OpenMRS
Encyclopedia
Open source
The term open source describes practices in production and development that promote access to the end product's source materials. Some consider open source a philosophy, others consider it a pragmatic methodology...
project to develop excellent software to support the delivery of health care in developing countries. It grew out of the critical need to scale up the treatment of HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
in Africa
Africa
Africa is the world's second largest and second most populous continent, after Asia. At about 30.2 million km² including adjacent islands, it covers 6% of the Earth's total surface area and 20.4% of the total land area...
but from the start was conceived as a general purpose electronic medical record system that could support the full range of medical treatments. The first ideas and prototype of OpenMRS were conceived by Paul Biondich and Burke Mamlin from the Regenstrief Institute
Regenstrief Institute
The Regenstrief Institute, Inc. is a private, non-profit research organization affiliated with the Indiana University School of Medicine and based in Indianapolis. It was founded in 1969 by Sam Regenstrief...
, Indiana
Indiana
Indiana is a US state, admitted to the United States as the 19th on December 11, 1816. It is located in the Midwestern United States and Great Lakes Region. With 6,483,802 residents, the state is ranked 15th in population and 16th in population density. Indiana is ranked 38th in land area and is...
on a visit to the AMPATH project in Eldoret, Kenya
Eldoret
Eldoret is a town in western Kenya and the administrative centre of Uasin Gishu District of Rift Valley Province. Lying south of the Cherangani Hills, the local elevation varies from about 2100 metres above sea level at the airport to more than 2700 metres in nearby areas...
in February 2004. Around the same time the EMR
Electronic medical record
An electronic medical record is a computerized medical record created in an organization that delivers care, such as a hospital or physician's office...
team at Partners In Health
Partners In Health
Partners In Health is a Boston, Massachusetts-based non-profit health care organization dedicated to providing a "preferential option for the poor". It was founded in 1987 by Dr. Paul Farmer, Ophelia Dahl, Thomas J. White, Todd McCormack, and Dr...
led by Hamish Fraser and Darius Jazayeri were looking at ways to scale up the PIH-EMR web-based medical record system developed to manage drug resistant tuberculosis
Multi-drug-resistant tuberculosis
Multi-drug-resistant tuberculosis is defined as TB that is resistant at least to isoniazid and rifampicin , the two most powerful first-line anti-TB drugs...
in Peru
Peru
Peru , officially the Republic of Peru , is a country in western South America. It is bordered on the north by Ecuador and Colombia, on the east by Brazil, on the southeast by Bolivia, on the south by Chile, and on the west by the Pacific Ocean....
, and HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
in rural Haiti
Haiti
Haiti , officially the Republic of Haiti , is a Caribbean country. It occupies the western, smaller portion of the island of Hispaniola, in the Greater Antillean archipelago, which it shares with the Dominican Republic. Ayiti was the indigenous Taíno or Amerindian name for the island...
. Paul, Burke and Hamish met in September 2004 at the Medinfo
Medinfo
MEDINFO is the name of the international medical informatics conference organized every 3 years by the International Medical Informatics Association. It is the most important international conference in the field with 3000+ health and medical informatics professions attending from all over the world...
conference in San Francisco, and recognized they had a common approach to medical information systems and a similar philosophy for healthcare and development and OpenMRS was born. Later, Chris Seebregts of the South African Medical Research Council (MRC) became the fourth founding member.
OpenMRS is founded on the principles of openness and sharing of ideas, software and strategies for deployment and use. The system is designed to be usable in very resource poor environments and can be modified with the addition of new data items, forms and reports without programming. It is intended as a platform that many organizations can adopt and modify avoiding the need to develop a system from scratch.
Design
OpenMRS is based on a "concept dictionary" that describes all the data items that can be stored in the system such as clinical findings, laboratory test results or socio-economic data. This approach avoids the need to modify the database structure to add new diseases for example, and facilitates sharing of data dictionaries between projects and sites. An important features of OpenMRS is its modular construction which allows the programming of new functions without modifying the core code. OpenMRS is web based but can be deployed on a single laptop or on a large server and runs on LinuxLinux
Linux is a Unix-like computer operating system assembled under the model of free and open source software development and distribution. The defining component of any Linux system is the Linux kernel, an operating system kernel first released October 5, 1991 by Linus Torvalds...
, Windows
Microsoft Windows
Microsoft Windows is a series of operating systems produced by Microsoft.Microsoft introduced an operating environment named Windows on November 20, 1985 as an add-on to MS-DOS in response to the growing interest in graphical user interfaces . Microsoft Windows came to dominate the world's personal...
or Mac OS X
Mac OS X
Mac OS X is a series of Unix-based operating systems and graphical user interfaces developed, marketed, and sold by Apple Inc. Since 2002, has been included with all new Macintosh computer systems...
.
