countries: A nine-year history and its future

Transcription

1 Electronic medical records in developing Joaquin A. Blaya (on behalf of OpenMRS) Decision Systems Group, Brigham & Women s Hospital Partners In Health countries: A nine-year history and its future

2 Outline Multi-Drug Resistant Tuberculosis (MDR-TB) in Peru Palm project for health centers without Internet e-chasqui for health centers with Internet HIV in Haiti OpenMRS for the world Commercial strategies in Chile

3 Problem Statement Clinical data storage Infrastructure Transportation - Mototaxi

4 PIH-EMR in Peru Secure web-based EMR Operational since 2001 (Gates grant) Usable with low-speed dialup connections Bilingual (Spanish/English) 33,000 patients tracked patients treated for MDR-TB Used in the Philippines (Tropical Disease Foundation)

5 Clinical TB System: PIH-EMR Smears Cultures DSTs Biochem Hematology Registration form History/exam Previous Rx Previous Dx Contacts Follow up Chest X-ray Drug regimens Pharmacy

6 TeleMedMail Text Web-based teleradiology Internet Camara Server Specialist

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8 Prediction of Medication Consumption Predicted Peruvian 3-year drug usage to within 3% Annual cost of medications in 2003 was $2.7M PAS Ciprofloxin-eq Pyridoxine Moxifloxacin Kanamycin Ethionamide Cycloserine Clofazamine Clarithromycin Capreomycin Amox/Clav Predicted Usage Actual Usage number of doses

9 Palm project for community data collection

10 Community data collection (Palm) To monitor MDR-TB patients a team collects lab results from over 126 health centers to enter them into PIH-EMR Visit every health center Collect results every month Verify all results for correctness

11 System Development Lab PIH-EMR Processing Section Patient Sync (PC) Processing & Verification Palm Pilot JA Blaya, HSF Fraser AMIA Annu Symp 2006 Final Bacteriology Section

12 Randomized Controlled Trial Delay times Intervention Control Errors 7 6 Intervention districts before Control districts after Intervention districts after Pre-PDA Post-PDA (days) (days) 30.5* * 22.7 Percent Discrepancy * * * p < 0.001, p < Total Errors * p * < p = p = p < Reduced workload by over 60% (p<0.001)

13 e-chasqui to communicate lab results to clinicians

14 Problem Statement 10% of results took > 60 days to arrive at clinic* Possible loss of result Inability to track samples by clinical staff Current status History of tests performed 16% of patients waited >100 days to start treatment Limited reporting and analysis capability *Yagui et al. Int J Lung Dis 2006

15 Usage Statistics 99.2% of DSTS and 97.6% of culture results viewed online e-chasqui expanded from 12 to 212 HCs; from 2 to 4 labs Events per site per result users including clinicians, nurses, lab and research staff 0 Sep-05 Mar-06 Oct-06 Apr-07 Nov-07 Time Page views per result per site System serves health centers that cover 4.1 million people ~50% of all MDR-TB patients in Peru

16 Culture Conversion TAT Randomized Trial Results Intervention HCs had significantly lower times (p=0.04) Control HCs 86 days Interv. HCs 68 days 21% decrease (18 days) in intervention HCs

17 Communication Errors Randomized Trial Cultures DSTs Results 1. Intervention HCs had a 91% less errors overall 2. System did not affect number of wrong name or result errors

18 HIV in Haiti

19 Rwinkwavu Hospital

20 Internet in Thomonde, Haití Use low cost satellites for Internet with generators and solar panels

21 Developing a common system for the world OpenMRS

22 Toward a Common Infrastructure

23 Toward a Common Infrastructure

24 Toward a Common Infrastructure API

25 Toward a Common Infrastructure API

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27 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

28 OpenMRS Plataform to simplify the creation of clinical systems Customizable to local needs Modular and expandible Uses concept dictionary for data storage Released with open source license (April 2007) Uses international standards (HL7, LOINC, SNOMED) Web-based, but has asynchronous (offline) application Created by community of developers

29 OpenMRS Structure

30 Over 20 countries USA Rwanda (PIH) Lesotho (PIH) Peru (PIH) Kenya South Africa Tanzania Uganda Haiti Zimbabwe Pakistan Norway OpenMRS sites Fall 2008

31 Google Maps Integration Credit: Owais Ahmed, Aamir Khan

32 Integration of OpenMRS with ETR.Net and DHIS Credit: Chris Seebregts (MRC)

33 Mateme Touchscreen Registration Credit: Jeff Rafter (Baobab), Evan Waters (PIH)

34 Credit: Rowan Seymour iphone App

35 African Implementers Network

36 Commercial Strategies in Latin America Creating a network of implementers in Latin America Both NGOs and companies to provide services Nicaragua, Peru, Bolivia, Chile Latin American Open Source Health Informatics Meeting Oct Lima, Peru

37 Acknowledgements Partners In Health & EMR team, Hamish Fraser, Socios en Salud, Rapid Methods team, OpenMRS collaborators