Partners In Health Malawi (APZU) EMR Case Study

Supporting rural health in Neno District, Malawi with OpenMRS

December 2017

Since 1987, Partners In Health (PIH), an international NGO headquartered in Boston, has been working with Ministries of Health in 10 countries to provide high-quality, comprehensive, community-based health
care—“a preferential option for the poor in the hardest to reach areas.

Known in Malawi as Abwenzi Pa Za Umoyo (APZU), PIH was invited in 2006 by the Malawi Ministry of Health to support health service delivery in the rural district of Neno. Today, APZU supports primary and secondary health care delivery at 12 health centres and 2 hospitals within the district for 165,000 people.

APZU Today

In 2015, APZU launched the Integrated Chronic Care Clinic (IC3), where patients are screened and treated
for HIV and non-communicable diseases (hypertension, diabetes, mental health, and asthma) during a single visit at the nearest clinic. PIH complements its clinical services with outreach programs. APZU conducts weekly community events where we screen Neno residents for a wide array of diseases, catching health problems early and referring patients to health centers for treatment. APZU Community Health Workers (CHW) also visit people in their homes. Our cadre of 1,200 CHWs support the health needs of entire households and accompany household members to clinics for care.

Implementing OpenMRS

Following work at PIH sites in Rwanda and Lesotho, OpenMRS began at APZU (Neno district in Malawi) in 2007, in conjunction with the launch of testing and treatment programs for HIV and TB. By 2010, six health facilities in Neno were providing ART to nearly 3,000 patients. There are currently 13,000 patients enrolled in OpenMRS. In the past 10 years, much innovation has come from collaboration between APZU clinical staff, Monitoring & Evaluation, Ministry of Health, and PIH Medical Informatics.

Goals of APZU OpenMRS

Register patients who have been enrolled into integrated chronic care at all facilities
Keep records of all patient encounters
Have a central manageable repository of patient data for data analysis for decision making
Help providers with decision making

The System

Our system includes 2 parent servers (located in Upper Neno and Lower Neno) and 14 child servers (8 in Upper Neno and 6 in Lower Neno). This design is due to connectivity and geographic issues. The APZU Informatics Team utilizes the sync module of OpenMRS to synchronize with the parent database to transfer the latest patient data.

Child servers have been installed locally on laptops so the informatics team can capture encounters at the facilities.

These enable teams in Upper and Lower Neno to connect to the internal network and still be able to
synchronize data to the parent servers. Data from the system is used by the monitoring and evaluation
team and various other stakeholders for informed decisions by clinical, procurement and administration teams. Several reports have been built into the system that help with retrieval of data for different client cohorts. The OpenMRS cohort builder is also extensively used to pull data for specific patient groups. The outpatient OpenMRS records are also summarized for inpatient clients, through a customized report, to support better clinical management.

Reports

Integrated Chronic Care Clinic (IC3): MOH-approved patient records are back-entered into
OpenMRS and generate a variety of key reports utilized during IC3 clinics.

Patient Tracking Report: OpenMRS generates a linelist of patients who have missed their recent
appointment that our tracking teams can use to provide follow-up.

Community Health Workers (CHW) Module: recently improvements to the Provider management module directly link 1,200 CHWs to IC3 clients. This link facilitates CHW-patient relationships and review CHW performance.

Appointment Reports: OpenMRS maximizes patient care by providing integrated list of key lab
tests needed, urgent lab results, and clinical reminders for all clients visiting that day.