1. Using OpenEMR to Document Primary Clinical Care and Track Health Programs in Rural Guatemalan Villages Jennifer L Hoock, MD, MPH Sean Murphy, Software Engineer Guatemala Village Health

2. With SPECIAL THANKs to KRIS FORDICE, RICHARD GALE, AND DEBBIE KUBAS Disclosures: NONE

3. Learning Objectives  Identify an Electronic Medical Record (EMR) system that can be adapted for use in the field (rural areas without electricity or internet) with minimal cost and infrastructure  Explore how an EMR system can be adapted to support the full scope of work in international health projects from continuity in the provision of primary care and chronic disease management to health program tracking and data collection for evaluation.  Discuss how a tool like this could be used in a project/program that you are involved with in your global health work.

4. Guatemala Village Health  Work in small rural Mayan villages of 20-250 houses  Many without electricity and none with connectivity  US teams spend 1 day every 6 months there with laptops and a generator providing clinical care  In-country team, now includes part-time doctor and nurse – visit every 6 weeks for training, supplies and monitoring projects  Needed a tool for  Clinical Care  Chronic Disease Management  and eventually Health Program Data collection

5. Identify an Electronic Medical Record System

6. We discovered OpenEMR (2011)  Explored several commercial products that were quite resource intensive ($ and negotiations)  Considered being a pilot development site  Explored open source VA EMR – way too much for us  Found OpenEMR through websearching  Compared it to  PHP database for HIV care and Mobile Medical Record  Chose Open EMR  Developed for low resource primary care settings (CHCs)  Open source using free and universally available databases  Very transparent and thus modifiable  Had database extraction capabilities

7. We Adapted OpenEMR  Tried to locate/contact developers without success  Small working group took the existing database and tried to customize it for our clinical work  Imported previous records – scanned Word documents with some data fields  Deployed in our newly built clinic on desktops  Challenges  Hard for older volunteers to use; paired retired medical personnel with students  Lab ordering system was very cumbersome

8. Taking It On The Road  Modified for mobile clinics in our villages  Adapted system to run off a robust intranet server with laptops all powered by generator  Developed system for backups after each US team trip  Mounted system on the internet so we can access from US  Triumphs  System is fully mobile  Functions on any platform – Mac/PC, iPad/Tablet, Smartphone  Data is accessible by internet while staff in Guatemala can use system

9. What can we do with it  Patient Visits  Vitals – can compare over time  SOAP Note – free text so easy to use  Labs – developing simpler data entry system  Chronic Disease Management  Identify population with reports based on Problem List  Track labs and medication doses to optimize care  Health Program Data  Track participants  Pull data reports for funders and organizational evaluation

10. DEMONSTRATION OPEN EMR… -CLINICAL CARE -PROGRAM TRACKING -DATA REPORTING

11. Why we chose Open EMR  Web-Based  Anyone can use it with any computer, nothing to install  Much better than using MS Word forms  Manageable size system  Open-Source  Flexibility to migrate to something better in future  Can be customized if needed  Support the open source community (Linux example)  Maturity continues to improve, features continue to be added  Open-Source database behind it  Relatively easy to do queries to statistically analyze data

12. Why we chose Open EMR  Small portable media server  Solid state disk; drop proof  2nd one for backup  Small processor is plenty of power for 10+ simultaneous users  Configured for remote access  Can roam off the web  Connects to mother ship when on the web  Able to reach in and access data or update it  Highly configurable  Supports multiple languages  Customize forms  Customize fields  Customize pick lists for fields

13. Open EMR Challenges It's Free, but…  Need someone who knows computers & Linux  Took some work to get the wifi hotspot to work  Development of remote access from the US was challenging  Need to have 2 servers and a current backup  Have to update to gain advantages of new development by Open EMR group

14. Lessons Learned  Invest in the beginning  COLLABORATE with others who have experience doing what you want to do  Adapt the EMR to meet YOUR needs  Training is essential  Train your volunteers  TRAIN YOUR STAFF – data cleanup is a hassle  Use Open Source  It is always YOUR DATA, and you can port to another platform in the future  You can GET INSIDE and change what you need to so it grows as you grow

15. References  OpenEMR -Free and Open Source electronic health records and medical practice management application that can run on Windows, Linux, Mac OS X, and many other platforms. System Information and Downlaods http://www.open-emr.orghttp://www.open-emr.org  OpenEMR Development Site http://www.openemr.org/wiki/index.php/OpenEMR_Wiki_Ho me_Page http://www.openemr.org/wiki/index.php/OpenEMR_Wiki_Ho me_Page  O EMR Nonprofit Organization http://www.oemr.orghttp://www.oemr.org  The State of Nonprofit Data. November 2012. http://www.nten.org/sites/default/files/data_report.pdf http://www.nten.org/sites/default/files/data_report.pdf  3 Kinds of Data That Actually Matter to Nonprofits http://www.nonprofithub.org/nonprofit-marketing-plan/best- ways-for-nonprofits-to-use-data/