Challenges – can’t really upgrade because application running the database, not integration level
Application development is on core features, we need customized things that work well in hospital setting, data collection up front and not having a place to do something with the data (M&E, reporting, point-of-care w/ interactivity of data)
Solutions – get confidence in the system and then build
Success – we have a lot of data, but data is not as reliable (soln – don’t do everything that is possible, but do things to a minimum to get it done)
Gilbert – AMPATH
It is scalable and robust enough to make information
Challenges – viruses, networks breaking down, no major issues with the system, lack of basic knowledge for daily running and maintenance of the system
Solutions – need IT support that is local, people need to know how to install and get services running, need knowledge in customization to fit forms to the situation that way it is easily adapted for use
PIH Rwanda
Using OMRS since 2006
Successes – OMRS is not only based on data entry people, clinicians are using it and are being trained so they can look on the machines in the consultation rooms, having patient lookup and patient summary; instead of only producing reports, they can go under their own username and have patient summary and looking at clinical history
Challenges – sometimes you can’t find the electricity in rural areas, collaboration
Solutions – PIH implemented generators and solar power
Andy Kanter – MVP
Primary care, rural implementation
Challenges – electricity, connectivity and bringing data together (have not explored Sync yet), need to provide feedback immediately to users (not yet solved how to in primary care setting to provide value to ppl immediately coming in for chronic and pediatric care), integration with the moving target of MoH reporting and reducing redundancy (soln – possible automation), HR capacity (networking, maintaining computer) (soln – deep freeze to lock computer and take care of viruses), train providers and people who maintain the servers (led to more centralized approach such as forms for central place for data entry), interaction with the community (rapid SMS – identifying pregnant women in the community), access to data
Soultion – solar power
Success – pivot table to access data on systems such as Microsoft Excel
John – AMPATH
Challenges – connectivity (depend on synching once/wk which gives problems for MoH reporting), capacity building (clinics to have ppl generate reports on their own)
Septarshi – HISP India
Challenges – train people and have them use the applications , trying to understand what real-use case is in district hosptials
Solutions – build new modules – billing, pharmacy, participatory design mockups (implement it for a week and collect information on experiences….slow process but more fruitful)
Success – good community around it and will help the system build up quickly, to get good feedback you need to deploy something and make it sustainable for people to use (sustainable = 1mth or so)
Roger – CDC – Panama
Challenges – geting used to the entire stack of applications and breadth of OMRS (steep learning curve), this was a national system (no ramp-up time), inability to have easy way to do iterations, hard to have multiple ppl working on the same things, expect more of customization process than development process (not quite the experience we had when we went into it)
Solutions – find a network or central model/design process
Hamish – PIH
Solutions – start with the goals and what you want from it
Challenge – number of people you need to do data entry
Solution –
Implementation Advice
Provide right data at the right time
Clean up the data that you have before you corporate data for other programs
Collect data that you are user someone will use and is really needed
Paper based forms are not necessarily the best template for html form
Understand the system environment
System manager function is important – have right ppl trained and capable
Make sure your data collection tools meet the usage requirements
If it’s a large network, have good data manager
Identify customer, know their needs, respond to needs
Need good support system
Don’t build concepts from scratch, use what exists in concept server
Provide early and often feedback on data back to ppl doing data collection
Involve the clinicians and have them use OMRS more often to get more information that you need
Have good training for those who will use OMRS to have better quality data
Don’t try to replace your whole paper-based system with the system, think about raw essentials you need and scale from there (patient registration, lab orders, pharmacy, obs)
Don’t operate it under faulty IT issues, have in place a system that gives feedback so you know data is useful enough and change it if you need to improve it
Don’t listen to what people are using the system tell you – have them show you
Steven – WHO
Suggests for people to share, blog experiences because many have the same situation
Andy Kanter
Questions (unanswered)
Virus issues
Connectivity is the root – if a computer isn’t always connected, it doesn’t receive updates and then you have multiple flashdrives being used
Frank Tilugulilwa - University Computing Centre Ltd - Tanzanoa
Support issue to clinicians in remote areas
Possibilities of overhauling these sites to Linux servers instead of Windows for stability e.g virus, clashes etc
Andrew
Getting qualified people to work in remote areas
Roger – some countries have 1yr of service where you can have IT students come work for you and they receive stipend from the government
Steve
ICDL – International Computer Driver License
Interested in health tracks and scaled down versions in other settings
IT Infrastructure Library (ITIL)? - a global framework for IT Best Practices