1. Regenstrief Institute, Inc. OpenMRS – A Community Developed, Open Source Medical Record System for Developing Countries Paul Biondich, MD MS Burke Mamlin, MD …and the OpenMRS collaborative Paul Biondich, MD MS Burke Mamlin, MD …and the OpenMRS collaborative

2. Regenstrief Institute, Inc. Overview  Our start  What OpenMRS is  Our progress to date  Where we hope to go  Guiding principles  Our start  What OpenMRS is  Our progress to date  Where we hope to go  Guiding principles

3. Regenstrief Institute, Inc. Introduction  Regenstrief Institute / IU – 30+ year of clinical informatics development in US, building large scale clinical information systems  February 2004: Asked to be “consultants”: give advice about how pre-existing HIV data repository (Access-based) could be extended / given more functionality -> supposed one week trip to Eldoret, Kenya  Regenstrief Institute / IU – 30+ year of clinical informatics development in US, building large scale clinical information systems  February 2004: Asked to be “consultants”: give advice about how pre-existing HIV data repository (Access-based) could be extended / given more functionality -> supposed one week trip to Eldoret, Kenya

4. Regenstrief Institute, Inc.

7. 40,000,000 95% 5%

8. Regenstrief Institute, Inc. February, 2004 AMPATH: example of successful HIV comprehensive care system in developing country… huge information needs Significant growth ahead: rapid ramp up to 20+ geographically disparate sites Immediate Observations: No “quick fix” or “retro-fit” of old system We were “hooked” and became very engaged after visiting Eldoret AMPATH: example of successful HIV comprehensive care system in developing country… huge information needs Significant growth ahead: rapid ramp up to 20+ geographically disparate sites Immediate Observations: No “quick fix” or “retro-fit” of old system We were “hooked” and became very engaged after visiting Eldoret

9. Regenstrief Institute, Inc. Silos

10. Regenstrief Institute, Inc. Existing Efforts Multiple “silos” of disparate efforts Focus on user interface Minimal opportunity for collaboration or interface Non-coded, unstructured data Lack of standards Aren’t directly helping clinicians Multiple “silos” of disparate efforts Focus on user interface Minimal opportunity for collaboration or interface Non-coded, unstructured data Lack of standards Aren’t directly helping clinicians

11. Regenstrief Institute, Inc. Design Dogma Follow the lead of the 30+ year experience of our mentors Graceful evolution towards enterprise- worthy systems We must enforce deep structure in the database to improve data integrity / quality Use of informatics standards throughout Follow the lead of the 30+ year experience of our mentors Graceful evolution towards enterprise- worthy systems We must enforce deep structure in the database to improve data integrity / quality Use of informatics standards throughout

12. Regenstrief Institute, Inc. OpenMRS - API Three code layers Database Layer Service Layer Presentation Layer Hibernate, Spring, AJAX Three code layers Database Layer Service Layer Presentation Layer Hibernate, Spring, AJAX

13. Regenstrief Institute, Inc. OpenMRS – Data Model In continuous development for 3+ years It simultaneously defines and directly stores clinical data Robustly defined concept vocabulary Form hierarchies Versioning system, public debate/input Data Repository vs. “Business” tables In continuous development for 3+ years It simultaneously defines and directly stores clinical data Robustly defined concept vocabulary Form hierarchies Versioning system, public debate/input Data Repository vs. “Business” tables

14. Regenstrief Institute, Inc. OpenMRS - Standards HL7: Method of bulk data input/output and reporting to national centers Local vocabulary can and will be mapped to ICD10, LOINC, and SNOMED where applicable Arden Syntax: logical constructs Liberal use of open source programming paradigms/standards HL7: Method of bulk data input/output and reporting to national centers Local vocabulary can and will be mapped to ICD10, LOINC, and SNOMED where applicable Arden Syntax: logical constructs Liberal use of open source programming paradigms/standards

