KenyaEMR, the OpenMRS distribution in Kenya, has contributed significantly to providing accessible healthcare services by automating workflows and improving patient care and management. By providing a digitized and reliable platform, KenyaEMR reduces the dependency on paper-based systems, enabling healthcare facilities to automate tasks, such as outpatient and inpatient management, appointment scheduling, and easy access to patient medical histories, allowing healthcare professionals to monitor and share patient information more efficiently during diagnosis.
The new OpenMRS frontend framework (O3) introduces an intuitive user interface, making it easier for users to navigate and perform various clinical and non-clinical operations within healthcare facilities. In this article, you’ll learn how KenyaEMR supports healthcare delivery in thousands of public health facilities and EMR sites, how the OpenMRS 3 (O3) frontend framework has been instrumental to their growth, and how the team implemented O3 into KenyaEMR v3 to support healthcare facilities across Kenya.
Figure 1: KenyaEMR – a tailored distribution of OpenMRS
KenyaEMR is a customized version of OpenMRS originally developed by the University of Washington’s I-TECH Center (International Training and Education Center for Health) and currently managed by the team at Palladium-Kenya. Like other OpenMRS distributions, KenyaEMR has significantly reduced the workloads in various healthcare facilities, ensuring a smooth working experience for professionals and accessible healthcare services to patients.
KenyaEMR’s widespread acceptance and impact have been made possible through collaborative efforts from the Kenya Community of Practice, which includes partners from various hospitals, software groups, and healthcare organizations dedicated to delivering quality healthcare services in Kenya.
Figure 2: KenyaEMR Footprint in Kenya
Over the years, KenyaEMR has undergone various modifications to provide modern and efficient healthcare solutions. Initially, it focused on data collection with a basic user interface and limited features using the OpenMRS 1.0 RefApp. It then adopted a form-driven design with OpenMRS 2.0 RefApp, which supported only large or desktop screens. Today, with OpenMRS 3, KenyaEMR offers an enhanced user interface design with advanced functionalities.
Figure 3: KenyaEMR on OpenMRS v 3
KenyaEMR has evolved through various iterations to reach its latest version, KenyaEMR 3. This advancement stems from addressing users’ needs and incorporating innovations to provide a modern and improved medical record system.
Adoption of Microfrontend Architecture (2019)
In 2019, the team began discussions on adopting a micro-frontend architecture to enhance reusability and flexibility. After several meetings and in-depth discussions, the Palladium-Kenya team decided to proceed with this approach. This transition allowed us to divide the application into various modules and components, setting the stage for the implementation of O3.
Following the decision to use micro-frontends, the University of California, San Francisco (UCSF) and OpenMRS hosted a series of hackathons focused on innovating and automating service queues. These hackathons led to the development of the Service Queues and Appointment Management modules featuring an interactive calendar interface. The Palladium-Kenya team spearheaded the development of these modules, addressing challenges and ensuring effective resource allocation. Palladium-Kenya also began piloting O3 at six sites, introducing and implementing the new Appointment and Service Queue system modules. This was an important part of their OpenMRS 3 roll-out strategy: Users of KenyaEMR were very keen to have features for appointment and queue management, so this was a helpful way to introduce them to the OpenMRS 3 user interface, while still allowing the bulk of patient-chart-based work to use the previous KenyaEMR UI.
Did you know? OpenMRS 3 allows for a hybrid change-management approach. Because OpenMRS 3 uses the same backend database as older versions of OpenMRS, implementers can allow their users to still use their old interface for some functionalities, while using O3 for newer ones. KenyaEMR introduced O3 to users by first adding attractive new features built into O3, but still allowing users to use most of the same old features they were used to. Then, later, users were coached on how to use the rest of the EMR in O3-mode. See a short example video here. |
Figure 4: The team during a visit to the first Nairobi site for Service Queues
In Eldoret, Kenya, in 2022, AMPATH and Palladium-Kenya joined together in an OpenMRS 3 hackathon, where teams were assigned to develop various features for O3. AMPATH conducted capacity-building sessions on the O3 Form Engine and training of developers on the skills required for O3 development and form migration from HTML to the O3 environment. So began the process of migrating old forms into the latest version of OpenMRS 3 forms, and AMPATH organized a two-week hackathon that successfully converted over 60 forms from HTML to the O3 Forms JSON schema for use within the O3 Form Builder module.
