OpenMRS in Hospital Settings
- Former user (Deleted)
- Former user (Deleted)
Facilitator: Wisdom Atiwoto
10 Sept 2010
Definition of hospital
Anything with an inpatient facility (definition in Africa)
Secondary hospitals – require referrals
Tertiary hospitals – require referrals
Small office outpatient à health center (can receive emergencies) à district hospital (30-40 beds, OB/GYN services, Peds, Surg, Int. Med) à regional hospital àteaching hospitals
What are others doing in hospitals?
AMPATH – District hospital
Used for clinical care
MTRH interested in implementing OMRS
Hospital now using patient registration
Goal is for teaching hospital to use it for clinical care, put terminals around the hospital for clinicians to look up information while on rounds
Many systems already in place but they are using OMRS to do patient registration, unification of patient identification across departments
Motivation of MTRH to start use OpenMRS – 250K patients in AMPATH clinic, (right next door to MTRH), want to integrate systems with AMPATH
Trying to push for using REAL data to meet the needs of local people so that there is feedback to the providers to improve the quality of data entered into the system
Ghana
Driving force is health insurance claims processing and other payment mechanisms
Questions usually asked: Can it help us with health insurance claims? Can it help us send reports to the district and regional health administration?
Billing needs are urgent
Mozambique – in 5 districts
Limited connectivity
In the main hospitals, not the rural hospitals
About 10-15 beds – Infirmary
5-10 beds – maternity
Patients do not move between wards
Implemented to do HIV treatment
Nigeria
One general hospital – inputting all the registers into OpenMRS
Using 2 computer – record keepers entering data into the registers
1 computer in delivery room – midwives writing info on labor cards first and then entering it into the computer
If they interact with the computer, midwives can see antenatal visits
Planning on expanding to 2 more hospitals (~15 beds and ~400 beds) – one teaching hospital
Treat implementation of the system as if each were an individual clinic (some get point of care some don’t)
Needs inpatient care module
Patients move between wards while in the hospital
Entire hospital needs to wired and networked, multiple wards may need to see the data at the same time
Steps to implementing OMRS in hospitals
Why did Ghana hospital choose an EMR?
Sync from the largest hospital down instead of the smallest up
Hospital is a large community that needs internal communication
Liked log in page with hospital events and information
Patient tracking feature
Staff scheduling
Resource scheduling
Ancillary services
What’s the minimum that is needed in order to provide services to all of the departments
Some labs get paid by the test and not the result so the lab won’t record the result
OpenMRS is not the answer to the other processes in the hospital
Need to do resource planning
Why openmrs?
District hospitals have 150-300 beds
Good for the patient, not looking for profitability
Private hospitals are looking for profitability
Implementing a hospital system that can help with resources and costs
A way to gather information about a group of people and associate that information to them. OpenMRS is not a good solution for supply chain management
What are the hospital’s needs? What are the motivations of the hospital for implementing EMR?
Example, OpenMRS can do minimal set of features for something like laboratory data and then when they outgrow OpenMRS, get a true lab system and then integrate it into OpenMRS
Using Rest Module and HL7 messages for integration
Compatibility discussion with other open source communities for ancillary services
Medical record is fundamentally the same between inpatient and outpatient
The types of data are different but we are still tracking medical information about patients
In the USA, there is a distinction between the medical record and the “hotel keeping” functionality (supply chain, billing, etc.)
OpenMRS is working to be able to integrate with other systems easily to help meet medical needs
Promotion of best practices
Hospital infection control – where does that fit in?
Lab safety – where does that fit in?
Incident reporting and investigation - where does that fit in?
OpenMRS can export relevant data to an external system
For bigger hospitals – one would need “real” ADT, lab, pharmacy systems, are there other examples of modules that are needed?
Lab, billing, pharmacy, radiology, patient registration
Modules need to work for individual organizational workflows so they need to be generic
Expectation management
Resources to build modules for inpatient/hospital needs
Billing module – got all the hospital services as concepts with a parent concept that is set as a global property in the billing module. Then you can assign prices to each of the services in an external table. Make a set that is billable concepts. Billing clerk can choose the necessary service.
2 kinds of orders sent from billing module – lab and pharmacy
Can identify 2 kinds of patients (above and below poverty line) – government discounts can be applied as well
Registration module determines income level (person attribute)
Customizable receipt
Not a detailed accounting system;
Data can be extracted
Working on financial module
Release date: 1 week (17 Sept 2010) to module repository
Are people anything working on? – need for documentation
Experiences in implementing OpenMRS in hospitals vs. clinics
Workflow complexities much higher in teaching hospitals over outpatient clinic
Possibly start with smaller hospitals before larger hospitals
Large failure rate in Nigeria at teaching hospital
Connectivity, hardware needs/costs, workflow complexity à failure
Evolve the implementation out from small wards (or small hospitals) and then let it expand
Possibly start with Surgery and OB/GYN and then expand from there
At AMPATH – start with registration
Workforce training
Had to change the overall process of maintaining record keeping throughout hospital à MAJOR work culture change
Lengthy discussions with record keepers prior to implementation
Sub-district hospitals – couldn’t have users test the system. Workers wanted pressure from the government which didn’t happen. No local leadership buy-in.
In Ghana – major workflow changes that may or may not be accepted by the workers à need to have input from the people who are going to be using the system
Need to get local leadership buy-in otherwise there will be failure
Blending inpatient and outpatient modules
Growth of OpenMRS in hospitals
Coordinate all departments in a hospital
Expectations for user interface in the medium term
Expect to see basic modules around ancillary services soon
Visits = grouping of encounters
Formal support for order entry
Medical Notes àcan store as observations, no templates exist yet. Can create handlers to create a new kind of template, not done yet.
Debate as to whether that should be OpenMRS core or not
Can a form be put together to do documentation? (limit for a field is 64K)
Looking to expand OpenMRS from clinics to hospitals
How to use OpenMRS in commercial hospital set ups
Challenges in implementing OpenMRS in hospitals
How to use in community mental health and social care in the community (challenges)
Observing mood and behavior daily, can incorporate concepts based on mood and behavior
Answers are very wordy, how is the data used? Is there information to be extracted?
Data that was collected was done in discreet ways (yes/no, scales)
Trying to develop a module for mental health care delivery in Ghana
Size of textual fields is limited (needs to be a narrative)
Trying to extract information from a long narrative is very difficult
How to reconcile between discreet questions (lengthy) vs. narrative (concise)
In form design, find the balance between discreet and narrative components
Why are we coding this? How are we re-using this? àthese questions help determine what should be discreet