15. Regenstrief Institute, Inc. AMPATH Medical Record System (AMRS)

16. Regenstrief Institute, Inc. Model- view- controller based data entry

17. Regenstrief Institute, Inc.

19. Concept Statistics

20. Regenstrief Institute, Inc. Cohort Builder

21. Regenstrief Institute, Inc. Building Enterprise EMRs  Difficult (if not impossible) to fully sustain internally within our environment  Grant/contract money for development limited  Difficult local hiring climate  Inconsistent with priority of academic culture  Human resource needs only scale over time (everyone wants a new feature)  Difficult (if not impossible) to fully sustain internally within our environment  Grant/contract money for development limited  Difficult local hiring climate  Inconsistent with priority of academic culture  Human resource needs only scale over time (everyone wants a new feature)

22. Regenstrief Institute, Inc. Open Source Communities – A Solution?  Open Source  Instruction code made freely available to public  Nurture environment that encourages outside developers to work with your code  Open source licensing ensures that those who add to your core code must also give it away  Community  Give everyone stake in decision making process  Make it fun/easy to participate  Open Source  Instruction code made freely available to public  Nurture environment that encourages outside developers to work with your code  Open source licensing ensures that those who add to your core code must also give it away  Community  Give everyone stake in decision making process  Make it fun/easy to participate

23. Regenstrief Institute, Inc. Open Source License in Place License formalized Essentially Mozilla Public License 1.1 with extra clause related to medical liability Main ideas: Core vs. Modules: all core will adhere to base license, modules are encouraged to do so Core managed by OpenMRS Management Group (Paul, Burke, Hamish, Chris) License formalized Essentially Mozilla Public License 1.1 with extra clause related to medical liability Main ideas: Core vs. Modules: all core will adhere to base license, modules are encouraged to do so Core managed by OpenMRS Management Group (Paul, Burke, Hamish, Chris)

24. Regenstrief Institute, Inc. Types of Participants  Large HIV programs throughout the world  Partners-in-Health  Medical Research Council  Millennium Village Project  Family AIDS Care and Services (FACES)  Clinton Foundation  Programmers with philanthropic leanings  CS students  Professionals with spare cycles  Other large FOSS communities  Large HIV programs throughout the world  Partners-in-Health  Medical Research Council  Millennium Village Project  Family AIDS Care and Services (FACES)  Clinton Foundation  Programmers with philanthropic leanings  CS students  Professionals with spare cycles  Other large FOSS communities

25. Regenstrief Institute, Inc. What this community “costs” us  Time  Initial education on our design  Building web portal / information content  Constant fielding of questions  Guiding the design towards the right direction  Slower progress on our own work  Time  Initial education on our design  Building web portal / information content  Constant fielding of questions  Guiding the design towards the right direction  Slower progress on our own work

26. Regenstrief Institute, Inc.

28. What this community gives us  Development scale  Cohort builder example  Fresh sets of eyes to strengthen design  Daniel Kawiya from Uganda  Implementation “cushion”  Chris Seebregts and implementation group  Sponsor “gravitational pull”  Development scale  Cohort builder example  Fresh sets of eyes to strengthen design  Daniel Kawiya from Uganda  Implementation “cushion”  Chris Seebregts and implementation group  Sponsor “gravitational pull”

29. Regenstrief Institute, Inc.

30. Where we want to go… Evolution of core development group into mentorship “team” – scaling development, educate in medical informatics, FOSS Continue to foster OpenMRS Implementation Group (Chris) Fundamental additions to OpenMRS (team) “deep” decision support functionality completion of research query tools / reports encourage tools that facilitate clinical care synchronization between OpenMRS instantiations Evolution of core development group into mentorship “team” – scaling development, educate in medical informatics, FOSS Continue to foster OpenMRS Implementation Group (Chris) Fundamental additions to OpenMRS (team) “deep” decision support functionality completion of research query tools / reports encourage tools that facilitate clinical care synchronization between OpenMRS instantiations

31. Regenstrief Institute, Inc.

32. OpenMRS Principles Serve care providers/patients first, reuse data Develop based on active implementations Be transparent Reduce redundancy Collaborate broadly Apprenticeship – Learning by doing Serve care providers/patients first, reuse data Develop based on active implementations Be transparent Reduce redundancy Collaborate broadly Apprenticeship – Learning by doing

33. Regenstrief Institute, Inc. It’s amazing how profitable it can be to give something away.

34. Regenstrief Institute, Inc. paul@openmrs.org