Update and Recommendations from Kigali Workshop on EMR November 11 th , 2009

1. Update and Recommendations from Kigali Workshop on EMR November 11th , 2009 Dr. William Motende, I-TECH Technical Consultant Bill Lober, M.D., Director of Informatics Lee Pyne-Mercier, Country Program Manager Jan Flowers, Technical Program Manager

2. General Lessons • Coordinate the efforts via a wiki • http://wiki.healthmetricsnetwork.info/wiki-kigali/ • Online update of documents – DMS • Buy – in / support from the higher offices • Need for TCO calculation • Role of building local support – to support software after partner support ceases, ease of system support

3. EMR Related • EMR needs to exist in the big picture: the national health enterprise architecture • Need for standards so that there is both interoperability and vendor control • EMR Specifications development • Software development standards • Disaggregate: • Operational standards • Information interaction standards

4. EMR Group - Tasks • Please specify the purpose of this application. • Who are the intended users of this application? • How do you expect this application to behave? (ie, what are it's functions?) One way of describing these functions would be to state them in a declaration. For example, “The EMR should provide a way to review previous patient information.” • If there are specific functionalities that could be addressed by other applications, please also describe functions that this application shouldn't perform.

5. EMR Purpose • Improve patient care • Allow efficient production of good reports – for both facility use and integration to national HIS and donor M & E systems • Monitor and evaluate patient care • Research purposes and disease surveillance

6. Other areas • Users • Allow access to information with different access levels • Interoperability features • Prevention of patient records duplication • Support for decision support systems • Standardized coding

7. Interoperability • Name: Results to EMR • Brief Description: test result from LIMS to EMR • Direction: LAB → EMR • Content: test results, normal range, date/time • Name: Orders from EMR to LMIS • Brief Description: order for lab test • Direction: EMR → LMIS • Content: test name, pt name or ID, ordering info, level of urgency, provider, date/time, • Name: demographic info lookup/access • Brief Description: LIMS should have understanding and ability to “see” the demographic info of the patient to confirm identity • Direction: could be either lab- EMR or EMR to lab

8. Interoperability • Name: Medication prescriptions • Brief Description: including the medications prescribed for each patient. Used for dispensing. Also valuable for forecasting especially chronic diseases like HIV. • Direction: From EMR to Pharmacy/supply chain • Content: coded medications, dose, start date, end date (HL7?) • Name: Medication adverse events • Brief Description: side effects that may be secondary to particular medication prescribed for each patient • Direction: From EMR to Pharmacy/supply chain • Content: coded medications, start date, end date, adverse events code SNOMED?

9. 2nd Pharmacy example • Name: Local formulary • Brief Description: official list of medications that should be available. • Direction: From Pharmacy/supply chain to EMR • Content: drug codes, date, if in stock • Name: Came for refill • Brief Description: patient picked up prescription • Direction: From Pharmacy/supply chain to EMR • Content: patient ID, drug codes,date, number dispensed

10. Way forward - general • Submit draft policy for review • Complete procurement guide - available for review on Nov. 3 on Google Groups site • Publish Wiki • eHealth harmonization paper (HMN) available for review • Interoperability: Use Rwanda as a test case study for developing interoperability profiles for several of the key systems discussed. Share these docs and templates publicly with all participants. • Contact list of participants to be circulated • WHO team should track progress on this global process

11. Thank you!