Remerciez-le!

Remerciez @Admin pour avoir partagé cet document gratuitement, de la manière la plus simple, en partageant sur les réseaux sociaux.

OPENMRS Published : 2011-10-27 License : None 1 INTRODUCTION 1. OPENMRS AROUND

OPENMRS Published : 2011-10-27 License : None 1 INTRODUCTION 1. OPENMRS AROUND THE WORLD 2. A BRIEF HISTORY 3. EXAMPLE: AMANI CLINIC 2 1. OPENMRS AROUND THE WORLD OpenMRS clinical and research locations as of 2011. OpenMRS is an electronic medical record system (EMR), designed for use in the developing world and first established in 2004. Today, the system has evolved into a medical informatics platform used on every continent, supporting health care delivery and research in an extremely wide variety of contexts. Our world continues to be ravaged by pandemics of epic proportions, as untold millions of people are infected with diseases such as HIV/AIDS, multi-drug resistant tuberculosis, malaria, and many others. Many of these infections occur in developing countries, where lack of education and resources contribute to scores of preventable deaths. Prevention and treatment interventions on this scale require efficient information management, which is particularly critical as clinical care must increasingly be entrusted to less skilled providers. Whether for lack of time, lack of money, or no access to software developers, most health care programs in developing countries manage their information with simple spreadsheets or small, poorly designed databases--if they have any electronic infrastructure at all. Most health care records in the developing world are still maintained on paper. As a response to these challenges in developing countries, OpenMRS was created as a medical record platform--a rising tide which we hope will lift all ships. It is designed to offer a better tool for information management, but also to reduce unnecessary, duplicate efforts. In the years since its inception, the OpenMRS community has grown from a handful of organizations to a massive collaborative effort by both groups and individuals, all focused on creating medical record systems and a corresponding implementation network that allows self-reliance in system development, even in resource-constrained environments. Since its beginning, OpenMRS has been based on the principles of openness and of sharing 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 the need to write complicated application code. It is intended as a platform that organizations can adopt and modify, avoiding the need to develop a system from scratch. And indeed, organizations around the world are doing just that. OpenMRS is now in use in clinics in Argentina, Botswana, Cambodia, Congo, Ethiopia, Gabon, Ghana, Haiti, Honduras, India, Indonesia, Kenya, Lesotho, Malawi, Malaysia, Mali, Mozambique, Nepal, Nicaragua, Nigeria, Pakistan, Peru, Philippines, Rwanda, Senegal, South Africa, Sri Lanka, Tanzania, The Gambia, Uganda, United States, Zanzibar, Zimbabwe, and many other places. This work is supported by many individuals and organizations, including international and government aid groups, NGOs, and for-profit and non-profit corporations. 3 OpenMRS is not only in use in many different places, but it is also being used to meet many different needs. In Kenya, it is used to support health care delivery for hundreds of thousands of patients at a network of over 50 clinics--some connected by typical networks, but many where the connection requires offline synchronization to external storage that can be physically transported between sites! Another NGO uses a central OpenMRS server connected to clinics in multiple countries via satellite Internet connections. In Malawi, creative individuals with a talent for technology have created a mobile cart running OpenMRS that physicians roll around their clinic, interacting with the system using a touchscreen. In Rwanda, the national ministry of health has worked to roll out a connected national health care system using OpenMRS. In the United States, OpenMRS is used to track patients at large sporting events, for mobile providers of health care to homeless people, and as a personal health record that allows cancer patients to share treatment and home health care information with caregivers and family members. OpenMRS in use at TRAC Plus Clinic in Kigali, Rwanda. In the last several years, use of mobile technology has increased dramatically, particularly in the developing world. In some developing countries, there are more mobile phones than people! Facilitated by other open source projects, OpenMRS can be integrated with SMS messaging, allowing community health workers to add information about adherence to medication regimens to a patient's record, as they make rounds through villages in rural Africa. Elsewhere, mobile phone applications are used to guide these community