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Electronic Health record

By Edmond Moses | 11 Mar, 2017

Discuss options in Electronic Health Record implementation for resource-limited settings.
We are developing an e-Health consultation service in rural Central Asia, and would like to know the best EHR to employ, particularly with reference to simplicity, low-cost (or no-cost), and using biometric sign-in data.

Replies

 

A/Prof. Terry HANNAN Moderator Replied at 3:21 PM, 11 Mar 2017

Edmond, I don't know if you were able to access the resource I referred to but if you give me your email address () I can send you the documents directly or via DropBox. Terry
1. AMPATH link: http://www.ampathkenya.org/our-programs/education-partnerships/consortium-mem...
2. The History of OpenMRS 2012: http://youtu.be/1krGBK39G-M
3. Andy Kanter MVP (short) http://www.youtube.com/watch?v=SgvqskZZ5-Y
4. IRDResearch Data visualization using Google Earth: http://www.youtube.com/watch?v=v-3lqG3hSYM

Steven Wanyee Macharia Replied at 4:51 AM, 12 Mar 2017

Edmond:

I would be happy to share my experiences implementing KenyaEMR in Kenya and currently Bahmni in Kenya and Tanzania at scale (national level). Both systems are based on OpenMRS. I imagine the implementation environments are very similar to rural Central Asia and therefore you might find it relevant and useful.
Let me know if you would be interested in that information. Email me on

Thanks.

A/Prof. Terry HANNAN Moderator Replied at 5:12 AM, 12 Mar 2017

Steven, thanks for this wonderful support. A strong feature of GHDonline and OpenMRS collaborations. terry

Pablo Pazos Replied at 10:14 AM, 12 Mar 2017

Hi Edmond,

When you talk about no cost you mean the software license, right?

Any software has adaptation and implementation costs associated, and even if the software is free, that cost might be high. As someone said: there are no free lunches.

Kind regards,
Pablo.
http://cloudehrserver.com

Steven Wanyee Macharia Replied at 3:43 AM, 13 Mar 2017

Thanks Terry, totally agree with you about the very special nature of GHDOnline, OpenMRS and definitely also OpenHIE!

Paul Amendola Replied at 7:00 PM, 13 Mar 2017

Hi Edmond,

VecnaCares deploys a CliniPAK, a portable server with wifi connectivity, optimized for low-resource settings that might be useful to consider as well. In addition to VecnaCares EMR software, OpenMRS or other software could be installed for use with no connectivity or infrastructure needed.

Please reach out with any questions,
Paul
www.vecnacares.org

Naomi Muinga Moderator Replied at 1:57 AM, 17 Mar 2017

Are you looking to implement in an entire facility or to manage a specific clinic within a facility?

Teja chandra Gudivada Replied at 9:19 AM, 17 Mar 2017

Hi,
I am dr.g.teja chandra have a 20 bed clinic in india located in a small town with most of my patients coming from rural areas, is it possible for me to use this software in my hospital
Thanking you

teja

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Teja chandra Gudivada Replied at 12:13 AM, 18 Mar 2017

Hi,
My wife and me are the only doctors in the clinic, though being a gen.surgeon my practise is more like family medicine with occasional surgeries and my wife only practises diabetes management, I don’t have an ICU I refer them to speciality hospitals. Most of my practise will be outpatient basis with few admissions.
Thanking you
teja

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Steven Wanyee Macharia Replied at 2:11 AM, 18 Mar 2017

Dr. G. Teja, please check out OpenMRS, www.openmrs.org and www.bahmni.org. Both are very good options for whet you are looking for to support your health facility. If you need direct introductions to people near you who can help and guide you, please let me know and I'll
introduce you to them.

Thanks.

Teja chandra Gudivada Replied at 3:30 AM, 19 Mar 2017

Hi,
Thanks steven wanyee went through both the sites bahmni seems to more suitable for me can u send me the contact details of anyone that can help me in install this in my hospital.

Steven Wanyee Macharia Replied at 11:29 PM, 19 Mar 2017

Dr. G. Teja,

Glad you found Bahmni promising, and great thing is that Bahmni is built on top of OpenMRS. Please email me on and I'll introduce you to the folks at ThoughtWorks who built the system right away.

Thanks.

A/Prof. Terry HANNAN Moderator Replied at 11:36 PM, 19 Mar 2017

Steven, you reflect the inherent gift for 'sharing' on GHDonline and the OpenMRS project. I suspect Teja has found this very reassuring and stimulating.

Teja chandra Gudivada Replied at 11:25 AM, 20 Mar 2017

Hi,
I messaged the team about my requiremets will contact you if they don’t reply to me

David Cawthorpe Replied at 11:43 AM, 20 Mar 2017

This e-record works anywhere you can use an iPad and can measure any intervention for any disease, etc. it is a full ehr and can be used to compare treatments. iPads have automatic biometric sign in and the date it is locally secure, low cost and can be sent electronically to central storage.

