2012-10-09 OpenMRS Implementers Meeting

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Plenary Speeches
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Who: Paul Biondich

Who: George (surgeon, public servant/govt)

Cavite province, municipality of Silang
Go to Tagatay
highlands (volcano in Batangas, but have a view in Cavite)
fruit (bananas, spikey red fruit)

Who: Dr. Parsh(?)

Yen Reconstruction center, created to rebuild from WW2.

Who: Dr. Manuel

21 countries represented
many in Africa
Asia: India, Pakistan, Sri Lanka, China, Philippines

Univeristy of Philippines (UP) Manila
Electronic University Philippines - trying to increase efficiency in all universities
National Telehealth Center - manages IT programs

Used in 2 district hospitals (for research on cost/benefit of hospital computerization)
UP Philippines "CHITS" is largest implementation in Asia. First electronic record in Asia

Who: Dr. Valera (Assitant Sec for Health Policy/Finance/Research, ICT focal point, Department of Health, former community doctor, VP of Philippine Health Insurance corporation)

iPhone and iPad jokes continue...
previous IIRR event she attended was with the "white witches", community healers
TeleMedicine - sometimes a MUST
Cavite - "best coffee in the country grown here"

1 thing - i think the biggest potential for this software is:
offline, mobile entry
ability of an OPD doc to be mobile

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The State of OpenMRS in 2012
======================================

Who: Paul Biondich

Where we are now, Where going in upcoming year
Implementations, Community Process, Ecosystem, Software Development, Organization

Implementations
Sometimes find out about OpenMRS implementations long after they've been started
How deep/serious are each of the existing implementations, what is their nature
Many implementations are changing in their nature (hospitals vs clinic vs other)
OpenMRS "atlas module" to allow implementations to identify themselves on the map, based on interests
-want people to be able to find other similar implementations
-also find other people "nearby" so they can support each other regionally
-this is something of "analytics" of how OpenMRS is used. But always privacy concerns of looking into individual sites' details.
@Seamus: How do you improve data quality? how do you use/analyze? reporting tools?

Community Growth/Process
Lots of energy put into working collabortively despite geographic distances
Trying to build OpenMRS features based on implementations, end-user needs. AMPATH, PIH... even the big ones feel that it doesn't fully meet their needs.
There are "short cycle" needs (2 weeks or a month from now), not just "long cycle" (annual goals). Shorter development cycle, focused on more specific implementation needs.
Last release had 72 contributors to it. Cool.
More organization. Need better "requirements gathering" --> from implementation need (abstract) to actual code needs. Getting more business analysts involved. Want to understand also where multiple sites have same needs.
@Michael Downey: Really serious about embracing new people who find openMRS (developers, implementers)... find their interests, talents, skills. Want to be quicker at matching them with tools and people in the community who they'll match best with. Mentorship/guidance. OpenMRS ID to unify some of this process.

Ecosystem
Countries that have gone "first in" are now reaching a significant scale. "Broad implementations", where countries have local ecosystems. More self-organization (like in Philippines, Kenya, Rwanda, others).
For-profit entities like Eli-Lily, Merck are getting interested. (Want people to be "greedy" in a way that benefits everyone else? So if for profits get involved and it helps everyone... great!)
Linear growth of contributors, implementers. Unusually active mailing lists
"Distributions". Suggest to make more customized versions of OpenMRS around specific needs. Rwanda-specific needs. Kenya-specific needs. Philippines CHITS around primary care. Raxa got shout out as another angle/approach.

Software Development
OrderEntry aiming to be completed asap.
Need a shift toward "application level functionality". Registration. Order Entry. A lot of energy into this over next year or two.
2.0 will have a "reference user interface" over the next 6-9 months.
-also, completely backwards compatible with other user interface
Still, treating OpenMRS as a platform. REST WS is of big importance in being a platform. E.g. can wrap and entirely different UI around it like Raxa.
Big shifts over last 2 years to get to Mvn. Also now using Git. Continuous integration.
Trying to be more "sprint focused", agile. "How can we define processes to create openMRS code that anyone can do?". Make processes that anyone can get involved in, or they could run on their own. Want this to become a community driven process. Someone can come in and say "we need feature A", and the community can join together to build it. Try to avoid bottleneck of OpenMRS core team.

