PIH EMR Maternal Center of Excellence Case Study

Background & Context

In Sierra Leone, women face a 1 in 74 lifetime risk of dying in childbirth. The Maternal Center of Excellence (MCOE) is changing that.

For more than a decade, Partners In Health (PIH) and Sierra Leone's Ministry of Health have collaborated to strengthen maternal care at Koidu Government Hospital (KGH) in Kono District. This partnership took an audacious step forward with the creation of the Paul Farmer Maternal Center of Excellence. Built in partnership with Sierra Leone’s Ministry of Health, Project for Awesome, and Build Health International, this state-of-the-art facility is designed to dramatically expand maternal services and set a new standard for care.

Koidu Government Hospital serves as a vital referral center for high-risk pregnancies and obstetric emergencies. Through innovative design and advanced medical training, the MCOE is raising the standard of maternal health in Sierra Leone, ensuring that every mother and baby has access to safe, dignified, and high-quality care.

Goals of the PIH EMR

The PIH Electronic Medical Record (EMR) system supports PIH-supported facilities by:

Improving clinical workflows and reducing reliance on paper records
Enabling real-time data entry at point of care
Supporting better decision-making and continuity of care
Integrating services such as maternal health, primary care, mental health, non-communicable diseases (NCDs), pharmacy, and laboratory services

PIH EMR in Sierra Leone

History

The initial PIH EMR in Sierra Leone was implemented at the Wellbody Clinic in 2015. It was built with the Bahmni distribution of OpenMRS and replaced disconnected excel spreadsheets that were used across different clinical departments (registration, vitals).

By 2016, the Wellbody EMR had been migrated to the PIH EMR distribution.

In 2020, additional capabilities were introduced, enabling the Wellbody EMR so the EMR is used by nearly every department including Primary Care, Mental Health, NCDs, Maternal Child Health (MCH), Laboratory, and Pharmacy.

The system has replaced Wellbody’s overflowing shelves of paper records, allowing staff to instantly access and more safely store patients’ medical histories. This has improving care for the approximately 200 patients who visit the clinic each day.

Aiah Gborie, Clinic Clerk at Wellbody Clinic in Kono District. “PIH has empowered me with personal growth like the use of computers and ability to pass knowledge to other staff” Photo by Ellen Ball / PIH

Current system (2026)

The PIH EMR is an OpenMRS distribution built on a hybrid of the OpenMRS Reference Application Version 2 and OpenMRS3. The system continues to evolve, with ongoing feature development.

The PIH EMR is currently used in Sierra Leone, Haiti, Liberia, and Mexico with customization for local requirements. It supports multiple languages, including Haitian Kreyol, French, and Spanish for non-English speaking settings.

KGH PIH EMR login locations

NOTE: Sierra Leone training videos show this hybrid system.

KGH (and MCOE) EMR Implementation

Following the success of the PIH EMR at Wellbody Clinic, Koidu Government Hospital (KGH) started using the PIH EMR for Mental Health, Triage, Vitals, Non-communicable diseases (NCDs), and Maternal child health (MCH).

In July 2025, the EMR was introduced to the KGH Maternity ward to support a smooth transition to the Maternal Center of Excellence.

The MCOE, located on the KGH campus, opened on February 14, 2026. EMR teams in Sierra Leone and Boston spent nearly three years preparing for the MCOE and collaborating closely with the OpenMRS community – particularly on OpenMRS 3 development.

The KGH EMR uses the PIH EMR distribution with customizations specific for the KGH campus, including the MCOE.

EMR Features at MCOE

The EMR system at MCOE includes:

Point-of-care with retrospective entry capabilities
Coverage across all inpatient wards, including:
- Antenatal ward
- Labor & Delivery
- Pre and post-operative wards
- Newborn Intensive Care Unit (NICU)
- Maternal Critical Care Unit (MCCU)
- Post-Anesthetic Care Unit (PACU)
Color-coded patient triage including TB screening
Bed management tools
Patient queues
Laboratory orders and results
Medication ordering and dispensing
Management of admissions, transfers, and discharges
Digital patient chart for clinical documentation
Real-time alerts to support clinical decision-making
Patient census tools for shift handovers
Data warehouse integration
Data analysis dashboards to improve data quality and transparency
Specialized clinician-facing dashboard for mother and newborns (see below)

Clinician-facing dashboard

For pregnant women

Clinician-facing dashboard: Pregnant mother

For newborns

Clinician-facing dashboard: Newborn

Clinical forms

Based on gender, age, and login location, appropriate clinical forms are shown on the visit dashboard. It is configured to only allow 1 unique form under some situations (ie. only one NCD Intake form per patient, one admission form per patient visit, etc).

MCOE Maternal

MCOE Newborn (NICU)

KGH Triage

NCD

Mental Health

Training

Training is a critical component of EMR implementation. Staff are trained to accurately record patient information, including medical history, and to use standardized documentation practices.

Mariama Gift Lahai, a critical care nurse with PIH Sierra Leone, completed EMR training alongside other clinical courses. She noted that the system allows clinicians to spend more time with patients and less time managing paperwork and locating records across units.

From second to left: Gladyse A. Kanu, Isata Bah, and Francess Kamara during an electronic medical record (EMR) training session for nurses, midwives, and doctors. The training placed a strong emphasis on the practical application of the EMR system in supporting the care delivery across the clinical work flow at the Maternal Center of Excellence. Photo by Sean Andrew Bangura / PIH

Training sessions emphasize practical application of the EMR within clinical workflows and include nurses, midwives, and doctors.

Training topics (videos):

Checking In Patients and adding them to the Triage Queue (1 minute)
Triage Queue and Triage form (3 minutes)
Maternal Vitals (2 minutes)
Newborn Vitals (2 minutes)
Clinicians: Discharge Medications (2 minutes)
Pharmacy: Discharge Prescription list (3 minutes)
Pharmacy: Dispense from Medication Closets (3 minutes)

Data use

The EMR supports improved patient flow and care coordination through real-time and aggregated data.

Ward management

For each inpatient ward at MCOE, staff can view:

Bed occupancy, including mother-baby shared bed
Pending laboratory orders
Pregnancy complications
Patient demographics (name, age, medical record number)
Admission time and duration in ward

Maternal handoff

Patient census data is available during morning and evening handoff meetings, supporting smooth transitions between clinical teams and continuity of care.

Data analysis dashboard

Integrated dashboards (e.g., Power BI) enhance data quality, visibility, and transparency, enabling better decision-making at both clinical and operational levels. As of April 2026, there are aggregate dashboards for referrals, catchment, labor & delivery, antenatal care, postnatal care, newborns, and data quality.

PowerBI MCOE Dashboard: Catchment (April 2026)

Future enhancements

In the future, there are two major projects for the PIH EMR. PIH will continue to migrate additional features to OpenMRS 3. In addition, implementing a Laboratory Information System (LIMS) and integrating with the PIH EMR is a priority.

Reference materials

MCOE:

OpenMRS:

Paul Farmer:

https://www.pih.org/article/9-initiatives-keeping-paul-farmers-name-and-legacy-alive