%0 Journal Article %J CMAJ %D 2019 %T A national electronic health record for primary care. %A Persaud, Nav %K Canada %K Delivery of Health Care %K electronic health records %K Health Policy %K Primary Health Care %B CMAJ %V 191 %P E28-E29 %8 2019 01 14 %G eng %N 2 %R 10.1503/cmaj.181647 %0 Journal Article %J BMC Med Inform Decis Mak %D 2018 %T Designing mHealth for maternity services in primary health facilities in a low-income setting - lessons from a partially successful implementation. %A Shiferaw, Solomon %A Workneh, Andualem %A Yirgu, Robel %A Dinant, Geert-Jan %A Spigt, Mark %K Cell Phone %K Delivery of Health Care %K electronic health records %K Ethiopia %K Female %K Health Facilities %K Humans %K Maternal Health Services %K Mobile Applications %K Poverty %K Pregnancy %K Telemedicine %X

BACKGROUND: Increasing mobile phone ownership, functionality and access to mobile-broad band internet services has triggered growing interest to harness the potential of mobile phone technology to improve health services in low-income settings. The present project aimed at designing an mHealth system that assists midlevel health workers to provide better maternal health care services by automating the data collection and decision-making process. This paper describes the development process and technical aspects of the system considered critical for possible replication. It also highlights key lessons learned and challenges during implementation.

METHODS: The mHealth system had front-end and back-end components. The front-end component was implemented as a mobile based application while the back-end component was implemented as a web-based application that ran on a central server for data aggregation and report generation. The current mHealth system had four applications; namely, data collection/reporting, electronic health records, decision support, and provider education along the continuum of care including antenatal, delivery and postnatal care. The system was pilot-tested and deployed in selected health centers of North Shewa Zone, Amhara region, Ethiopia.

RESULTS: The system was used in 5 health centers since Jan 2014 and later expanded to additional 10 health centers in June 2016 with a total of 5927 electronic forms submitted to the back-end system. The submissions through the mHealth system were slightly lower compared to the actual number of clients who visited those facilities as verified by record reviews. Regarding timeliness, only 11% of the electronic forms were submitted on the day of the client visit, while an additional 17% of the forms were submitted within 10 days of clients' visit. On average forms were submitted 39 days after the day of clients visit with a range of 0 to 150 days.

CONCLUSIONS: In conclusion, the study illustrated that an effective mHealth intervention can be developed using an open source platform and local resources. The system impacted key health outcomes and contributed to timely and complete data submission. Lessons learned through the process including success factors and challenges are discussed.

%B BMC Med Inform Decis Mak %V 18 %P 96 %8 2018 11 12 %G eng %N 1 %R 10.1186/s12911-018-0704-9 %0 Journal Article %J Appl Clin Inform %D 2017 %T Leveraging the Value of Human Relationships to Improve Health Outcomes. Lessons learned from the OpenMRS Electronic Health Record System. %A Kasthurirathne, Suranga N %A Mamlin, Burke W %A Cullen, Theresa %K Data Collection %K Delivery of Health Care %K electronic health records %K Humans %K Interpersonal Relations %X

OBJECTIVES: Despite significant awareness on the value of leveraging patient relationships across the healthcare continuum, there is no research on the potential of using Electronic Health Record (EHR) systems to store structured patient relationship data, or its impact on enabling better healthcare. We sought to identify which EHR systems supported effective patient relationship data collection, and for systems that do, what types of relationship data is collected, how this data is used, and the perceived value of doing so.

MATERIALS AND METHODS: We performed a literature search to identify EHR systems that supported patient relationship data collection. Based on our results, we defined attributes of an effective patient relationship model. The Open Medical Record System (OpenMRS), an open source medical record platform for underserved settings met our eligibility criteria for effective patient relationship collection. We performed a survey to understand how the OpenMRS patient relationship model was used, and how it brought value to implementers.

RESULTS: The OpenMRS patient relationship model has won widespread adoption across many implementations and is perceived to be valuable in enabling better health care delivery. Patient relationship information is widely used for community health programs and enabling chronic care. Additionally, many OpenMRS implementers were using this feature to collect custom relationship types for implementation specific needs.

CONCLUSIONS: We believe that flexible patient relationship data collection is critical for better healthcare, and can inform community care and chronic care initiatives across the world. Additionally, patient relationship data could also be leveraged for many other initiatives such as patient centric care and in the field of precision medicine.

