Gloria Ingabire, Carnegie Mellon University
OpenMRS is an existing, robust medical record system (MRS), and Ingabire is proposing some additional functions for it, called OpenMRS+. She was inspired to take on this challenge by her mother’s history of diabetes and uncle’s history of cardiovascular disease. If people knew the likelihood of getting a non-communicable disease, they might be more likely to take precautions.
When Ingabire began her research, Rwanda used two paper-based systems and one type of electronic medical record system. They use a “patient health notebook,” to which there are inputs from the patient, the hospital register, the doctor, the lab, and the pharmacist. They also have “patient hospital files,” which receive inputs from the same sources. And Rwanda has an electronic medical record system, which doctors use in addition to the paper record sources. This system also receives input from the same sources as both paper records. Another important thing to note is that the patient may have to travel for hours to get to the hospital. It’s difficult for a patient to move around the country and receive consistent treatment because doctors cannot easily access all the records.
Problem statement: Non-communicable diseases kill 38 million people each year, of which 28 million occur in low- and middle-income countries. 16 million of these deaths are people below the age of 70. Some of these deaths, at least, are premature.
Proposed solution: Establish a more complete electronic medical record system from open sources. OpenMRS is a web/mobile-based open source MRS developed using Java. It has a modular architecture, dictionary basics, and encrypted data. It was implemented in Rwanda in 2005 to collect HIV and tuberculosis patients’ records, but Ingabire sees a necessity for extending its uses to non-communicable disease applications.
OpenMRS has a database layer, a service layer, and an html/jQuery presentation layer. To its existing modules, Ingabire proposes a module for non-communicable diseases, which can receive inputs from patients, doctors, hospitals, labs, and pharmacies. It includes basic screening capabilities for diabetes and cardiovascular disease, and scoring certain results on the screening can alert the doctor. OpenMRS can even store videos and pictures on the servers. In addition, Rwanda is shortly launching a national ID, which is a smart ID, so among other uses it can assist with hospital registration and become part of the OpenMRS. Community health workers could also access modules of OpenMRS. These include administration, appointment scheduling, diabetes management, and screening modules.
Key to success will be securing data sharing among health care institutions. Who is willing to share? Who has time for electronic systems? These are the biggest challenges, but the motivation for everyone involved is saving lives.
During the Q and A, someone posed the question of whether Rwanda could use the smart ID cards to track relationships among families for health history. Ingabire replied that yes, the smart ID contains the names and information of your family members so through it doctors can access patients’ family health histories.