Organization
Applied for a Not-for-profit organization in support of OpenMRS.
Organization vs OpenSource Community. NFP Org -> just to make sure that basic processes happen (Implementers meeting, Dev of Online presence, support of Core team). But DONT lose existing OpenSource community.

Joaquin Blaya helped get a board of Directors
Board: Amir Khan (Pakistan), Mitchell Baker (Mozilla, helped establish OpenMRS license and Mozilla foundation), Bill Tierney (health informatatics), Chris Bailey (WHO, "ethical rudder" to help focus on broad set of needs)
many geographies, backgrounds, expertises

5-yrs basic financial support, led by Rockefeller Foundation
Explicit leadsership roles and responsibilities
Want people in this implementers audience, community to rise into leadership roles
Examples: Chief Software Architect (currently Burke Mamlin), Online Presence/Community (currently Michael Downey)
Big push toward engaging community in leadership activites

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Unconference Planning
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Who: Michael Downey

Unconference
Rules of an "Unconference" -> There are no rules :)
Whatever happens is what happens. no specific goals
Starts when it starts, feel free to walk in late.
Over when it's over. But decide - continue or talk later?
"Law of 2 feet". If you're not getting something out of it.. go take a break

The venue
RR - RRHall - where hackathon was the previous 2 days, adjacent to dhall. LARGE room
PS - Penshing(?) Hall - SMALL room
JJ - Jim Johnson Hall - LARGE room

BoF Sessions - common topics, not needed to be OpenMRS related.
**Lightening Talks - short 5 min talks about something OpenMRS related (Wednesday evening). Signup for Raxa. Cut off at 5 min sharp!
**Demo Session "OpenMRS Lab" - show n tell. After lunch on Wednesday. No need to sign up.

Must be a note-taker from all sessions! Save to notes.openmrs.org or wiki. Add a link from Implementers 2012 -> etherpad

some topics to discuss
point-of-care
understanding 80%, "common" use case (e.g. "primary care") that we could solve.

mobile devices, tablets
offline use
REST WS

concept dictionaries -- how to streamline and make it usable for lookup by doctors? how to fork and share?
Large implementations (multiple openMRS instances, cloud backed, sync'ing)

Note... be specific: "interfaces" might mean UI, might mean software interfaces

***
When I leave this conference, what do I want to leave with?
-sharing what Raxa has done so far, getting feedback on whether people think it's a good direction and what we should focus on
-forming bonds with people who have really cool projects, interests
-getting lots of email contacts of people with similar mind
-understand to what extent we "plug in" with existing OpenMRS. Is it a db backend that can support us in the long run?

Ideas:
@Shawn Grenich - interested in state-of-the-art biometrics (fingerprint readers, etc)
@Roger Friedman - reporting framework, tutorials
@Lauren - Pharmacy Module @ AMPATH + OpenBoxes
@Ellen - sync, openMRS upgrades, lab systems, testing strategy
@Burke Mamlin - roadmap, throw rocks at openmrs :p, groovy
@James (Haiti)- overview of everyone's implementations . OpenMRS Jr.
@Tobin - mHealth and SMS systems. Drug orders. Point-of-care systems Lessons learned.
@Bill - interoperability between OpenMRS and lab, phramacy, etc
@Seamus - more formal study on kinds of sites, usability, economic evals (cost to set up a distribution)
@Julie - business analyst
@Roger - Architecture. Better diagram, descriptive on arch :P At what levels/places to add features. Happy or stuck on current arch.
@Dawn + Lauren - Want to know more about implementers. Atlas. Better ways to engage and keep track of community (who, what - living map)
@?? - Mobile app for Android. challenge of DB model on the phone, interacting with OpenMRS server, sync between phones
@?? - user interfaces for physicians
@?? - migrate data from .NET system to OpenMRS
@?? - Vietnam. Use OpenMRS + .NET framwork. how to connect, translate to other systems.