Figure 5: The Palladium and AMPATH teams during the O3 hackathon in Eldoret, Kenya
In 2023, KenyaEMR developers began working on non-clinical modules, such as billing and inventory. While the OpenMRS community typically recommends that implementers use fit-for-purpose software for non-clinical workflows (such as Enterprise Resource Planning (ERP) software), the Palladium-Kenya team helped the community understand the need for some “Lite” billing and inventory modules for sites that are too small to warrant a full ERP system. Upon completion, these new modules were harmonized and integrated – together with the Kenyan organization HealthIT from the University of Nairobi – to ensure they met the required standards to support Kenya’s new UHC (Universal Health Coverage) programming. The KenyaEMR team also expanded the pilot phase to 24 sites.
In 2024, Palladium-Kenya conducted Training of Trainers (TOT) sessions to familiarize users with the latest upgrades and ensure they could effectively utilize the new technology. We also selected pilot sites for infrastructure assessments, educating users about the new capabilities through site visits and meetings. These trainings covered detailed sessions on all modules including system navigation, new forms, enhanced data capturing tools, and areas that improve reporting in strengthening the Ministry of Health Kenya efforts.
Figure 6: KenyaMHIS team during a training session with implementing partners on KenyaEMR 3
KenyaEMR 3 offers an improved version of KenyaEMR that leverages modern technologies to meet user needs. It is optimized for small screen sizes, such as tablets, ensuring a smooth user experience across multiple devices. Some of its latest features include:
Figure 7: Appointment Management in KenyaEMR 3
Figure 8: Service Queues in KenyaEMR 3
Figure 9: Patient Summary Dashboard in KenyaEMR 3
The growth and widespread adoption of KenyaEMR 3 owes much to the global community of implementers, developers, and users. Their dedication has been the driving force in advancing the software.
The KenyaEMR development team plays a vital role in the global squad and is responsible for creating and managing the OpenMRS appointment and service queues. This contribution has been transformative for patient care and management, providing a seamless experience for both healthcare professionals and patients.
Figure 10: KenyaEMR community members during an event
KenyaEMR team organizes a series of hackathons in collaboration with Jomo Kenyatta University of Agriculture and Technology (JKUAT) and the Ladies in Coding program. These events enable students to acquire relevant industry skills and improve their problem-solving skills while creating innovative digital health solutions and contributing to KenyaEMR.
Figure 11: Ladies in Coding Program students at the Grand Finale Ceremony, June 2024
KenyaEMR is a community-driven software that evolves based on users’ feedback and their experiences with the system. As the saying goes, “Users are the ultimate metric of success,” emphasizing the importance of listening to end-users to drive improvement. Insights and collaboration with end-users have greatly contributed to the growth of the KenyaEMR software.
Figure 12: Development and design teams getting feedback from Vihiga CRH O3 Pilot
The Software Development and Data Use teams are the core maintainers of KenyaEMR. Composed of experienced professionals, these teams manage resources and coordinate contributors to meet project requirements and deliver solutions. Their efforts are supported by service delivery partners, government institutions, HIS and religious organizations.
Figure 13: Software Development Team
Figure 14: KenyaEMR team during a brainstorming session
Our development partners and implementers have significantly contributed to the rapid implementation of KenyaEMR across various health facilities in Kenya. Their support has been instrumental in ensuring the effective deployment and utilization of KenyaEMR.
KenyaEMR 3 is achieving remarkable success and making a great impact. We anticipate further advancements and innovations in KenyaEMR and OpenMRS, continuing to enhance healthcare delivery and outcomes.
Figure 15: OpenMRS Implementers during a conference
Once you have used the course and documentation to onboard yourself to O3’s technology, we welcome developer newcomers to the O3 community! Here are some helpful community touchpoints you may wish to explore: