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Job posting: French or Creole speaking OpenMRS programmer for Haiti

Posted by hfraser on August 13, 2010

PIH is looking for a French and preferably Creole speaking Java programmer to work on the expansion of OpenMRS in Haiti. This is part of our IDRC funded  project with Itech and trhe Haitian government. The full job description is here.  Hamish



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OpenMRS Workshop for Central America

Posted by jblaya on July 12, 2009

Workshop participantsWe just finished a 3 day (July 8-10, 2009) workshop on OpenMRS in Guatemala for Ministry of Health and CDC personnel from different Central American countries, though unfortunately those from Honduras were not able to make it because of the current conflict there.

During this workshop we addressed:

  • The current state of medical informatics in the world and lessons learned from developed countries in the implementation of Electronic Medical Records (EMRs)
  • Overview of the PEPFAR program and CDC’s involvement in the region
  • Overview of OpenMRS, it’s vision, and current implementations
  • Other open source projects working with OpenMRS such as mobile devices (OpenROSA) and DHIS.
  • Installation of OpenMRS and modules
  • Creation of concepts and forms
  • Working with cohort builder
  • Creating reports and exports

In a broad group discussion we also found what were the benefits and disadvantages of OpenMRS that were most important in this region.  They will be included in a separate document to be attached. Finally, we had small group discussions about possible implementations of OpenMRS in projects and clinical sites throughout the different countries represented at the meeting.  All were excited about the ability of OpenMRS to unify the many disparate information systems that were being implemented for all of the different programs in their respective countries.  Overall, the meeting ended with a lot of enthusiasm showing the need for a Latin American OpenMRS Implementers meeting, which should happen in Lima in late september.

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Rwanda Upgraded to OpenMRS 1.4

Posted by djazayeri on November 20, 2008

I want to congratulate Chase and Maros for getting Rwinkwavu and Kirehe’s OpenMRS servers upgraded to version 1.4 with sync. Jeremy and Evan, you two owe them beers for having upgraded first and finding and fixing a whole slew of bugs in 1.4 that you would otherwise have had the pleasure of experiencing firsthand.

I’d also like to share this conversation for those who couldn’t be here:

(Scene 1: Wednesday night, 10pm)

Maros: So, Darius, unless you tell us not to, we’re going to start the upgrade now.
Darius: Hmm…okay, go ahead.
Simon (BCG): WTF? You’re going to do a major upgrade on a Wednesday night?
Chase: Yes.

(Maros and Chase leave.)

Simon: You’re really okay with this?
Darius: Yes, I have complete confidence.

(Scene 2: Thursday morning, 8am. Chase and Maros are sitting around their laptops. They haven’t slept. Darius and Simon arrive.)

Simon: So?
Chase: Rwinkwavu is up and running.
Darius: Whew.

Not that I doubted for a moment. 🙂


PS- Anyone reading this from the broader OpenMRS community, we’re going to release 1.4 as alpha now that this first round of bugfixing has happened.

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OpenMRS Implementers Meeting

Posted by ellenball on July 15, 2008

It was a great honor to attend the OpenMRS Implementers Meeting – 17-20 June 2008 at the Elangeni Hotel in Durban, South Africa.  It was my first OpenMRS meeting and also my first trip to Africa.

Monday was spent at an OpenRosa meeting which was moderated by our old friend and colleague, Neal Lesh.  This group has made great progress.  Here’s a description of OpenRosa:

OpenROSA is a consortium formed to create open source,
standards-based tools for mobile data collection, aggregation,
analysis, and reporting. By developing open source solutions and
conforming to standards based on the XForms specification, our
different projects can easily share code, data, ideas and

The rest of the week was filled with OpenMRS.

The most interesting presentations were ones from the implementers — the ones from our own PIH team Jeremy Keeton for Lesotho, Christian Allen about synchronization with great graphics about doctors traveling by camel and many funny subliminal messages), Baobab (Mike McKay and Jeff Rafter), Millennium Village Project (Andy Kanter) and Albert Schweitzer Hospital in Haiti (James Arbaugh).  The many different uses of OpenMRS is fascinating and creative.  Albert Schweitzer has over 700K patients in OpenMRS!  MVP uses OpenMRS as a primary care system.

