Have you implemented OpenMRS? Please participate in the Implementation Site Survey. If you already have, thank you!
There are individual installations where each installation is based at a facility (no guarantee of a consistent Internet connection), and is at the same version (OpenMRS, HTML forms, concepts and other metadata) - but there is a need to bring the patient records (or extracts) together to a central database. Site level users and metadata are not synced, neither are concepts and forms, as they are expected to be similar. The merged data (father instance) would be read-only, used reporting and analysis purposes.