OpenMRS-Ebola Electronic Health Record System used in Sierra Leone

The prestigious, open access, Journal of Medical Internet Research recently published a study looking at the effectiveness of OpenMRS’ use during the 2014-2016 Ebola epidemic in West Africa. The article highlights the work of a team who developed new user-interface components for OpenMRS and rapidly deployed the system in an Ebola Treatment Centre (ETC) in Sierra Leone. The team, composed of members from OpenMRS, Save the Children International, Thoughtworks, The London School of Hygiene and Tropical Medicine, Partners In Health, University of Leeds, and Columbia University. The team came together in response to an urgent request for healthIT from colleagues at Save the Children International to develop an EHR suitable for deployment in a new Ebola treatment Centre being set up in Kerry Town outside the capital, Freetown.

The EHRs had to be easy to use by staff in the highly infectious “red zone” while using gloves and eye goggles and run on water-proof, sterilizable Android tablets. Rapid developmenta and distribution was critical as the Ebola epidemic was spreading. It was successfully deployed less than 4 months from the first request and 2 ½ months after the main development team from ThoughtWorks Inc. commenced work. Key features of the work included an “Agile” approach with daily communication between the development team and ground-based operations team, iterative processes, and phased development and implementation.

One of the main challenges when using paper-based data collection systems during an outbreak is acquiring patient data from the red zone. Using paper-based systems wasn’t an option due to health and safety concerns. Without an electronic system, communication was also a challenge where healthcare workers would shout, radio, or scan and digitize information to be sent over a local wireless network.

At the time of the Ebola outbreak, there was no EHR software that could be rapidly deployed in the affected areas. Most EHR systems are designed for the needs of high-income health facilities that have reliable power, network infrastructure, and technical support. Although many EHRs are designed for low-resource settings, their use in hospital settings, especially for intensive care, is limited. Furthermore, most EHRs were not flexible enough to be quickly modified to support the Ebola-specific use case.

OpenMRS-Ebola can support patient tracking (registration, bed allocation, and discharge); recording of vital signs and symptoms; medication, and intravenous fluid ordering and monitoring; laboratory results; clinician notes; and data export. It displays relevant patient information to clinicians in infectious and noninfectious zones. It was used for 112 patient registrations, 569 prescription orders, and 971 medication administrations before the ETC was shut down, due thankfully to a big drop in new Ebola cases. The phase 1 evaluation suggested that OpenMRS-Ebola worked well in the context of the rollout, and the user feedback was positive. We hope the experience from this project and the software produced will allow faster and more effective responses in future humanitarian crises.

OpenMRS is freely available to download and use at no cost; however, specific use cases may require additional development beyond the core platform. Save the Children International spent approximately US $50,000 for OpenMRS-Ebola where $38,000 was used for software development and $12,000 for hardware. ThoughtWorks donated approximately $260,000 through staff time, equipment, and travel. The cost of re-deploying the system with adaptations in a new emergency would be considerably less with reuse of the workflow, UI designs, and code.

The article in JMIR concluded the OpenMRS-Ebola EHR is well suited for patient records in an ETC because it allows for instant communication between infectious and noninfectious zones over a local wireless network, access to full clinical histories in both zones, and has a fast, easy UI suited to this difficult environment.

The full study can be found on JMIR’s website.

Oza S, Jazayeri D, Teich JM, Ball E, Nankubuge PA, Rwebembera J, Wing K, Sesay AA, Kanter AS, Ramos GD, Walton D, Cummings R, Checchi F, Fraser HS
Development and Deployment of the OpenMRS-Ebola Electronic Health Record System for an Ebola Treatment Center in Sierra Leone
J Med Internet Res 2017;19(8):e294
URL: http://www.jmir.org/2017/8/e294
DOI: 10.2196/jmir.7881
PMID: 28827211