Other key features of OpenMRS:
- Built on the MySQLMySQLMySQL officially, but also commonly "My Sequel") is a relational database management system that runs as a server providing multi-user access to a number of databases. It is named after developer Michael Widenius' daughter, My...
database (but uses HibernateHibernate (Java)Hibernate is an object-relational mapping library for the Java language, providing a framework for mapping an object-oriented domain model to a traditional relational database...
allowing it to be ported to other databases) - programmed in JavaJava (programming language)Java is a programming language originally developed by James Gosling at Sun Microsystems and released in 1995 as a core component of Sun Microsystems' Java platform. The language derives much of its syntax from C and C++ but has a simpler object model and fewer low-level facilities...
- Includes tools for data export and reporting
- Versions currently exist for HIV/AIDSAIDSAcquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
, Drug resistant TBMulti-drug-resistant tuberculosisMulti-drug-resistant tuberculosis is defined as TB that is resistant at least to isoniazid and rifampicin , the two most powerful first-line anti-TB drugs...
, primary carePrimary carePrimary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...
and oncologyOncologyOncology is a branch of medicine that deals with cancer... - Supports open standards for medical data exchange including HL7, LOINCLOINCLogical Observation Identifiers Names and Codes is a database and universal standard for identifying medical laboratory observations. It was developed and is maintained by the Regenstrief Institute, a US non-profit medical research organization, in 1994...
and IXF
New features:
- New open source form based tools, OpenXdata, and HTMLForm entry
- Tools to link to hand held devices and cell phones (JavaROSA project)
- Research data collection tools for clinical trials and community data collection projects
- A "logic service" that allows clinical alerts and reminders to be created in a medical standard Arden Syntax
- Support for report generation and transmission to national reporting systems like DHIS and TRACnet using the SDMX-HD standard
Currently being tested:
- Tools for data synchronization between systems connected by slow or unreliable internet
- User interface improvements
- Links to cell phone based data collection and messaging tools using SMS
- Touch screen patient registration systems supporting bar coded patient IDs, in collaboration with Baobab Health Systems
Deployments
The first deployment was in Eldoret, KenyaEldoret
Eldoret is a town in western Kenya and the administrative centre of Uasin Gishu District of Rift Valley Province. Lying south of the Cherangani Hills, the local elevation varies from about 2100 metres above sea level at the airport to more than 2700 metres in nearby areas...
in February 2006 followed by the PIH hospital in Rwinkwavu, Rwanda
Rwanda
Rwanda or , officially the Republic of Rwanda , is a country in central and eastern Africa with a population of approximately 11.4 million . Rwanda is located a few degrees south of the Equator, and is bordered by Uganda, Tanzania, Burundi and the Democratic Republic of the Congo...
in August 2006 and Richmond Hospital in the KwaZulu-Natal
KwaZulu-Natal
KwaZulu-Natal is a province of South Africa. Prior to 1994, the territory now known as KwaZulu-Natal was made up of the province of Natal and the homeland of KwaZulu....
province of South Africa
South Africa
The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...
later that year. As of March 2010, OpenMRS is in use in at least 23 developing countries (mostly in Africa
Africa
Africa is the world's second largest and second most populous continent, after Asia. At about 30.2 million km² including adjacent islands, it covers 6% of the Earth's total surface area and 20.4% of the total land area...
) and it has been used to record over 1 million patient records around the world. Most deployments are run by independent groups who carry out the work on the ground with technical support and training provided by the core team of OpenMRS developers, and other implementers. There have been four annual OpenMRS meetings in South Africa, organized by Chris Seebregts, who also leads the OpenMRS implementers community. Shorter meetings were held in Boston
Boston
Boston is the capital of and largest city in Massachusetts, and is one of the oldest cities in the United States. The largest city in New England, Boston is regarded as the unofficial "Capital of New England" for its economic and cultural impact on the entire New England region. The city proper had...
in May 2009, and a developer training in Indianapolis in February 2010. There are five known deployments supporting clinical care in the US - three in Indianapolis
Indianapolis
Indianapolis is the capital of the U.S. state of Indiana, and the county seat of Marion County, Indiana. As of the 2010 United States Census, the city's population is 839,489. It is by far Indiana's largest city and, as of the 2010 U.S...
, one in Los Angeles
Los Ángeles
Los Ángeles is the capital of the province of Biobío, in the commune of the same name, in Region VIII , in the center-south of Chile. It is located between the Laja and Biobío rivers. The population is 123,445 inhabitants...
, and one in Maryland
Maryland
Maryland is a U.S. state located in the Mid Atlantic region of the United States, bordering Virginia, West Virginia, and the District of Columbia to its south and west; Pennsylvania to its north; and Delaware to its east...
. OpenMRS use will be expanded in Haiti
Haiti
Haiti , officially the Republic of Haiti , is a Caribbean country. It occupies the western, smaller portion of the island of Hispaniola, in the Greater Antillean archipelago, which it shares with the Dominican Republic. Ayiti was the indigenous Taíno or Amerindian name for the island...
to assist with the patients recovering from the January 2010 earthquake
2010 Haiti earthquake
The 2010 Haiti earthquake was a catastrophic magnitude 7.0 Mw earthquake, with an epicentre near the town of Léogâne, approximately west of Port-au-Prince, Haiti's capital. The earthquake occurred at 16:53 local time on Tuesday, 12 January 2010.By 24 January, at least 52 aftershocks...
.
Support
OpenMRS is supported by core teams from Partners In HealthPartners In Health
Partners In Health is a Boston, Massachusetts-based non-profit health care organization dedicated to providing a "preferential option for the poor". It was founded in 1987 by Dr. Paul Farmer, Ophelia Dahl, Thomas J. White, Todd McCormack, and Dr...
, Regenstrief Institute
Regenstrief Institute
The Regenstrief Institute, Inc. is a private, non-profit research organization affiliated with the Indiana University School of Medicine and based in Indianapolis. It was founded in 1969 by Sam Regenstrief...
, and the South African Medical Research Council
South African Medical Research Council
The South African Medical Research Council is a para-statal medical research organisation in South Africa. Its mission is To improve the nation's health status and quality of life through relevant and excellent health research aimed at promoting equity and development. The current president is...
. Other organizations that collaborate on OpenMRS are the Millennium Villages Project
Millennium Villages Project
The Millennium Villages Project is a project of the Earth Institute at Columbia University, the United Nations Development Programme, and Millennium Promise....
, based at Columbia University
Columbia University
Columbia University in the City of New York is a private, Ivy League university in Manhattan, New York City. Columbia is the oldest institution of higher learning in the state of New York, the fifth oldest in the United States, and one of the country's nine Colonial Colleges founded before the...
, and Baobab Health Systems in Malawi
Malawi
The Republic of Malawi is a landlocked country in southeast Africa that was formerly known as Nyasaland. It is bordered by Zambia to the northwest, Tanzania to the northeast, and Mozambique on the east, south and west. The country is separated from Tanzania and Mozambique by Lake Malawi. Its size...
. There are several groups of programmers working on OpenMRS in developing countries including Kenya
Kenya
Kenya , officially known as the Republic of Kenya, is a country in East Africa that lies on the equator, with the Indian Ocean to its south-east...
, Rwanda
Rwanda
Rwanda or , officially the Republic of Rwanda , is a country in central and eastern Africa with a population of approximately 11.4 million . Rwanda is located a few degrees south of the Equator, and is bordered by Uganda, Tanzania, Burundi and the Democratic Republic of the Congo...
, Uganda
Uganda
Uganda , officially the Republic of Uganda, is a landlocked country in East Africa. Uganda is also known as the "Pearl of Africa". It is bordered on the east by Kenya, on the north by South Sudan, on the west by the Democratic Republic of the Congo, on the southwest by Rwanda, and on the south by...
, South Africa
South Africa
The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...
, Pakistan
Pakistan
Pakistan , officially the Islamic Republic of Pakistan is a sovereign state in South Asia. It has a coastline along the Arabian Sea and the Gulf of Oman in the south and is bordered by Afghanistan and Iran in the west, India in the east and China in the far northeast. In the north, Tajikistan...
, Chile
Chile
Chile ,officially the Republic of Chile , is a country in South America occupying a long, narrow coastal strip between the Andes mountains to the east and the Pacific Ocean to the west. It borders Peru to the north, Bolivia to the northeast, Argentina to the east, and the Drake Passage in the far...
, and India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...
. In Rwanda, a training program for software developers to learn advanced Java skills and OpenMRS development, graduated 10 students in October 2009 after an intensive 11-month training program. Nine graduates are currently working on OpenMRS and related eHealth
EHealth
eHealth is a relatively recent term for healthcare practice supported by electronic processes and communication, dating back to at least 1999...
technologies.
Community
The OpenMRS community includes developers, implementers, and users from multiple countries who collaborate through mailing lists, [irc://irc.freenode.net#openmrs IRC], and annual conferences. OpenMRS has participated in Google Summer of CodeGoogle Summer of Code
The Google Summer of Code is an annual program, first held from May to August 2005, in which Google awards stipends to hundreds of students who successfully complete a requested free or open-source software coding project during the summer...
in 2007, 2008, 2009, and 2010; according to that program's manager, than the Apache Software Foundation
Apache Software Foundation
The Apache Software Foundation is a non-profit corporation to support Apache software projects, including the Apache HTTP Server. The ASF was formed from the Apache Group and incorporated in Delaware, U.S., in June 1999.The Apache Software Foundation is a decentralized community of developers...
.