One of the real challenges I see in the development of EMR systems around the world is the constant "re-invention of the wheel". Every project that creates a medical information system such as an EMR has to build all the basic tools before they get on to creating the parts
that are different and specific for a particular project. These tools include management of patient IDs and a master patient list, management of logins and role based authentication, systems to audit changes in the data, and tools for data management and reporting.
Developers can handle this in a couple of ways. They can skip these systems and then try to deal with the problems when the system has to scale, or they can invest a lot of time doing this work up front. An additional problem is that these functions require considerable expertise to build effectively.
What is the alternative? At present you can buy a system from a company which may have built all these basis tools, but then you must rely on the company to do all the work, a process which is time consuming and typically expensive. In a few cases an EMR system may be open source such as VistA. Then you can hire programmers and modify the system (though it will take a while to get up to speed with a large system).
There is an alternative approach which is complementary to open source and in some cases offers an alternative. In a recent paper in the New England Journal of Medicine Isaac Kohane and Kenneth Mandl describe the principle of an EMR platform. Taking the analogy of the Iphone or Facebook, this system would allow developer to add functionality to an existing EMR system in a modular fashion without having to change the core code. This would allow flexibility and rapid innovation, and is fundamentally different from having hundreds of companies all competing with different EMRs, as we currently have in the US. A well established platform should allow many different functions to be mixed and matched on top of the basic system. At present the best functions of each of these different EMRs are separated from the best functions of the others. Imagine if you could simply download modules for certain diseases, modules to link to specific lab or pharmacy systems and tools for visualizing data for particular purposes. Some would be open source, others proprietary but in addition you could commission or build your own.
This is the approach we are taking with the OpenMRS EMR system (www.openmrs.org) which is not only open source but provides a modular architecture. There are now 35 modules in the respository on the OpenMRS site some of which are widely shared across sites others just built for local use. There are 96 in total in various stages of completion. We are hoping that other projects with important functionality in their EMR systems will consider building a module in OpenMRS that can be widely shared.
Are there other systems out there like this is use in developing countries? Any thoughts on how might this strategy be used for other systems?
Link leads to: http://nejm.highwire.org/cgi/content/full/360/13/1278
Summary: In this Perspective piece in the New England Journal of Medicine, the authors describe the principle of an EMR platform that would support interoperable and substitutable modules.
"The economic stimulus package signed by President Barack Obama on February 17 included a $19 billion investment in health information technology. How can we best take advantage of this unprecedented opportunity to computerize health care and stimulate the health information economy while also stimulating the U.S. economy? A health care system adapting to the effects of an aging population, growing expenditures, and a diminishing primary care workforce needs the support of a flexible information infrastructure that facilitates innovation in wellness, health care, and public health.
Flexibility is critical, since the system will have to function under new policies and in the service of new health care delivery mechanisms, and it will need to incorporate emerging information technologies on an ongoing basis. As we seek to design a system that will constantly evolve and encourage innovation, we can glean lessons from large-scale information-technology successes in other fields. An essential first lesson is that ideally, system components should be not only interoperable but also substitutable..."
Read the entire article by clicking the link above.
Join GHDonline Members discussing this issue here: http://www.ghdonline.org/tech/discussion/the-potential-of-modular-design-for-...
Source: New England Journal of Medicine - NEJM
Publication Date: March 26, 2009
Keywords: EMR modules, EMR platform, Pharmacy Information System, Software