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

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

3. 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 years
Infant mortality 152/1000
Maternal mortality 1071/100K
Medium income $230
HIV prevalence 3%
Malaria prevalence 46%

4. 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

5. 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

6. Rwanda

7. 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

8. OpenMRS dashboard - HIV Care

9. Physician looking up ARV patient

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

11. Report of MDR-TB cases
BIRT report

12. 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

13. Proposed primary care version of OpenMRS for Rwanda2 4
Clinical Diagnostics
Laboratory testing 1
Patient Registration 3 5
Prescription Drugs
Mutuelles de Santé
<insert relevant illustration>

14. 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

15. 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

16. 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

17. 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

18. 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

20. 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

21. 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

22. 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

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