BahmniOpen Source EHR System

- Ranjan Sakalley

(Lead Developer)

S i m p l e . A ff o r d a b l e . S c a l a b l e

Bahmni - Focus on all aspects of patient care

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Bahmni Implementations

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• Possible - Accham, Nepal• JSS Hospital, Ganiyari(Bilaspur), India• SEARCH Hospital, Gadchiroli, India• The Banyan Mental Health Clinic - Chennai, India• Union Health Clinic - Kaligonj, Bangladesh (pilot primary health

care centre for national rollout)

Coming soon – • Bahmni Offline - Community Health Workers for Dhaka division

of Bangladesh• Bahmni for large TB program for 3 global NGOs in 16 countries

Learnings from implementations

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• Extremely low to reasonably low computer literacy levels in staff

• Cannot depend on Internet for hosting, in most places (remote hospitals)

• Requires physical presence for technical tasks (Extremely busy clinical and non-clinical staff)

• Disruption cost is quite high, esp. in case of system problems. Low risk appetite.

• Service delivery context differs vastly, leading to unique data requirements

Bahmni – design principles and guidelines

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• Design for resource constrained settings - no internet required• Simplicity of use - easier to learn and use with minimal

supervision• Adaptable - use on variety of devices - tablets/computers• Configurable - location specific user interface changes,

languages (internationalization)• Modular - choose parts from a super-set• Build for Integrations - allow others to integrate easily• Use Open Source Software – affordable and customizable

Bahmni – a union of well-built OSS tools

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• OpenMRS • OpenERP/Odoo• OpenELIS• DCM4CHEE (Oviyam2)• New EMR UI for OpenMRS

Leveraging – • Domain expertise built over years of development and

support• Vibrant communities that are progressively adding features

and integrations• Customizable Open Source code

OpenMRS

• Well known Open Source Medical Record System• Patient Management• Concept Dictionary

– Diagnosis– Tests– Procedures– Drugs, and more

• Heart of the Bahmni system• Very friendly and encouraging community

OpenERP/Odoo

• Well known Open Source Resource Management System• Billing and inventory management• Extremely flexible, wide community of contributors and

implementers

OpenELIS

• Open Source Lab Management System• Contributions from the Bahmni team towards new API

additions and more

DCM4Chee – Oviyam2

• Open Source Library – robust implementation of DICOM standard

• Oviyam2 – web based DICOM viewer

• to make investigation orders which are sent to digital radiology devices. sends patient and the investigation details to the radiology technician.

• Bahmni also allows you to view the radiology results (DICOM images) from within Bahmni.

Bahmni User Interface

Bahmni User Interface

• Focus on simplicity and intuitive user interface• Responsive - use on different devices• Pre-built dashboards that can be customised• Pre-built library of EMR reports that can be customised• Offline applications for android and chrome coming soon• Open Source, driven by the ThoughtWorks team

Integrations and Interoperability

• All bahmni components communicate with each other using standard Atom feeds over Http Protocol (authorized clients can easily program to listen)

• Each Bahmni component publishes a log of relevant events happening - other subcomponents can listen to this feed using standard libraries

• New components (for e.g. an offline android application) may make use of the same mechanism

• Bahmni provides rich data interface over standard REST API - this means that given the right credentials, components can pull and push data updates directly

Integrations and Interoperability

• Bahmni can be enhanced at multiple levels to add new integrations. - Adding custom OpenMRS module to integrate with other systems (eg. Bangladesh SHR) - Adding custom OpenERP modules - Adding/Importing new standard definitions in OpenMRS - Adding new components based on standards - HL7 standard for Radiology Order built for PACS(Picture Archiving and Communication System) integration

• Bahmni is modular - new components (like a new lab management system) can be plugged in and old ones removed (in this case OpenELIS)

Standards

• Bahmni supports various international standards –

• DICOM for communicating digital medical images• Bangladesh SHR system communicates using standard HL7

(FHIR) data formats – an enhancement to Bahmni and OpenMRS

Engineering Standards

• Standard Communication– HTTP / REST/ Atom feeds

• Web standards for our apps• Standard and predictable data formats for communications

based on OpenMRS• Most Stable and Free OS supported – Centos 6• Proven free open-source engines – MySQL, PostGreSQL• Extensibility using well known OpenMRS / OpenERP module

systems

Bahmni as part of a Shared Health Record System

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Central Registries– Terminology – Personnel/Providers– Locations– Patients (MCI) –[ National Health ID ]– Encounters

Centralised Reporting (DHIS2)

Bahmni as part of a Shared Health Record System

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Bahmni on facility (primary clinic to multi-specialty hospital)

• Works just like any other Bahmni instance, and more.• New Bahmni OpenMRS module to regularly sync reference

data – terminology, locations, personnel etc.• Sync patient and encounter data – FHIR HL7 format• Push data recorded at facility for national integration• Operational reports for the hospital• Ability to import patients in the central registry• Sync on demand – no need to be online all the time

Bahmni as part of a Shared Health Record System

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Bahmni Offline for Community Health Workers (CHWs)

• Publicly Hosted Bahmni server for CHWs• Not tied down to a physical facility• Offline usage• Integrated with SHR system using the same OpenMRS module

THANK YOUFor questions or suggestions

Contact rsakalle@thoughtworks.com@rnjn

@BahmniOrghttps://www.bahmni.org