%B Appl Clin Inform %V 8 %P 108-121 %8 2017 Feb 01 %G eng %N 1 %R 10.4338/ACI-2016-08-RA-0139 %0 Journal Article %J Glob Health Sci Pract %D 2017 %T A Mobile-Based Community Health Management Information System for Community Health Workers and Their Supervisors in 2 Districts of Zambia. %A Biemba, Godfrey %A Chiluba, Boniface %A Yeboah-Antwi, Kojo %A Silavwe, Vichaels %A Lunze, Karsten %A Mwale, Rodgers K %A Russpatrick, Scott %A Hamer, Davidson H %K Community Health Services %K Community Health Workers %K Delivery of Health Care %K Health information systems %K Humans %K Mobile Applications %K Referral and Consultation %K Zambia %X

INTRODUCTION: Effective community health management information systems (C-HMIS) are important in low-resource countries that rely heavily on community-based health care providers. Zambia currently lacks a functioning C-HMIS to provide real-time, community-based health information from community health workers (CHWs) to health center staff and higher levels of the health system.

PROGRAM DESCRIPTION: We developed a C-HMIS mobile platform for use by CHWs providing integrated community case management (iCCM) services and their supervisors to address challenges of frequent stock-outs and inadequate supportive supervision of iCCM-trained CHWs. The platform used simple feature mobile phones on which were loaded the District Health Information System version 2 (DHIS2) software and Java 2 platform micro edition (J2ME) aggregation and tracker applications. This project was implemented in Chipata and Chadiza districts, which supported previous mHealth programs and had cellular coverage from all 3 major network carriers in Zambia. A total of 40 CHWs and 20 CHW supervisors received mobile phones with data bundles and training in the mobile application, after which they implemented the program over a period of 5.5 months, from February to mid-July 2016. CHWs used the mobile phones to submit data on iCCM cases seen, managed, and referred, as well as iCCM medical and diagnostic supplies received and dispensed. Using their mobile phones, the supervisors tracked CHWs' reported cases with medicine consumption, sent CHWs feedback on their referrals, and received SMS reminders to set up mentorship sessions.

OBSERVATIONS: CHWs were able to use the mobile application to send weekly reports to health center supervisors on disease caseloads and medical commodities consumed, to make drug and supply requisitions, and to send pre-referral notices to health centers. Health center staff used the mobile system to provide feedback to CHWs on the case outcomes of referred patients and to receive automated monthly SMS reminders to invite CHWs to the facility for mentorship. District- and central-level staff were able to access community-level health data in real time using passwords.

LESSONS LEARNED: C-HMIS, using simple feature phones, was feasible and viable for the provision of real-time community-based health information to all levels of the health care system in Zambia, but smartphones, laptops, or desktop computers are needed to perform data analysis and visualization. Ongoing technical support is needed to address the hardware and software challenges CHWs face in their day-to-day interaction with the application on their mobile phones.

%B Glob Health Sci Pract %V 5 %P 486-494 %8 2017 09 27 %G eng %N 3 %R 10.9745/GHSP-D-16-00275 %0 Journal Article %J Stud Health Technol Inform %D 2010 %T Combining vital events registration, verbal autopsy and electronic medical records in rural Ghana for improved health services delivery. %A Ohemeng-Dapaah, Seth %A Pronyk, Paul %A Akosa, Eric %A Nemser, Bennett %A Kanter, Andrew S %K Cause of Death %K Database Management Systems %K Delivery of Health Care %K electronic health records %K Ghana %K Medical Record Linkage %K Quality Assurance, Health Care %K Quality Improvement %K Registries %K Rural Health Services %K Vital Statistics %X

This paper describes the process of implementing a low-cost 'real-time' vital registration and verbal autopsy system integrated within an electronic medical record within the Millennium Village cluster in rural Ghana. Using MGV-Net, an open source health information architecture built around the OpenMRS platform, a total of 2378 births were registered between January 2007 and June 2009. The percentage of births registered in the health facility under supervision of a skilled attendant increased substantially over the course of the project from median of 35% in 2007 to 64% in 2008 and 85% midway through 2009. Building additional clinics to reduce distance to facility and using the CHEWs to refer women for delivery in the clinics are possible explanations for the success in the vital registration. The integration of vital registration and verbal autopsies with the MGV-Net information system makes it possible for rapid assessment of effectiveness and provides important feedback to local providers and the Millennium Villages Project.

