ThoughtWorks, in partnership with Save the Children, has developed an open-source and adaptable electronic medical record (EMR) system to facilitate the rapid collection of high-quality patient data under stressful and potentially dangerous conditions, thereby replacing often dangerous paper-based systems.
First implemented at Save the Children’s Ebola Treatment Centre (ETC) in Kerry Town, Sierra Leone – where rigorous decontamination measures mean that paper medical records cannot be brought from the Red Zone (wards for suspected and confirmed Ebola patients) to the Green Zone (where non-patient activities are set up, such as the pharmacy and meeting rooms) – this efficient and user-friendly system is the most comprehensive clinical EMR built for a medical emergency in a resource-limited environment, and can be adapted for use in a range of future medical crises, including disease outbreaks and natural disasters.
“The complexity of the current West African Ebola epidemic – which is the largest and most widespread Ebola outbreak ever recorded – has created enormous barriers for patient care,” says Darius Jazayeri, Global Health Technical Principal, ThoughtWorks. “Even seemingly straightforward tasks like collecting and accessing quality patient clinical records have been nearly impossible using conventional methods. The patient data collected using our electronic medical record platform allows Save the Children not only to collect invaluable patient data to be used for immediate care, but also allows us to better understand a disease about which so little is still known.”
Developed by volunteers and staff from ThoughtWorks, Save the Children, the London School of Hygiene and Tropical Medicine, the University of Leeds, Elsevier, and the OpenMRS community – and led from Kampala, Uganda, with contributions from teams spanning Sierra Leone, Brazil, China, Canada, Australia, the USA, and the UK – this innovative EMR is built using OpenMRS 2.1, a modular open-source electronic medical record platform used in more than 60 low- and middle-income countries.
The system runs on laptops in the Green Zone and waterproof sterilizable Android tablets in the Red Zone, with different User Interfaces (UIs) for each. While the Red Zone UI is optimized for readability, speed, and ease of use while wearing personal protective equipment (including high-contrast color schemes, large buttons and text, and careful selection of limited information per page), the Green Zone UI presents detailed information that clinicians can review in a less-constrained environment.
The EMR supports patient registration, bed allocation, discharge of patients, recording of vital signs and symptoms, ordering and administration of medications and IV fluids, laboratory results, clinician notes, and data export for analysis. Tablets and laptops communicate securely with a server on a local wireless network, which, together with uninterruptible power supplies, means the system can continue running even when power or external network connections go down. This level of reliability allows for the replacement of paper-based systems even in settings with poor infrastructure. The data can also be easily backed up.
“Save the Children is proud of its partnership with ThoughtWorks, which has allowed us to successfully employ electronic medical records at our Kerry Town ETC,” says Michael von Bertele, Humanitarian Director at Save the Children. “This software, which is easier, faster and safer to use than a paper system, allows us to collect information in the Red Zone and share it in real time, which has helped improve efficiencies and, more importantly, has the potential to help save lives – including those of patients and clinicians.”