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OpenMRS – A Community Developed, Open Source Medical

Record System for Developing Countries

Paul Biondich, MD MSBurke Mamlin, MD

…and the OpenMRS collaborative

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Overview Our start What OpenMRS is Our progress to date Where we hope to go Guiding principles

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Introduction Regenstrief Institute / IU – 30+ year of

clinical informatics development in US, building large scale clinical information systems

February 2004: Asked to be “consultants”: give advice about how pre-existing HIV data repository (Access-based) could be extended / given more functionality -> supposed one week trip to Eldoret, Kenya

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40,000,00095%5%

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February, 2004• AMPATH: example of successful HIV

comprehensive care system in developing country… huge information needs

• Significant growth ahead: rapid ramp up to 20+ geographically disparate sites

• Immediate Observations:• No “quick fix” or “retro-fit” of old system• We were “hooked” and became very

engaged after visiting Eldoret

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Silos

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Existing Efforts• Multiple “silos” of disparate efforts• Focus on user interface• Minimal opportunity for collaboration

or interface• Non-coded, unstructured data• Lack of standards• Aren’t directly helping clinicians

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Design Dogma• Follow the lead of the 30+ year

experience of our mentors• Graceful evolution towards enterprise-

worthy systems• We must enforce deep structure in the

database to improve data integrity / quality

• Use of informatics standards throughout

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OpenMRS - API• Three code

layers• Database Layer• Service Layer• Presentation

Layer• Hibernate,

Spring, AJAX

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OpenMRS – Data Model• In continuous development for 3+ years• It simultaneously defines and directly

stores clinical data• Robustly defined concept vocabulary• Form hierarchies

• Versioning system, public debate/input• Data Repository vs. “Business” tables

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OpenMRS - Standards• HL7: Method of bulk data input/output

and reporting to national centers• Local vocabulary can and will be

mapped to ICD10, LOINC, and SNOMED where applicable

• Arden Syntax: logical constructs• Liberal use of open source

programming paradigms/standards

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AMPATH Medical Record System (AMRS)

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Model-view-

controller based data entry

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Concept Statistics

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Cohort Builder

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Building Enterprise EMRs Difficult (if not impossible) to fully sustain

internally within our environment Grant/contract money for development limited Difficult local hiring climate Inconsistent with priority of academic culture

Human resource needs only scale over time (everyone wants a new feature)

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Open Source Communities – A Solution?

Open Source Instruction code made freely available to public Nurture environment that encourages outside

developers to work with your code Open source licensing ensures that those who

add to your core code must also give it away Community

Give everyone stake in decision making process Make it fun/easy to participate

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Open Source License in Place

• License formalized• Essentially Mozilla Public License 1.1 with

extra clause related to medical liability• Main ideas:

• Core vs. Modules: all core will adhere to base license, modules are encouraged to do so

• Core managed by OpenMRS Management Group (Paul, Burke, Hamish, Chris)

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Types of Participants Large HIV programs throughout the world

Partners-in-Health Medical Research Council Millennium Village Project Family AIDS Care and Services (FACES) Clinton Foundation

Programmers with philanthropic leanings CS students Professionals with spare cycles Other large FOSS communities

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What this community “costs” us

Time Initial education on our design Building web portal / information

content Constant fielding of questions Guiding the design towards the right

direction Slower progress on our own work

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What this community gives us

Development scale Cohort builder example

Fresh sets of eyes to strengthen design Daniel Kawiya from Uganda

Implementation “cushion” Chris Seebregts and implementation group

Sponsor “gravitational pull”

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Where we want to go…• Evolution of core development group into

mentorship “team” – scaling development, educate in medical informatics, FOSS

• Continue to foster OpenMRS Implementation Group (Chris)

• Fundamental additions to OpenMRS (team)• “deep” decision support functionality• completion of research query tools / reports• encourage tools that facilitate clinical care• synchronization between OpenMRS instantiations

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OpenMRS Principles• Serve care providers/patients first, reuse

data• Develop based on active implementations• Be transparent• Reduce redundancy• Collaborate broadly• Apprenticeship – Learning by doing

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It’s amazing how profitable it can be to give something away.

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Regenstrief Institute, Inc.

paul@openmrs.org