OpenMRS

OpenMRS is a collaborative open source project to develop excellent software to support the delivery of health care in developing countries.^[1] It grew out of the critical need to scale up the treatment of HIV in Africa but from the start was conceived as a general purpose electronic medical record system that could support the full range of medical treatments. The first ideas and prototype of OpenMRS were conceived by Paul Biondich and Burke Mamlin from the Regenstrief Institute, Indiana on a visit to the AMPATH project in Eldoret, Kenya in February 2004. Around the same time the EMR team at Partners In Health led by Hamish Fraser and Darius Jazayeri were looking at ways to scale up the PIH-EMR^[2][3] web-based medical record system developed to manage drug resistant tuberculosis in Peru, and HIV in rural Haiti. Paul, Burke and Hamish met in September 2004 at the Medinfo conference in San Francisco, and recognized they had a common approach to medical information systems and a similar philosophy for healthcare and development and OpenMRS was born. Later, Chris Seebregts of the South African Medical Research Council (MRC) became the fourth founding member.

OpenMRS is founded on the principles of openness and sharing of ideas, software and strategies for deployment and use. The system is designed to be usable in very resource poor environments and can be modified with the addition of new data items, forms and reports without programming. It is intended as a platform that many organizations can adopt and modify avoiding the need to develop a system from scratch.

Design

OpenMRS is based on a "concept dictionary" that describes all the data items that can be stored in the system such as clinical findings, laboratory test results or socio-economic data. This approach avoids the need to modify the database structure to add new diseases for example, and facilitates sharing of data dictionaries between projects and sites. An important features of OpenMRS is its modular construction which allows the programming of new functions without modifying the core code. OpenMRS is web based but can be deployed on a single laptop or on a large server and runs on Linux, Windows or Mac OS X.

Other key features of OpenMRS:

• Built on the MySQL database (but uses Hibernate allowing it to be ported to other databases)
• programmed in Java
• Includes tools for data export and reporting
• Versions currently exist for HIV/AIDS, Drug resistant TB, primary care and oncology
• Supports open standards for medical data exchange including HL7, LOINC and IXF

New features:

• New open source form based tools, OpenXdata, and HTMLForm entry
• Tools to link to hand held devices and cell phones (JavaROSA project)
• Research data collection tools for clinical trials and community data collection projects
• A "logic service" that allows clinical alerts and reminders to be created in a medical standard Arden Syntax
• Support for report generation and transmission to national reporting systems like DHIS and TRACnet using the SDMX-HD standard

Currently being tested:

• Tools for data synchronization between systems connected by slow or unreliable internet
• User interface improvements
• Links to cell phone based data collection and messaging tools using SMS
• Touch screen patient registration systems supporting bar coded patient IDs, in collaboration with Baobab Health Systems

Deployments

The first deployment was in Eldoret, Kenya in February 2006^[4] followed by the PIH hospital in Rwinkwavu, Rwanda^[5] in August 2006 and Richmond Hospital in the KwaZulu-Natal province of South Africa later that year. As of March 2010, OpenMRS is in use in at least 23 developing countries (mostly in Africa) and it has been used to record over 1 million patient records around the world. Most deployments are run by independent groups who carry out the work on the ground with technical support and training provided by the core team of OpenMRS developers, and other implementers. There have been four annual OpenMRS meetings in South Africa, organized by Chris Seebregts, who also leads the OpenMRS implementers community. Shorter meetings were held in Boston in May 2009, and a developer training in Indianapolis in February 2010. There are five known deployments supporting clinical care in the US - three in Indianapolis, one in Los Angeles, and one in Maryland. OpenMRS use will be expanded in Haiti to assist with the patients recovering from the January 2010 earthquake.

Support

OpenMRS is supported by core teams from Partners In Health, Regenstrief Institute, and the South African Medical Research Council. Other organizations that collaborate on OpenMRS are the Millennium Villages Project, based at Columbia University, and Baobab Health Systems in Malawi. There are several groups of programmers working on OpenMRS in developing countries including Kenya, Rwanda, Uganda, South Africa, Pakistan, Chile, and India. In Rwanda, a training program for software developers to learn advanced Java skills and OpenMRS development, graduated 10 students in October 2009 after an intensive 11-month training program. Nine graduates are currently working on OpenMRS and related eHealth technologies.

Community

The OpenMRS community includes developers, implementers, and users from multiple countries who collaborate through mailing lists, IRC, and annual conferences.^[6] OpenMRS has participated in Google Summer of Code in 2007, 2008, 2009, and 2010; according to that program's manager, it receives more student applications than the Apache Software Foundation.

External links

• OpenMRS
• Regenstrief Institute
• Partners In Health
• Podcast/MP3 of an episode of the BBC radioprogramme Digital Planet. Described OpenMRS on 2008-06-23; 07m 02s - 14 m 23s.
• OpenMRS presentation for Google Tech Talks. August 23, 2007
• Lecture slides on OpenMRS from the May 2009 meeting, Boston, MA, USA

References

1. ^ Mamlin, BW; Biondich, PG; Wolfe, BA; Fraser, H; Jazayeri, D; Allen, C; Miranda, J; Tierney, WM (2006). "Cooking up an open source EMR for developing countries: OpenMRS - a recipe for successful collaboration". AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium: 529–33. PMC 1839638. PMID 17238397. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1839638. 
2. ^ Fraser, HS; Jazayeri, D; Nevil, P; Karacaoglu, Y; Farmer, PE; Lyon, E; Fawzi, MK; Leandre, F et al. (2004). "An information system and medical record to support HIV treatment in rural Haiti". BMJ (Clinical research ed.) 329 (7475): 1142–6. doi:10.1136/bmj.329.7475.1142. PMC 527691. PMID 15539669. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=527691. 
3. ^ Fraser, HS; Blaya, J; Choi, SS; Bonilla, C; Jazayeri, D (2006). "Evaluating the impact and costs of deploying an electronic medical record system to support TB treatment in Peru". AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium: 264–8. PMC 1839453. PMID 17238344. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1839453. 
4. ^ Mamlin, BW; Biondich, PG (2005). "AMPATH Medical Record System (AMRS): collaborating toward an EMR for developing countries". AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium: 490–4. PMC 1560633. PMID 16779088. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1560633. 
5. ^ Allen, C; Jazayeri, D; Miranda, J; Biondich, PG; Mamlin, BW; Wolfe, BA; Seebregts, C; Lesh, N et al. (2007). "Experience in implementing the OpenMRS medical record system to support HIV treatment in Rwanda". Studies in health technology and informatics 129 (Pt 1): 382–6. PMID 17911744. 
6. ^ Seebregts, CJ; Mamlin, BW; Biondich, PG; Fraser, HS; Wolfe, BA; Jazayeri, D; Allen, C; Miranda, J et al. (2009). "The OpenMRS Implementers Network". International journal of medical informatics 78 (11): 711–20. doi:10.1016/j.ijmedinf.2008.09.005. PMID 19157968.