AHRQ-Funded Research in Health Information Technology Impacts Care in Developing Countries

Partners in Health (PIH), a global health nonprofit organization that brings care to individuals in some of the poorest countries in the world, helped develop an open source electronic medical record (EMR) system known as OpenMRS, which was influenced by AHRQ-funded research on electronic order writing and computer reminders. OpenMRS is now impacting health care delivery in developing countries, as well as in the United States, Canada, and Europe.

PIH and the Regenstrief Institute in Indianapolis conceived of OpenMRS in 2005 as a flexible, open source EMR that would be capable of meeting the demand for high-quality health information in developing countries such as Rwanda and Kenya, where the two organizations were then working. The work was inspired by AHRQ-funded research by William Tierney, MD, and his colleagues at the Regenstrief Institute, which identified factors that are important to the design and successful implementation of EMR systems. PIH and Regenstrief used this research as a central contribution toward the development of OpenMRS. OpenMRS has since grown into a multi-institution, nonprofit software collaborative backed by a global software development community.

According to Evan Waters, Director of Medical Informatics at PIH, the organization has a long history of using OpenMRS in developing countries. In Rwanda, PIH has worked in three rural districts since 2005, operating in three hospitals and 37 health centers that care for 800,000 citizens. This system provides decision support for clinicians managing HIV care, based on the work of Tierney and others. PIH is working with the Rwandan government to support an ongoing rollout of OpenMRS, reaching over 200 health clinics in the country and registering more than 80,000 patients as of March 2013. The government EMR system supports HIV treatment, and PIH is also working to support primary care and management of chronic diseases, such as heart failure.

In Malawi, PIH partnered with Baobab Healthcare, a local nonprofit organization, to develop a point-of-care primary care EMR using the OpenMRS data model. The system runs on touch screens, and once a patient is registered, a simple bar code prints out that allows for efficient patient tracking and testing during visits. PIH's OpenMRS platform is also helping manage HIV patient care in 12 facilities in the country, and is performing similar functions in seven clinics in Lesotho.

In Lima, Peru, OpenMRS research data management tools are being used to track the spread of multidrug-resistant tuberculosis (MDR-TB). The tools were implemented in 2009 as part of a large National Institutes of Health study of MDR-TB transmission in Peru.

Waters adds that Haiti is PIH's longest operational site, with 12 existing hospitals. However, it was the last of the four main sites where PIH operates to begin using OpenMRS, as PIH had deployed an earlier EMR there to manage HIV patient care, prior to the creation of OpenMRS. In 2009, PIH started to implement OpenMRS in Haiti, beginning with the implementation of the MDR-TB system and extending to a pilot of a point-of-care primary care EMR at Lascahobas Hospital.

The organization is working to open a new 312-bed teaching hospital in the town of Mirebalais, Haiti, which will serve a primary catchment area of 185,000 people and a tertiary catchment area of over 3,000,000. PIH expects to scale up its current OpenMRS models for the hospital once it is fully operational.

PIH is also building a point-of-care system that will be integrated into workflows at the hospital. Waters says the new system will be an important evolution of PIH's prior work with OpenMRS, and should eventually be scaled to PIH's 12 sites in Haiti and the other countries where PIH operates. It will allow staff at the hospital to register every patient and capture cross-sectional information on important data points such as diagnoses and disposition. As the system matures, it will be expanded to support other program areas, such as women's health and surgery. This will provide a unique opportunity for real-time decision support, ranging from alerts for abnormal laboratory results and potentially risky drug orders to triaging emergency room patients based on vital signs and pain scores.

"The goal with the OpenMRS-based system at Mirebalais Hospital is to register every person who walks through the door, thereby improving data quality and making it efficient," says Waters.

For more information about Partners in Health or OpenMRS, visit www.pih.org or www.openmrs.org.

To read other impact case studies related to William Tierney's research on electronic order writing and computer reminders, visit http://www.ahrq.gov/research/findings/case-studies/health-it/hit2004.htm or http://www.ahrq.gov/research/findings/case-studies/health-it/hit2008b.htm.