I’ll be taking about the use of electronic medical records in global oncology. In many international sites and in many poor countries medical records are on paper and it’s really complicated and it’s hard to track patients. My talk is really about an example of implementation of an electronic medical record into places where I work in Haiti and in Rwanda. The name of the electronic medical record system is called OpenMRS and I will show examples of OpenMRS and examples of how we’re able to implement them in both sites.

Haiti and Rwanda are very geographically different, so do you notice any disparities?

I would say many poor countries are quite similar, so even poor countries in different places face the same, or similar, challenges. The reason why I work in Haiti and in Rwanda is because we collaborate with an organisation that is based in Boston called Partners in Health and they have international sites and both places are two of their international sites. So the challenges for caring for oncology patients actually are quite similar in both places. That’s the beauty of OpenMRS is it’s a system that was designed specifically for low resource settings that can be implemented in different low resource settings. The basic platform is an open source system that is available online and it can be customised, depending on the needs of the different places.

How does OpenMRS run?

I don’t know all the back technical portions with regards to the coding but it is an online based system which you can download to a local server at the different sites. Similar to the way a lot of electronic medical records work, there is a login page where each user has their own special ID login using a main password. The interface itself, the basic interface, has an introductory page or a face page for the patient and you can create multiple additional pages behind that depending on how you want to customise it for your site.

So, for us we have a basic consultation page, we have pages for when patients come back for follow-up appointments. This also interfaces with a system that stores radiology which is called a PACS system and you can also have it interface with a laboratory system as well. Also in our specific case, because we use the system for oncology, there is some oncology specific functionality which includes an area for ordering chemotherapy or forms for ordering chemotherapy as well as forms for recording when the chemotherapy has been administered as well as a final page which is an appointment page for how to follow up patients afterwards.

What happens to all the current hardcopy records?

Thankfully the programmes in Haiti and Rwanda when the oncology programmes started they actually from the get go started using the electronic medical record system. In both places there was also always an element of paper records so it’s not entirely all electronic but the bulk of the patients’ records with regards to oncology is electronic. So the ultimate goal is really to have everything up into the computer system. We’ve taken a stepwise fashion in the way we’ve implemented it and that’s part of what I’ll be talking about tomorrow. So just showing how we started from the really basic records and seeing the additional forms that we added over the years.

How long could the whole process take?

Some of the challenges with having fully electronic medical record systems are electricity is an issue or having constant internet is also an issue. Thankfully for this record system you don’t necessarily need to be connected to the web constantly; there is a central repository where the records get stored on the web but you don’t need constant contact with the web to be able to use the records day to day. But you’ve got to think about electricity and other considerations as well.
I would say until it gets to a time where all of those things are constant in both places it might be a challenge to be fully and entirely electronic. Even in this country, in the US, occasionally we do have issues when the electronic medical records go down in the US so there are backup systems for how to bridge with using paper records in the meantime. I’m not answering your question directly, however it’s going to take some time.