PEOPLE’S EMRScaling across multiple countries

THE STORY SO FAROur journey

2

Jan Swasthya Sahyog

3

▪ Pro-poor hospital in the most underdeveloped part of central India

▪ High quality patient care▪ Appropriate technology▪ We love JSS for their social mission

JSS - EMR

4

▪Rescue of a year and half old EMR project▪ Started off as a project (not product)▪ EMR that meets the needs of the clinicians

Why only JSS?

5

▪OpenMRS and Odoo provided generic platform▪Widespread need for such a system

What is Bahmni

6

o EMRo Hospital Systemo OpenMRS distributiono Open Source, AGPLo Multiple Open Source Productso Developed by ThoughtWorkso For community of implementers

BAHMNIThe tapestry of open source

7

LOW RESOURCE SETTINGWhat are the constraints? What are the available resources?

8

9

BahmniThe Village

BAHMNIUsability to enable better patient-care is the focus of the product

10

Bahmni Goals

11

▪ Improve quality of patient care and health of community

▪ Accessible, easy to use and implement▪ Build community that takes Bahmni places where

ThoughtWorks cannot▪ For the Global South▪ Community to Tertiary Care

BAHMNI AND THOUGHTWORKS

12

▪ Committed for the long term▪ Social mission▪ Largely funded by ThoughtWorks▪ Doing implementations to learn and develop the

right product▪ Majority of implementations done by the

community not by ThoughtWorks

ARCHITECTURE

13

Apache Web Server

Bahmni MRS Frontend

(JavaScript, HTML5, AngularJS)

OpenMRS Server(REST API)

Java

OpenMRS DB(MySQL)

Browser

Server (Linux)

User’s Machine

OpenERP Server(XML-WS API)

Python

OpenERP DB(PostgreSQL)

OpenELIS Server(REST API)

Java

OpenELIS DB(PostgreSQL)

Background jobs consuming feeds

all communication over httpno orchestrator

Apache Web Server

Bahmni MRS Frontend

(JavaScript, HTML5, AngularJS)

OpenMRS Server(REST API)

Java

OpenMRS DB(MySQL)

Browser

Server (Linux)

User’s MachineBahmni Lite

16

▪Choose sub-systems you want○ sub-systems not chosen are not even

deployed▪Choose apps you want○ applies to EMR○ applies to ERP○ apps not chosen are not deployed

As lightweight as you want it to be

17

Medical Device Integration

18

DESIGNED FOR DIFFERENT DEVICES

19

DESIGN

20

Registration

21

22

Configurable patient dashboard

23

24

Discharge summary completely via configuration

25

Configurable patient dashboard"sections": {

"patientInformation": {

"title": "Patient Information",

"name": "patientInformation",

"ageLimit": 5,

"patientAttributes": [

"smoking",

"alcohol",

"landHolding",

"rationCard",

"familyIncome",

],

"addressFields": [],

"displayOrder": 0

},

"nutritionalValue": {

"title": "Nutritional Values",

"name": "vitals",

"isObservation": true,

"dashboardParams": {

"conceptNames": [

"Height",

"Weight",

"BMI Status Data"

],

"scope": "latest"

},

"displayOrder": 1

26

Observation Control

Drug Order Control

Lab Result Control

Diagnosis Control

Patient Profile Control

Disposition Control

Graph Control

Graph With Reference Data ControlOrders Control

Programs Control

Pacs Orders Control

Flow Sheet Control

Custom Control

Navigation Links Control

Obs To Obs Flow Sheet

Chronic Treatment Chart

Drug Order Details Control

Configurable patient dashboard

27

Multiple dashboards

28

Observation Forms Platform

29

30

Forms using Configuration, not programming

31

Lab, Procedure Orders

32

Reports

33

Canned and Configurable

34

"visitReport" : { "name": "Visit Report", "type": "visitReport", "config": { "personAttributes": ["caste", "class", "education", "occupation", "primaryContact"], "visitAttributes": ["Visit Status"] }

● Configurable for your needs● Performance optimised SQL● Presentation based on excel

Laboratory

35

36

Odoo

37

38

Bahmni Offline

39

▪Web technologies▪AngularJS helps▪Crosswalk, Ionic Framework▪ Service Workers▪ Sqlite on Android; Indexeddb + Lovefield

elsewhere▪ Same user interface, some features

Implementations

40

IMPLEMENTATIONS

Implemented at 6 hospitals■ Jan Swasthya Sahyog | Bilaspur, India

■ Society for Education, Action, Research in Community Health | Gadchiroli, India

■ Lok Biradari Prakalp | Gadchiroli, India

■ Bayalpata Hospital, Possible Health | Accham, Nepal

■ The Banyan | Chennai, India

■ Kaliganj (sub-district) hospital, Bangladesh

Over 25 implementations underway across the world, mostly outside the Indian subcontinent

41

Bahmni (and TW) within OpenMRS community

42

Bahmni Product Team

ThoughtWorks Implementation Team

(~ 2% Bahmni implementations)

OpenMRS Platform

Bahmni

TW Clients

Rest of the world

OpenMRS Core Team

Community Implementations(98% of Bahmni implementations)

non-Bahmni OpenMRS Implementations

Roadmap Principles

1. Performance, security, technical operational improvements and general robustness of the software

2. Strengthen outpatient clinic, secondary care hospitals and vertical programs

i. Features that improve patient careii. Improve implementers user experience

3. Offlinei. basic clinical features

4. Tertiary Care (may be)

44

Bahmni Wiki

45

www.bahmni.org

There are many criticisms of technology, indicating that it can take away the human element of health care. ThoughtWorks has shown us how technology can

help, and still remain very human.

- Dr. Yogesh Jain, JSS

46

THANK YOUFor questions or suggestions

Contact Vivek Singh: vsingh@thoughtworks.com