Two other presentations were valuable.  Ben Wolfe from Regenstrief Institute gave a demo of building odules. This was well timed since I was building my first module.  Too bad this wasn’t more of a hands-on lab class, but it was still very useful.  A panel discussion about the current concept dictionary, OpenMRS Concept Co-op (OCC), Terminology Service Bureau (TSB) and OpenEHR archetypes was a useful finale to a wonderful week.  This area needs attention, but hopefully additional resources will focus on this.  I’d like to do more work in both these areas.

It was great to meet so many active participants in the OpenMRS community and a once-in-a-blue opportunity to get the Partners In Health OpenMRS team together.

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Reporting Framework at Durban

Posted by pihemr on July 14, 2008

The Durban conference presented the community with a great opportunity to discuss many newly developed features soon to be released in OpenMRS version 1.3.  One of the most significant of these is the new reporting framework.

Although general in nature, the primary goal of the reporting framework is to ease development of aggregate indicator-based reports.  Given that many organizations share the same reporting requirements for agencies like Pepfar and the Global Fund, our goal is to foster collaboration and knowledge, thus reducing the work involved for all.

As developers involved with producing this framework, we entered the conference aiming to demonstrate the capabilities, to gather feedback, particularly on usability, and to rework the functionality as needed.  This proved to be a very valuable experience.  Initial feedback, early in the week, was that the interface was far too unwieldy for a non-technical user of the system.  This resulted in the first of our redevelopment efforts, a completely rebuilt report design interface, in which the user follows a configuration wizard to complete the design process.  As this was iteratively developed on site, by the end of the week we were able to demonstrate these revisions to the wider audience.  We received a very positive response and a number of useful suggestions for continued improvement.

One of the more interesting suggestions came from Christian, never shy with his opinions on user experience.  His contention is that the report design process can be driven wholly from an “example report”, expanding on the ideas utilized in the ReportTemplate module.  The basis of this design would involve starting with a template file in a format that most users are very familiar with – Excel, Word, Text, or similar, and initiating the design process from there, with wizards to help the rest of the way.

It is clear to me following the meetings in Durban that user-experience will continue to play a larger and larger role in the success of OpenMRS and, as with the reporting framework, iterative design and continued community involvement will be key to this success.

-Mike Seaton

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Data Management in Durban

Posted by evanjmwaters on July 9, 2008

PIH’s team of OpenMRS implementers and data mangers based in Rwanda, Lesotho and Malawi conducted a data management workshop at the HISA 2008 Conference in Durban.  The purpose of the workshop was to identify common data management problems and brainstorm as a group to come up with good solutions.  In addition to the PIH team, current and prospective OpenMRS implementers based in Kenya, Uganda, Tanzania and South Africa were present at the workshop.

The problems discussed ranged from challenges with the initial implementation through to common issues faced by an established project with a large patient population.  Specific examples that attendees gave included:

  1. Getting started with OpenMRS at an existing HIV clinic with approximately 6,000 historical patients, but very poor paper and electronic record keeping practices
  2. Internet and/or power unavailability presenting challenges to a typical implementation
  3. Proliferation of transcription errors leading to poor data quality
  4. Lack of motivation from clinicians to use EMR forms leading to incomplete record sets
  5. Incorrect patient identifiers resulting in lab results being assigned to incorrect patients

Most of the data management problems that were discussed were common experiences for the implementers in attendance, and a number of interesting solutions were shared during the second half of the workshop.  These included:

