Last week I had this great opportunity to be a participant at the fifth annual OpenMRS implementers meeting in Cape Town. The meeting brought together implementers, developers and the leadership of OpenMRS. The meeting was of the 'unconference' style and being relatively less experienced with OpenMRS, I found myself simply following through the intense sessions, soaking up a lot of knowledge and insights. There were many lessons and great experiences including ideas on how to actualize the dream in my earlier post on adopting OpenMRS in Kenya. I shall try and describe three of them in this post - based on my personal synthesis.
Lesson 1: Clinical Systems Not Reporting Systems
During one of the evening discussions with Dr. Alvin Marcelo and a few others round a dinner table, I had this bulb light somewhere in my mind that 'Really, medical record systems need not be seen as reporting tools'. In fact, to some health care practitioners, that the medical records system assists in retrieving a patient's medical history and perhaps assists in diagnosis is all that should be expected of the system. To them, other information management issues including aggregation of patient and treatment statistics for what we know as monitoring and evaluation - (read reporting) is almost out of scope for a medical records system. The idea that an EMR system needs to primarily address the health care givers' information requirements at their points of care implies that national Monitoring and Evaluation (M&E) and reporting needs become secondary in an EMR. These observations got me thinking that perhaps the efforts to have electronic medical records systems (EMR) in Kenya will not necessarily yield the desired expectations. In Kenya, the National STI and AIDS control program (NASCOP) and the division of Health Information Systems (HIS) in the Ministry of Public Health and Sanitation have over the last couple of years been working hard towards having elaborate EMR systems used at the country's public health facilities. With the country's drive for implementation of EMR systems being 'national reporting', it appears NASCOP and the division of HIS might be better off concentrating efforts on district health information systems such as DHIS2. It should be possible to allow for diverse EMR systems that support the SDMX-HD protocol for data exchange with the DHIS system to facilitate upward aggregation of data - hence national reporting. This of-course is not to disregard the need to foster data use and M&E at the administrative level of health facilities.
Lesson 2: Symbiotic Relationships Paramount
It is fairly easy for health experts to say that the field of health information systems (eg medical record systems) is their exclusive domain. Such a perspective can be 'legitimized' by many valid arguments to the extent that the relevance of input from other professions can be seriously downplayed. Conversely, from a different perspective, information systems experts can easily 'justify' why health information systems is their domain. When these perspectives are not adequately reconciled, there exists a high probability that in an health information systems implementation, either the health or the information systems aspects will fail to be optimized on. During the meeting, several participants emphasized that the development and implementation of successful medical records system calls for a symbiotic relationship between health care professionals and IT professionals. Moreover, health information systems implementation require meaningful engagement of all would-be beneficiaries. This was well summarized in Chris Bailey's observation that "if you want the truth about an Electronic Health Records system implementation, talk to the nurse".
Lesson 3: Who and What really is OpenMRS?
Am sure this is a lingering question in most readers' minds. To me the question was answered better during the meeting. A plenary session with Dr. Paul Biondich helped to understand the idea that OpenMRS is both a global community and a software platform. It is a non-profit, multi-institution collaborative. Its mission is to improve health care delivery in resource-constrained environments by coordinating a global community that creates a robust, scalable, user driven, open source medical records system platform. From a different perspective, OpenMRS is also a software platform and a reference application which enables design of a customized medical records system. One more related learning point was that there was an on-going undertaking to incorporate a non-profit organization that would facilitate a more proactive pursuit of the community's mission.
In general there was a sense that for a health information systems initiative like OpenMRS, maintaining a balance between meeting health care delivery and software evolution objectives is paramount. Some nice photos of the meeting can be found here as posted by John Wesonga
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