<html><head><title></title></head><body>Venue: Tree Tops
Moderated by Andy Kanter and Hamish Fraser
Note taker: (Isaacholeman 12:39, 16 September 2009 (EDT))
Examples of OMRS for primary care:
Millennium Villages Project in 10 African countries
RwandaÃ¢â‚¬â„¢s Ministry of Health
Hospital Albert S in Haiti - James Arbaugh
Baobab in Malawi
MVP's experience trying to achieve the millennium dev goals at cost of about $110 per person per year.
They use OpenMRS for:
sharing data across sites, languages
integrating with existing ministry of health systems
primary care is the main reason for using the system Ã¢â‚¬â€œ also see HIV, TB, etc. patients, so it's really comprehensive care.
Started with AMPATH concept dictionary, increased it to capture initial encounters in rural villages. They are doing retroactive data entry (not point of care) for:
vitals and registration
birth and death forms
verbal autoposy forms
antenatal and family planning visits
Jonathan Dick about MVP in Uganda
They are currently drastically reducing the amount of information they are collecting.
Design your forms based on the specific interventions you intend to do. If you only have a few drugs and can only do a few lab tests, only collect data relevant to decisions regarding those interventions.
Baobab has streamlined the process for out patients, using diagnosis coded by national system. Rwanda is coding using snomed. Looking at 100-200 concepts (as opposed to MVPs 30k).
It's very important to make sure entering data doesnÃ¢â‚¬â„¢t slow down care where health care providers are already overburdened. One third of a page form is pushing it for primary care.
Carol: For primary care it makes sense to move away from forms. Primary care should be defined in a modeling manner first.
Side discussion: if you are stocked out of live saving treatments, it's vital that you use your info system to document the shortages and make the case for a more effective supply chain.
Point of care versus retroactive data entry:
Point of care info and decision support may be even more helpful in primary care, but there are still challenges to implementing such systems in many resource poor environments.
You are not just capturing name of disease, drug, etc. Sometimes you need to look at drugs to figure out what the diagnosis was (diagnose diarrhea and prescribe malaria drugs).
The capacity required, need to train clinicians to go to a point of care system is large.
Electricity is a major issue for point of care systems Ã¢â‚¬â€œ point of care the whole system breaks when you loose power and backup batteries run out.
When you consider challenges/benefits of point of care, consider the amount of time that your institution spends looking for needed charts. If point of care can mean you don't need to look for charts anymore, it may pay for itself in terms of staff time.
point of care: have you looked at mobile devices that don't need stable electricity?
PDAs: Andy Kanter feels the info they want to collect within clinic are too much for PDA screen size.
Martin of AMPATH says much of primary care discussion intersects with chronic disease management. You can get into a big mess if Ã¢â‚¬Å“primary careÃ¢â‚¬Â module is expected to record everything. Ampath is breaking comprehensive TB, antenatal, well child clinic (esp immunization info). Managing multiple providers per encounter is another big issue.
Carol mentions her group has defined 11 processes or modules of primary care, such as maternal care, geriatric etc.
Note: In many settings the vast majority of cases are acute care not chronic issues. The information requirements are different in these settings Ã¢â‚¬â€œ examining/recording longitudinal information wastes time if 85+% of cases are one of 3 infectious diseases or an obvious injury.
Reimbursement for primary care clinics:
Primary care is often drastically under funded, but being able to electronically document care and drugs dispensed can increase funding very much.
In Rwanda they are beginning to look at how they can feed OpenMRS for billing.
Andy notes that the things providers prescribe are not always what gets distributed, pharmacy only records what is dispensed and paid for, so it can be more accurate.
For primary care it might be very helpful to have a module that would manage cost and practice management information.
Richard on OMRS for primary care in Rwanda. Key functionality:
lab data for various diseases
pharmacy, including dispensing and stock management