  1. Focusing on getting a particular record set right at the beginning of an implementation over trying to get all of the data into the system at once.  In the case of the implmenter with 6,000 historical patients, this could involve building a recordset for patients currently enrolled at the clinic, and leaving out patients that were already deceased or transferred out.
  2. Being flexible with power and internet requirements.  Prior to getting internet at its clinics in Lesotho, PIH developed a system for offline data entry using Excel, which were uploaded to a central server in Maseru.
  3. Empowering the data entry team to notify clinicians of transcription errors on forms, and motivating the team to hold itself accountable.  The OpenMRS implementers in Eldorat have developed data accuracy targets and data clerks are rewarded for meeting them.
  4. Making it worthwhile for clinicians to use forms by (a) making the forms themselves improve workflow and (b) focusing on developing useful reports.  Allowing the data entry team to be part of the process by delivering the reports to the clinicians can help build good relationships between the two groups.
  5. Building an electronic system for issuing unique identifiers to patients.  In Malawi, the team from Baobab uses label printers and barcode scanners to issue ids and access patient records.

One of the overriding themes that came out of the workshop is how integral data management is with clinical practice as a whole.  From the moment a patient arrives at a hospital through to the point at which the patient’s record is entered into an EMR, there are countless opportunities for encountering data errors.  Each of these problem points poses an opportunity however, as good data management practices can greatly improve the clinical workflow as a whole.

Another theme from the discussion is that data management should not be an end point, but rather a part of a closed loop between the developers of an EMR and the clinical setting.  Some of the best solutions that were discussed in the workshop involved both a proactive data manager and an attentive development team that was able to help come up with a solution to the problem.

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OpenMRS in the news!

Posted by pihemr on June 25, 2008

Coming off the heels of a successful conference in Durban, Paul Biondich from the Regenstrief Institute was interviewed by the BBC about OpenMRS. A podcast of the interview is available online, as is the article resulting from the interview.

Keep an eye out for upcoming blog entries about the OpenMRS Conference and the latest developments from PIH project sites!

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Collaboration with OpenELIS, an open source lab information system

Posted by jblaya on April 27, 2008

In the last few weeks the OpenMRS team along with collaborators from the University of Washington have been meeting with members of the OpenELIS team, an open source laboratory information management system (LIMS) that’s been implemented in Minnesota, Kansas, Missouri, and Vietnam. The members of this team are from the Association of Public Health Laboratories (APHL) and from labs in the US. Conversations have focused on how the OpenELIS group can learn from the community building experience of OpenMRS and how the two systems can connect to provide countries with the possibility of implementing both systems.

Our first meeting last month was extremely productive. Dr. Gail Cassell was also present. We’re now coordinating meetings to meet the two goals mentioned above: helping in creating an OpenELIS developer community and connecting both systems.

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Observing a Usability Test at Kayak.com

Posted by hsiung on March 20, 2008

On Monday 3/17, Darius & Bob had the privilege of attending a Kayak.com usability session. Paul English, one of the founders of Kayak.com, is both a usability evangelist/guru and a huge PIH supporter. Since we are actively working on redesigning the OpenMRS user interface, he generously invited us to take an inside peek at how they conduct their usability tests there.

The set up was pretty simple. The test user was given a set of tasks to perform and was instructed to talk through his thought process aloud as he tried to perform the tasks. We sat in an adjacent room with 4-5 Kayak employees watching a projected copy of his monitor and listening to him talk.

It was pretty fascinating – especially with Paul (what is it with guys named Paul?) sitting there adding his insights. Obviously an airline ticket/hotel search application is very different from an open source medical records system, but there are definitely basic principles that hold true for both applications. Principles like – “Faster is better.”, “Not making people think is good.”… Not exactly rocket science, for sure, but it was eye-opening to watch an actual user make assumptions and mull over interfaces that everyone assumed were completely intuitive.

Here’s just one small example from this test. People in the room were shaking there heads when this particular user expressed surprise that a certain fare was more expensive than he thought it should be. “It’s a first class ticket! It says ‘1st’ right there!” someone said.

“Well… why isn’t he seeing it? Maybe that indicator should be right next to the price rather than on the side (everyone slaps their foreheads), maybe it should say ‘first class ticket’ rather than just ‘1st’ (more forehead slaps) Or maybe he really needs to be told explicitly that there are no available economy class tickets for this route. (doh!)”