Go to Internationalgme.org
Click on TRACT

Teja chandra Gudivada Replied at 7:29 AM, 21 Mar 2017

Sir where is the link of the app u r talking about
Teja

Steven Wanyee Macharia Replied at 12:08 PM, 21 Mar 2017

Sounds good, and if you need to hear about real implementation experience with these systems, many people here, including me, will be happy to share our experiences.

Teja chandra Gudivada Replied at 12:26 AM, 22 Mar 2017

Hi,
I need some information as a rural practitioner and with illiterate patients, how do I implement biometric login at the time of registration and I want some note taking option using stylus, these things are very important to me and bahmni does not have these two, they are in the process of development I think, any other way of introducing these into my clinic

Donald Catanzaro Replied at 1:21 AM, 6 Apr 2017

Hi Teja,

I was curious - do you want/need biometric login for the clinician to securing use the system or for patient identification?

Teja chandra Gudivada Replied at 2:56 AM, 6 Apr 2017

Hi
I need biometric login for patient not for me, as my patients are rural and illiterate they will not bring the file or can they remember the id or will say correct name (spelling) in their next visit.
Thank you
Teja

Donald Catanzaro Replied at 9:18 PM, 6 Apr 2017

Hi Teja,

Specific to India, are you familiar with Aadhar and/or Unique Identification Authority of India (UIDAI) ?

See https://uidai.gov.in/ and/or https://en.wikipedia.org/wiki/Aadhaar. There was a biometric component added to the system for instance see this fascinating article from 2011: https://www.wired.com/2011/08/ff_indiaid/.

According to their website there is an approval and devices have been certified (see https://authportal.uidai.gov.in/web/uidai/developer).

Once you decided on a device/vendor the data it captures would of course have to interface with whatever system you already use but that is very "doable"!

Teja chandra Gudivada Replied at 11:40 PM, 6 Apr 2017

Hi Donald catanzaro
I know about Aadhar but I need a emr or ehr software that can integrate with Aadhar and I don't have technical information regarding that. There are private vendors with those facility but costly to implement so looking for something cheaper
Thank you
Teja

Gordon Cressman Replied at 7:52 AM, 7 Apr 2017

Hi Teja:

My team has implemented and tested fingerprint registration for patient identification with our own Coconut-based mobile app. We have not tried to integrate this into OpenMRS. See this discussion for what is likely to be the state of the art for OpenMRS:

https://talk.openmrs.org/t/fingerprints-in-openmrs/6783/17

There are contacts in that thread who may be able to help. They may have made progress since last June. Implementing this in a reusable way for OpenMRS, and demonstrating resuse, would be a great contribution to this field.

-gmc

Donald Catanzaro Replied at 9:22 PM, 10 Apr 2017

Hi Teja,

I looks as if the technology is there to help you (e.g. software and hardware) but what you lack is the technical skillset to install, maintain, deploy the system *and* you lack the financial wherewithal to pay a vendor to do that for you.

I would suggest contacting a local university and/or vocational school to see if they can partner with you to get the system up an running. Failing that, your option(s) appear to learn how to install/run the EMR yourself or just paying someone else to do it for you.

I wish I could be more helpful!

Teja chandra Gudivada Replied at 4:16 AM, 11 Apr 2017

Hi
Yeah I lack the skill in implementing the EMR system, but thanks to steve wanyee I am in discussion with bahmini group regarding implementation

Georgee Mathew Replied at 6:00 AM, 11 Apr 2017

Dr Teja,

We are a group of social entrepreneurs providing affordable software
solutions to rural charity hospitals. Please find the attached brochure of
ours. We will be glad to help you.

NOWSHAD ALAM Replied at 7:28 AM, 11 Apr 2017

Get Outlook for Android<https://aka.ms/ghei36>

Robert Dent Replied at 7:10 AM, 20 Apr 2017

Hi there,
We are also just getting started with Bahmni and wondered if anyone knew of Bahmni being used anywhere in the Middle East. If so, please let me know...
Rob

Robert Dent Replied at 2:43 AM, 25 Apr 2017

Hi there,
We are also just getting started with Bahmni and wondered if anyone knew of Bahmni being used anywhere in the Middle East. If so, please let me know...
Rob

Joaquin Blaya, PhD Moderator Replied at 6:22 PM, 1 May 2017

I don't know if there are implementations but there have been a couple of
organizations that have contacted ThoughtWorks about working in the Middle
East. If you'd like I could send you their information, please email me at
jblaya [ at ] thoughtworks [ dot ] com


Joaquín

Abdullah Al Parvez Replied at 2:25 PM, 2 May 2017

Great archive of information regarding emr experiences. Open mrs is very good software as well stable. In real life scenario there is always need of some customization according to local need. I had few experience of implementing emr in different scenario. It was always challenging (interms of matching existing workflow, data automation, workforce training) and as well become stressfull when low resource factor added.