volunteers in home-based HIV testing and counseling, enrolling prospective patients from the comfort of their own homes. Besides clinical care, the platform can also be used in research settings. In the United States, OpenMRS has been used both in training medical informatics students, as well as in conducting various research projects in the fields of public health. In Peru OpenMRS is used as the research database for a large study of drug resistant tuberculosis funded by the US National Institutes of Health. Because the system has been designed as an extensible platform, it is very easy for researchers to adapt OpenMRS to do what they need. 4 2. A BRIEF HISTORY One of OpenMRS's birthplaces--Moi University Teaching and Referral Hospital, Eldoret, Kenya (2004) Throughout the 1990s, an academic partnership flourished between Indiana University School of Medicine in the United States and Moi University in Eldoret, Kenya, providing Kenyan medical students with access to health care training. This program continued to grow for several years until a severe outbreak of HIV/AIDS in Western Kenya caused the program to rethink its goals, at which point the Academic Model for Prevention and Treatment of HIV/AIDS (AMPATH) was created. The number of patients in Kenya continued to grow, and basic IT systems including Microsoft Access were used to monitor patient care. In February 2004, the amount of data had become too large for AMPATH's existing systems, so their medical director invited Burke Mamlin, from the Regenstrief Institute in Indianapolis, United States, to visit the site and evaluate how improvements in medical informatics technology could improve AMPATH's data management. Regenstrief had long been recognized as a leader in medical informatics research, and Burke brought his colleague Paul Biondich along with him on the visit to Kenya. It quickly became apparent that a new system was needed. Paul and Burke began to design the data model for a new medical record system for AMPATH, which would go on to become OpenMRS. At the same time, a Boston-based non-profit named Partners In Health (PIH) was pioneering the use of web-based EMRs in developing countries. They had built the PIH-EMR, which they were using to support the treatment of multi-drug resistent tuberculosis in Peru, and HIV in Haiti. But Hamish Fraser, PIH's director of the EMR project, was worried: PIH was about to expand into Rwanda, Lesotho, and Malawi, and he feared it would be difficult to maintain their home-built system in 5 countries. In September 2004, Paul and Burke met Hamish at the World Congress on Medical and Health Informatics (MedInfo) conference in San Francisco. It became apparent that the three shared similar goals and needs, so they agreed to work collaboratively to develop a system that would be suitable for the various needs of humanitarian work in African nations and beyond. 5 Paul and Burke hired developer Ben Wolfe to begin work on programming an early prototype of OpenMRS, based on their previous work at AMPATH and Regenstrief. Several months later, PIH's lead developer Darius Jazayeri joined the project, merging PIH-EMR's functionality into the new system. The previous systems at AMPATH focused on data entry, while at PIH, the focus was more on clinical workflow. The new system combined features of both the AMPATH and PIH systems. Because of the strong cooperation between PIH and Regenstrief and the long distances involved, it became clear that an open source software model of development was the best way to sustain and grow the platform, and the OpenMRS project was born. While the collaboration between Regenstrief and PIH continued and the new system was being designed, the groups were looking for additional support in Africa. They turned to their colleague Chris Seebregts, from the South African Medical Research Council (MRC). Chris was already heavily involved in the field of medical informatics throughout sub-Saharan Africa, and brought with him a wealth of knowledge about the needs of informatics implementations. Seebregts had been adapting OpenMRS for use in South Africa and started to build up a community of implementers of the software around the world. His work led to massive growth of the OpenMRS community (now nearly 2,000 strong as of late 2011). In February 2006, AMPATH launched OpenMRS in Kenya, and PIH brought it to Rwinkwavu, Rwanda, in August of the same year. The South African MRC first switched on the system at Richmond Hospital in KwaZulu-Natal at the end of 2006. As both the OpenMRS application and open source community grew, they gathered the attention of many other large projects and agencies. Some of these have extended both financial and consulting support over the past several years, including: The United States Center for Disease uploads/Sante/ openmrs-guide.pdf