“Actually, we really should continue to focus on the test & not talk about potential solutions at this point,” Paul said to us quietly. “The really important thing is that we’ve identified a problem that this user is having and if he’s having it, you can bet that there are a whole lot of other users out there having the same sort of problems.

Our attention to usability has given us a lot of success, but we can’t afford to let that make us arrogant. We have to stay humble. We will always have a lot to learn from our users to help us to continue to improve their user experience. This is why these tests are essential.”

(For more on the progress of the OpenMRS redesign, check out the OpenMRS wiki – http://openmrs.org/wiki/WorkingGroup/EndUserInterface)

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Synchronization… at last

Posted by christianallen on March 4, 2008

It’s not time to throw the confetti yet. But maybe we can throw just a little for now.

In November, the EMR Team attempted to rollout an edition of the EMR at the Rwanda Project that included “Synchronization”. Synchronization, for those of you that haven’t heard this little buzzword, is the ability for different machines to automatically communicate data about our patients back and forth with each other. The benefits of this are many. We can have offline entry in at sites with no computers or electricity by bringing a laptop and then have that data copied back to a central database. In sites like Lesotho where there is no internet connectivity at some of the sites, a single roaming data team member can go from site to site collecting data on a flash drive and then have it merge in to a central EMR database back in Maseru. Theoretically, data from all project sites could be accumulated in Boston for high-level analysis.

The rollout of the Synchronization Edition of the EMR was a tricky process for 2 reasons. For one, Synchronization was the single largest change to the system since the creation of the new EMR (EMR 2.0, aka OpenMRS), not to mention the most likely to cause corruption of medical data. Secondly, the rollout had to take place in a relatively short window of time during which a member of the EMR Team was actually in Rwanda. Sadly, on the day of launch the shuttle failed inspection, and Synchronization was held at Cape Canaveral indefinitely, until another window opened.

In Febuary, the skies opened again for the Synchronization Edition of the EMR to launch. This time, with luck and hard work on the part of a few dedicated developers, it passed inspection and the countdown began.


On February 7, the button was pushed, and another, identical EMR came online in Kirehe. For the remainder of the day, all changes and entries that were done in Rwinkwavu magically appeared minutes later in Kirehe. Changes made in Kirehe magically appeared minutes later in Rwinkwavu. A team of extremely nerdy people looked on from a control room with anxiety and awe. By 5pm, the data entry teams had gone home for the day, and the shuttle appeared to still fly straight. It was a brief but welcomed victory.

The next day, Synchronization held strong again. And the next day. And the next. By the end of the first week of usage, the team encountered their first minor setback, but the problem was quickly corrected and the launch back on target. Another week went by. Still no problems.

At this point, Synchronization has been running without error, copying all kinds of data back and forth between the distant project sites for almost 4 weeks. To date, it has successfully copied over 75,000 changes between the sites. It is done so automatically and in the background. The entry teams working at the sites don’t even notice that it is happening, but instead can focus on the priorities and daily tasks. The only thing they really notice is that now entry is fast and efficient, since they have their own, local version of the EMR.

Most hospital systems in the Western world are unable to successfully set up systems that provide universal access to patient data, such that a patient can check in to multiple facilities and those facilities have instant (yet secure) access to their patient charts. But we have it in the Eastern Province of Rwanda. And we’ll have it soon at our other sites.

So why no confetti yet? Because we’re not finished. There still remain a growing number of sites in Rwanda that don’t have their server set up yet. Or they have a server that is being tested, but hasn’t been shipped out to the site yet. Also, Synchronization is not yet ready for the greater OpenMRS community – the vast number of people who have started to use our EMR. It still needs a simpler and more intuitive setup process.

No – there will be no confetti and champagne for Hamish, Darius, and their team yet. But maybe, just maybe, we could throw a *little* bit for this one small step for the EMR Team.

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