By the way, as a hobby i learned filemaker platform to develop database. Personally i developed a simple emr for my practice and using it for last 1 year and happy with it ( though building different features at regular interval). I will be glad , if i can help any with my little experience. Thanks.

Anna E. Schmaus Replied at 8:20 PM, 2 May 2017

Dear all,
I am in Mongolia planning a health project for disadvantaged people.
Part of the project will be data collection, EMR, EHR, mobile data collection etc.

Now I am a little confused. The topic of this blog is "Electronic Health Record", but you are mainly discussing about EMR.
What is the original need exactly?

If anybody needs EHR, they could get in contact with me as we are developing one for LMICs.

Anna

ABU FARUQUE Replied at 12:26 AM, 3 May 2017

Dear Anna:
I need EHR and other documents to update me on EHR.
We will go for data collection using electronic devices.
Looking forward to hearing from you.

Teja chandra Gudivada Replied at 2:29 AM, 3 May 2017

Hi Abdullah,
I am dr.teja from india practising in a small town, I am planning to implement emr at my hospital and don’t have any knowledge of installing at my hospital or have any IT guy to do it for me, I tried openmrs and bahmini though they are free the implementation guys are charging heavily.
Can u tell me more about you emr and how did you implement at your clinic or hospital
Thank you
teja

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Dhafer Ben Amor Replied at 3:20 AM, 5 May 2017

Hello,

If you need something more sophisticated than OpenMRS, you can use www.hippocrate.org

It provides an All-in-One Cloud software from the EMR (HIPAA compliant for High Security, and Meaningful Use complaint) and it comes with telemedicine helping Dr. to make online consultation with online payment, SMS reminder and lot of more features.

www.hippocrate.org is largely used by MD, in more than 122 countries (like the US, Canada, UK, Japan, France, Germany and South Korea) and in 6 continents.

There is no hidden costs like for OpenMRS, no server to buy, no upgrades to pay. The only thing that MD have to do to use HIPPOCRATE.org is to offer 1 free consultation per year to poor people.

Joaquin Blaya, PhD Moderator Replied at 5:01 PM, 8 May 2017

Hi Dhafer,
hippocrate.org looks interesting and it's impressive that you have users in
that many countries. Very exciting.

I do want to correct your comment about the "hidden costs" of OpenMRS.
Hidden costs usually refers to costs that an organization is not up front
about and as such is seen as a negative way (though perhaps legal) to get
more money from users/customers. OpenMRS is an open source, community
driven software, so yes, you have to pay for hosting or a server and the
staff to implement the system within your organization, but where you host
it or buy the server and who you choose to implement whether your own staff
or another organization is completely up to the organization who chooses
OpenMRS and none of those costs are hidden. In fact, if you go unto the
OpenMRS community forum (http://talk.openmrs.org) they will be the first to
tell you the things you need to do/buy.

Anna E. Schmaus Replied at 6:16 AM, 27 May 2017

to ABU FARUQUE
Can you please contact me at regarding the EHR you were asking for.

KAPESH KUNWAR Replied at 6:48 AM, 27 May 2017

Hi everyone! EHR is good thing to record the informations about the patients. I experienced it in USA during my observership. I believe it helps to coordinate between different hospitals and the informations can be saved for a long time. It really is useful in Asia and Nepal .

A/Prof. Terry HANNAN Moderator Replied at 7:29 AM, 27 May 2017

Kapesh, you may be discussing something different with your words (e.g. an EHR project) however we have come to a phase in our eHealth evolution to understand that and EHR is more than a "good thing to record the informations about the patients".
We have systems stuck in the EHR concept that 'basically reproduces the paper record in an electronic system" which has often led to failure.
We now see the "EHR concept" as a complex 'clinical information management tool that supports not only clinical decision making but all functional aspects of health care including research, administration, epidemiology, etc." In fact the systems are now evolving into the recently defined concepts within a Learning Health System.
I hope this helps.
Your input is why many of us see GHDonline as a fantastic learning and sharing forum.
Terry
1. Toward an Information Infrastructure for Global Health Improvement
C. P. Friedman1, J. C. Rubin1, K. J. Sullivan2
Year book of Med Inform 2017: http://dx.doi.org/10.15265/IY-2017-004
Published online May 8, 2017
12. The Agency for Healthcare Research and Quality and the Development
of a Learning Health Care System AndrewB. Bindman, JAMA Internal Medicine Published online May 25, 2017

Philip Craig Replied at 9:54 PM, 27 May 2017

Dear Terry,

GHDonline is truly a wonderfully​informative site. Thank you for your timely contribution on the development of the Learning Health System.
As I move towards assisting a developing country in the basic management of their EMR this concept of a Learning Health System is both timely and profound to say the least. I am devouring your cited article and following that theme. Just a note to say a deep thank you.

Phil

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