UgandaEMR+ O3 Success Story: UgandaEMR’s Journey with OpenMRS 3

UgandaEMR, an electronic medical record (EMR) system first released by the Ministry of Health (MoH) in July 2016, has become a widely used digital health solution across various healthcare facilities in Uganda. EMR systems like UgandaEMR have significantly improved patient management, clinical documentation and reporting throughout the country. 

In this article, you’ll learn how UgandaEMR – a tailored distribution of OpenMRS supports healthcare delivery in thousands of public health facilities, how the OpenMRS 3 (O3) frontend framework has been instrumental to their growth, and how the team implemented O3 into UgandaEMR+ to support healthcare facilities across Uganda.

UgandaEMR+: An Overview

UgandaEMR+ uses the latest version of OpenMRS, O3. It is managed by the Monitoring and Evaluation Technical Support (METS) team at Makerere University School of Public Health (MakSPH) with guidance from the Ministry of Health. Like other OpenMRS distributions, UgandaEMR has significantly reduced the workloads in various healthcare facilities, ensuring a smooth working experience for professionals and accessible healthcare services to patients.

Originally designed to support HIV care in Uganda, UgandaEMR+ has grown to be implemented in over 1,700 health facilities, supporting a wide range of healthcare services and automating patient care and management in Uganda. UgandaEMR+ provides a reliable and user-friendly platform accessible across multiple devices, enabling clinicians to efficiently carry out their daily activities while ensuring that patients receive adequate and responsive healthcare services. 

UgandaEMR+ is available in various customized versions such as General, Prison, Uganda Peoples’ Defence Forces (UPDF), MU-JHU Maternal Child Health (MCH), and ISS Youth Clinic customizations, all supporting a wide range of organizations and patients throughout Uganda. Additionally, the  UgandaEMR mobile application ensures that every user is catered to regardless of internet connectivity or limited access to technology.

Development Journey of UgandaEMR+

Over the years, UgandaEMR has undergone a few modifications to provide continuous, modern, and efficient healthcare solutions. From being a system designed to combat the spread of HIV, it has evolved into a comprehensive system that manages patient care from reception and queuing to receiving adequate healthcare services. UgandaEMR+ has significantly contributed to enabling healthcare professionals to monitor patients’ health and provide accurate diagnoses effectively.

Stratified Systems across Implementing Partners (2003)

In 2003, each Implementing Partner had its own system for HIV prevention and care. There was no consistent system to facilitate data sharing across different organizations. Each partner created a system tailored to their specific needs, resulting in varying functionalities depending on the organization’s level and tasks. Examples of systems used for HIV prevention and care include IQCare, CareWare, EpiInfo, and Access. However, the lack of standardization made it difficult for partners to collaborate or share data effectively.

HIV Clinic EMR Pilot System (2008)

In 2008, an OpenMRS pilot system was adopted and implemented in 3 Uganda HIV clinics to support patient care and management. By 2011, the OpenMRS pilot system had expanded to an additional 20 HIV clinics, and within six years, it was adopted by 200 clinics, primarily in the Western and Southern regions of Uganda. Implementing Partners were impressed by the idea of having a unified, open-source digital health management system with a global community of developers and implementers working collaboratively to ensure its reliability and efficiency. OpenMRS also reduced the costs associated with each clinic managing its own system, enabling implementers to work together, discuss common issues, and suggest improvements to the software.

UgandaEMR Customization and Implementation (2015)

In 2015, MOH Uganda and MakSPH-METS partnered to customize OpenMRS for use in Ugandan clinics, transitioning UgandaEMR from an HIV-specific system to a general digital healthcare solution that accommodates various health issues, diagnoses, and management needs. UgandaEMR became widely used across the country and implemented in 1,700 clinics to support the daily operations of healthcare professionals and enhance patient care and management.

UgandaEMR Over the Years: Lightning Talk, OpenMRS Conference, Sept 2024 https://youtu.be/WF9eS8sKT0Y?feature=shared 

UgandaEMR+: What’s New?

UgandaEMR+ continues to evolve. Current improvements focus on improving disease tracking, laboratory systems, data exchange, and infrastructure support. Leveraging O3, UgandaEMR+ adopts modern technologies to create a software solution optimized for small screen sizes, such as tablets, ensuring a smooth user experience across multiple devices. Some of its latest features include:

• Easy-to-use and Intuitive User interface

UgandaEMR+ offers an improved and intuitive user interface that is easy to navigate and leverages modern technologies, such as React, to deliver highly performant, reusable, and shareable UI components. With O3, UgandaEMR+ adopts modern design principles to create a consistent user interface that renders data effectively within various UI components.

