpatient initial visit, outpatient return visit, etc.)
Obs
Order
Location: describes the physical location where observations and orders occur (clinics, hospitals, labs, etc.)
Business
AMRS Data Model v0.70

29. Encounter User Patient Form Concept Obs Order Business Order
(The “How”):
Tables that record care provider actions (Dr. Mamlin ordered a CXR), (Start Joe on AZT), etc
Start vs. Completion vs. Discontinue
Drug Orders vs. Orders … still working through consensus..
Encounter
User
Patient
Form
Concept
Obs
Order
Business
AMRS Data Model v0.70

30. Database Key Points Advantage: Disadvantage: Highly scalable
Highly configurable
Disadvantage:
Direct Database reporting is slightly tricky

31. Other Major Sections
Form: collection of questions asked during a patient interaction
Each form consists of “fields”, each field relates to a concept
Key is in defining “set of questions” once
Relationship: defines relationships between people
Various types of relationships (familial, primary care provider, etc.)

32. Demo: Concept Dictionary Development

33. Translating Forms to Vocabularies

34. Coded Data from Encounter Forms

35. OpenMRS Application Development Process – Step 4
Define Data and Develop Structured Medical Record Forms
Install and Configure OpenMRS
Define Concepts and Database Elements
Develop Form Schema
Develop Electronic Medical Record Forms
Data Entry

37. Forms and Database Development

38. Demo: Form Schema Design

39. OpenMRS Application Development Process – Step 5
Define Data and Develop Structured Medical Record Forms
Install and Configure OpenMRS
Define Concepts and Database Elements
Develop Form Schema
Develop Electronic Medical Record Forms
Data Entry

41. XForms Development in Microsoft InfoPath 2003

42. Demo: InfoPath Form Design

43. HIV/ART Adult Patient Registration

44. OpenMRS Application Development Process
Define Data and Develop Structured Medical Record Forms
Install and Configure OpenMRS
Define Concepts and Database Elements
Develop Form Schema
Develop Electronic Medical Record Forms
Data Entry

45. Selecting Forms

46. Conclusions

47. CONCLUSIONS
OpenMRS is a powerful application for development of medical data collection and electronic medical record applications
Low cost and configurable
Non-programming application development option
Robust control over concept and field definition
Powerful mechanisms for data integration
Scaleable and extensible database
Secure remote access options
Compatible with a range of existing infrastructure and tele-medicine implementations

48. OpenMRS Resources OpenMRS web resources: OpenMRS List servers
OpenMRS Wiki (
OpenMRS List servers
Developers list
Implementers list
Announcements
Google! (