AHRQ spotlights global health IT work

By Bernie Monegain
10:36 AM
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AHRQ-funded health IT research has helped organizations provide better care in developing countries, a new report from the agency shows. The report spotlights what Boston-based Partners in Health has accomplished on this score.

Partners in Health, or PIH, a global health nonprofit organization, which provides care in some of the poorest countries in the world, helped develop an open source electronic medical record system known as OpenMRS. The work was influenced by AHRQ-funded research on electronic order writing and computer reminders. OpenMRS is now impacting healthcare delivery in developing countries, as well as in the United States, Canada and Europe, according to AHRQ.

[See also: Boston-based group employs IT strength in Haiti.]

As the AHRQ report explains it, “PIH and the Regenstrief Institute in Indianapolis conceived of OpenMRS in 2005 as a flexible, open source EMR that would be capable of meeting the demand for high-quality health information in developing countries such as Rwanda and Kenya, where the two organizations were then working. The work was inspired by AHRQ-funded research by William Tierney, MD, and his colleagues at the Regenstrief Institute, which identified factors that are important to the design and successful implementation of EMR systems. PIH and Regenstrief used this research as a central contribution toward the development of OpenMRS. OpenMRS has since grown into a multi-institution, nonprofit software collaborative backed by a global software development community.”

According to Evan Waters, director of medical informatics at PIH, the organization has a long history of using OpenMRS in developing countries.

In Rwanda, PIH has worked in three rural districts since 2005, operating in three hospitals and 37 health centers that care for 800,000 citizens. The EHR provides decision support for clinicians managing HIV care, based on the work of Tierney and others. Beginning this month, PIH is working with the Rwandan government to support a rollout of OpenMRS to reach more than 200 health clinics in the country and to register more than 80,000 patients.

The government EMR system supports HIV treatment, and PIH is also working to support primary care and management of chronic diseases, such as heart failure, according to AHRQ.

Other work highlighted in the AHRQ report:

  • In Malawi, PIH partnered with Baobab Healthcare, a local nonprofit, to develop a point-of-care primary care EMR using the OpenMRS data model. The system runs on touch screens, and once a patient is registered, a simple bar code prints out that allows for patient tracking and testing during visits. PIH's OpenMRS platform is also helping manage HIV patient care in 12 facilities in the country, and is performing similar functions in seven clinics in Lesotho.
  • In Lima, Peru, OpenMRS research data management tools are being used to track the spread of multidrug-resistant tuberculosis. The tools were implemented in 2009 as part of a large National Institutes of Health study of MDR-TB transmission in Peru.
  • Haiti is PIH's longest operational site, with 12 existing hospitals. However, it was the last of the four main sites where PIH operates to begin using OpenMRS, as PIH had deployed an earlier EMR there to manage HIV patient care, prior to the creation of OpenMRS. In 2009, PIH started to implement OpenMRS in Haiti, beginning with the implementation of the MDR-TB system and extending to a pilot of a point-of-care primary care EMR at Lascahobas Hospital. PIH is working to open a new 312-bed teaching hospital in the town of Mirebalais, Haiti, which will serve a primary catchment area of 185,000 people and a tertiary catchment area of over 3,000,000. PIH expects to scale up its current OpenMRS models for the hospital once it is fully operational.

[See also: Haiti after the quake: Telehealth helps heal one of world's poorest.]

PIH is also building a point-of-care system that will be integrated into workflows at the hospital. Waters told AHRQ the new system would be an important evolution of PIH's prior work with OpenMRS, and should eventually be scaled to PIH's 12 sites in Haiti and the other countries where PIH operates. It will allow staff at the hospital to register every patient and capture cross-sectional information on important data points such as diagnoses and disposition. As the system matures, it will be expanded to support other program areas, such as women's health and surgery. This will provide a unique opportunity for real-time decision support, ranging from alerts for abnormal laboratory results and potentially risky drug orders to triaging emergency room patients based on vital signs and pain scores.

"The goal with the OpenMRS-based system at Mirebalais Hospital is to register every person who walks through the door, thereby improving data quality and making it efficient," says Waters.

See a video: "The Road to Mirebalais"