%B Stud Health Technol Inform %V 160 %P 416-20 %8 2010 %G eng %N Pt 1 %0 Journal Article %J Stud Health Technol Inform %D 2010 %T Experience implementing OpenMRS to support maternal and reproductive health in Northern Nigeria. %A Thompson, Adam %A Castle, Evelyn %A Lubeck, Paul %A Makarfi, Provost Shehu %K Delivery of Health Care %K electronic health records %K Maternal Health Services %K Maternal Welfare %K Models, Organizational %K Needs Assessment %K Nigeria %K Reproductive Medicine %K Utilization Review %X

In Northern Nigeria a deteriorating health system has resulted in one of the World's highest rates of maternal and infant deaths. The dire situation in Northern Nigeria is only amplified by the lack of an effective health information system, leaving hospitals and clinics to make decisions about patient care with only uninformed guesses about medical history and access to unreliable and unintelligible patient registers and summary reports. In 2009 we implemented an electronic medical records system using OpenMRS for the Family Health Unit of the Shehu Idris College. The three-month process resulted in electronic forms for all clinical areas, greatly reduced data duplication and a monthly reporting process that takes minutes instead of days. This system provides not only access to the first patient-based health indicators in Nigeria (as opposed to previously error-prone aggregate data) but is also an example of the potential to overcome the harsh computing environment in Nigeria to implement eHealth systems that will improve the quality of patient care.

%B Stud Health Technol Inform %V 160 %P 332-6 %8 2010 %G eng %N Pt 1 %0 Journal Article %J Stud Health Technol Inform %D 2010 %T Implementing OpenMRS for patient monitoring in an HIV/AIDS care and treatment program in rural Mozambique. %A Manders, Eric-Jan %A José, Eurico %A Solis, Manuel %A Burlison, Janeen %A Nhampossa, José Leopoldo %A Moon, Troy %K Database Management Systems %K Delivery of Health Care %K electronic health records %K HIV Infections %K Information Storage and Retrieval %K Medical Record Linkage %K Mozambique %K Population Surveillance %K Rural Health Services %X

We have adopted the Open Medical Record System (OpenMRS) framework to implement an electronic patient monitoring system for an HIV care and treatment program in Mozambique. The program provides technical assistance to the Ministry of Health supporting the scale up of integrated HIV care and support services in health facilities in rural resource limited settings. The implementation is in use for adult and pediatric programs, with ongoing roll-out to cover all supported sites. We describe early experiences in adapting the system to the program needs, addressing infrastructure challenges, creating a regional support team, training data entry staff, migrating a legacy database, deployment, and current use. We find that OpenMRS offers excellent prospects for in-country development of health information systems, even in severely resource limited settings. However, it also requires considerable organizational infrastructure investment and technical capacity building to ensure continued local support.

%B Stud Health Technol Inform %V 160 %P 411-5 %8 2010 %G eng %N Pt 1 %0 Journal Article %J Journal of medical systems %D 2009 %T Barriers to open source software adoption in Quebec's health care organizations. %A Paré, Guy %A Wybo, Michael D %A Delannoy, Charles %K Attitude of Health Personnel %K Delivery of Health Care %K Health Facility Administrators %K Health Policy %K Humans %K Medical Informatics %K Organizational Innovation %K Quebec %K Software %K Systems Integration %K Technology Transfer %X We conducted in-depth interviews with 15 CIOs to identify the principal impediments to adoption of open source software in the Quebec health sector. We found that key factors for not adopting an open source solution were closely linked to the orientations of ministry level policy makers and a seeming lack of information on the part of operational level IT managers concerning commercially oriented open source providers. We use the case of recent changes in the structure of Quebec's health care organizations and a change in the commercial policies of a key vendor to illustrate our conclusions regarding barriers to adoption of open source products. %B Journal of medical systems %V 33 %P 1-7 %8 2009 Feb %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/19238891?dopt=Abstract %0 Journal Article %J Health Aff (Millwood) %D 2009 %T Infrastructure for a learning health care system: CaBIG. %A Buetow, Kenneth H %A Niederhuber, John %K Cooperative Behavior %K Delivery of Health Care %K Diffusion of Innovation %K Humans %K Medical Informatics Applications %K Medical Informatics Computing %K National Cancer Institute (U.S.) %K United States %K United States Food and Drug Administration %B Health Aff (Millwood) %V 28 %P 923-4; author reply 924-5 %8 2009 May-Jun %G eng %N 3 %R 10.1377/hlthaff.28.3.923-a