---

****@Nick - VERY interested in mobile. RESTWS. Want to get a "mobile" discussion and include Darius (REST)
@Tobin - successful processes. Using standalone. IT Best practicies for resource poor areas.
@Roger - feature needs for Hospital systems.
@?? - national health in Kenya..
@?? -
@Burke - discussion on Order Entry, API for this. Registration, identifying patients (many divergent efforts). Paul singing session.
@Roger - looking at ways to flatten learning curve for OpenMRS. lots of techs, modules. takes time to come up to speed to "do something right" when building on OpenMRS

ALWAYS find Michael or Paul if you need help making conference successful. It is a conf for the people, not for the planners.
can email events@openmrs.org to get started

Scheduling method
"Mayhem" :)
pick the most important topic. 1st pri.
mobile devices, tablets + REST WS
point-of-care
concept dictionaries -- how to streamline and make it usable for lookup by doctors? how to fork and share?
use offline?
Large implementations (multiple openMRS instances, cloud backed, sync'ing)

List of attendees and all their backgrounds will be published (if you opted in)
Online schedule site via Lanyrd.
Link online profiles yo.

Morning review + evening review -- only will be done in the morning to save time.

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Implementation Overview / Engaging Implementers
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@James, Hospital Albert Schweitzer (Haiti)
-community health
-mobile
-hospital

ubuntu 11
tomcat6
mysql
apache
running on a high end desktop computer

OpenMRS 1.9

Modules:

Rest Web Services 1.9 Extension 1.0.29298 OpenMRS Publishes Rest Web Service Resources for OpenMRS 1.9 API...
Rest Web Services 1.1.29293 OpenMRS Publishes Rest Web Services exposing the OpenMRS API...
RaxaEMR Core 0.1 Raxa Provides core RaxaEMR - managing patient lists
JSSLab Module 1.9.0-SNAPSHOT jss raxa lab rats Specimen-based lab module for JSS...

rural hospital in India
~200 patients per day
can check # of patients, encounters, obs

http://notes.openmrs.org/omrs12-IO

--

Atlas
-who, where, patients/encounters/obs
-must be internet connected
-want it to be embedded, but not required
-want to fade out implementations that don't update.. sense is to make it up-to-date/living version of openMRS usage
-possible leadership role "implementation coordination". (reach out to implementations, someone in community who follows up with automated data, gets more descriptions. (text, youtube walkthroughs, screenshots))
-have a contact person for each implementation

Country level openMRS meetups (more frequent, more accessible)
Connect physician to implementer and developer
http://notes.openmrs.org/omrs12-IO

-How to get a implementation setup with no effort
-concept dictionary
-forms
some "distro"s due exist, e.g. MDR tb, that can easily be picked up in a new place.
they don't believe that one size fits all... many tools that meet multiple need. but some will refactor/share/etc.
-developers have difficult providing this content.

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OPENMRS at Point of Care
==============================

Etherpad notes from meeting
http://notes.openmrs.org/Pointofcare

OpenMRS at point of care vs forms with a data-entry clerk

Which people
AMPATH - right now, not point of care entry
challenge: which device to do data entry?
tablets vs phones
android almost for sure

James
using point of care @ hospital albert schweitzer
registration, outpatient clinic, and hospital admissions
using OpenMRS Junior at point of care for nutrition referrals.

Tobin
A few months old
Are using OpenMRS @ Point of Care
Registration, nurse consultation and vital signs
Clinician consultation using HTML forms
Q: How to manage workflow through the clinic? (digital system you can't just carry your forms through the clinic. Where are people?)
-> raxa solution

Dawn
registration for health clinics
how to integrate

Nathan
workflow is a question for us too
should be able to look up a patient at any point
different devices per location

?? (Kenya)
Not yet implemented, still customizing
workflow - sometimes clinicians room is dispensing point
difficulty to make intuitive system
moving patient
last provider to check you out of the workflow
re-assigning for provider-to-provider
ideally, anybody should be able to send patient home or move you to another provider (but in HIV care is often on exit from pharmacy)

Matamai (Malawai)
fully point of Care
running on top of OpenMRS database. Plan is to use openMRS for reporting. actual system for datacapture in Ruby on Rails on touch screens.
Sometimes workflows change.
(Should there be some kind of management to define accepted workflows, a la JIRA? or should it be more flexible?)
No patient queue currently. But clinician can see how many patients have been seen, and they can lookup history of patient when it arrives.

??
has a patient dashboard

Common challenges
workflow
devices
training

Managing a list of waiting patients
-order of arrival
-"todo" list for each doctor
-patient needs a direct link to their patient dashboard
(uses mytinytodo.net via an iframe... on a "doctor" role based homepage)
-assigning to a doctor... also need a room!