• Role-Based Access Control for HealthCare Teams

UgandaEMR+ supports the diverse roles of healthcare teams. For instance, when a patient arrives at a facility, they are first registered into the queuing system at the reception. Triage nurses then log into the system to record the patient’s vital signs, which are automatically forwarded to the appropriate clinician or lab technician based on the patient’s needs. Clinicians can access the patient’s dashboard to review medical history, conduct assessments, and order medications from the pharmacy. The pharmacy staff, in turn, can access the patient’s data to dispense the prescribed medication.

Additionally, UgandaEMR+ features a stock-taking module that allows pharmacists to manage inventory by ordering medical supplies and clinical tools directly within the system. The role-based access control in UgandaEMR+ ensures that each team member has the appropriate permissions to perform their tasks, reducing the potential for conflicts and ensuring smooth operation across the facility.

• Improved Appointment and Service Queues

UgandaEMR+ simplifies the process of managing patient appointments and service queues. It registers patient visits using various forms of identification, tracks the number of visits, and ensures orderly in/outpatient management. It streamlines appointment scheduling by evenly distributing workloads across the week, preventing healthcare professionals from being overwhelmed on particular days. UgandaEMR+ allows healthcare facilities to view and schedule appointments, ensuring balanced workloads and improved patient care.

• Complete Healthcare Facility Management

UgandaEMR+ provides comprehensive patient care and management through an easy-to-use system for tracking patient visits and medical history. It also integrates the O3 stock management and billing modules, enabling healthcare professionals to track and manage payments. The pharmacy can also dispense drugs to patients and order medical supplies from their sources directly within the system. UgandaEMR+ is a complete healthcare facility management system that ensures accessible and high-quality healthcare services are available to patients.

Figure 1: UgandaEMR+ Point of Care Workflow

Community Impact: Making UgandaEMR+ Possible

In May 2022, the OpenMRS team collaborated with METS and SPIRE representatives during a hackathon in Jinja, Uganda, to prepare an O3 pilot focused on Cervical Cancer and Maternal Child Health (MCH), covering Maternity, Antenatal Care (ANC), Postnatal Care (PNC), and Early Infant Diagnosis (EID). The hackathon focused on three main areas: building forms, packaging the necessary content for MCH+, and developing reporting mechanisms.

Figure 2: A community session showcasing the initial version of an O3-equipped distro.properties file for UgandaEMR.

Figure 3: An introductory session to the slots and extensions system of O3, using OHRI.

In line with the Ministry of Health’s directive to institutionalize patient-level digital systems at the point of care and transition to paperless operations by 2026, the METS team, in collaboration with the MOH and other partners, has begun training and system activation at selected facilities. This effort includes ongoing work to establish national coordination and upgrade additional sites. As part of this initial phase, the MOH has designated ten high-volume sites, including two in Kampala and eight regional referral hospitals, to showcase paperless clinics by the end of 2024.

Figure 4: UgandaEMR+ training session with healthcare workers from Kawaala HCIV and Kisenyi HCIV

Figure 5: A training session with clinicians on the developed POC workflows for HIV and TB clinics.

UgandaEMR+ uses a combination of Retrospective Data Entry, Point of Care, and the UgandaEMR mobile application to ensure accessible and high-quality healthcare services are available to patients through digitized forms. In March 2024, the METS team began piloting and rolling out UgandaEMR+ in collaboration with the Baylor Foundation and Reachout Mbuya in the Kampala region. The process included conducting entry meetings at both the healthcare facilities and the Baylor Bunyoro offices, upgrading the facilities’ UgandaEMR systems to the UgandaEMR+ version, and providing orientation to the facility teams on how to use UgandaEMR+. As of now, 24 facilities have successfully upgraded to UgandaEMR+.

Figure 6: A monitoring tool by the METS team showing daily UgandaEMR+ usage across facilities.

Special thanks to the Ministry of Health-Uganda, Monitoring and Evaluation Technical Support (METS), Baylor Foundation, Reachout Mbuya and implementing partners  for working tirelessly to ensure that UgandaEMR+ is implemented in more healthcare facilities. Their efforts are crucial in making modern healthcare services available across Uganda.

You can find a detailed Demo here: UgandaEMR+ Demo & Discussion with OpenMRS Community, Oct 2023