Concept Creation and Management Need Your Advice

Our team is cuurently working on deploying a single EMR across all ART sites in the country using OpenMRS. The number of sites is very large about 1000+ some primary health care centers, secondary and tertiary care. We need advice on how we can manage concept creation so that when we create an OpenMRS module, it can work on all instances without need for code modification. Taking into consideration the following facts;

  1. We want to be able to create modules that can work on all instances without changing codes

  2. We also want hospitals to take ownership of the EMR and be able to add Hospital specific forms and concepts without us acting as dictators. Locally created concept should not interfer with the functionality of our modules .

  3. We have already uploaded the CEIL dictionary on the base version for distribution but we need a very flexible protocol that will allow hospitals to add hospital specific forms and concepts without having to go through lengthy bureaucracy.

    Advice from the community is very welcome. (Bright Ibezim - Nigeria)

@brightoibe hope this offer some help

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As @akanter @ball and others get in the mix, you could, in the meantime, take a look at this:

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Indeed. This is the entire meaning behind CIEL and OCL. Having done this work for more that 20 years I can tell you that hospitals do not have the expertise to self manage controlled terminology. I would strongly recommend a system them emphasizes sharing of curated dictionaries along with an exception process which is highly controlled but still can leverage subject matter expertise. Happy to discuss more!


Thanks a lot Sir

Thank you very much Sir.

@brightoibe We can organize a Design forum for Next Wednesday at 6pm UTC to discuss further?

@akanter @dkayiwa

Thank you very much @c.antwi

@akanter @paynejd @maurya would you be available for a Design call Wednesday Sept 11 at 6pm UTC to discuss the above topic further?

cc @dkayiwa @jennifer

@brightoibe This sounds alot like what the UgandaEMR team in Uganda is doing in about 1000 sites, currently in the 4th year of rollout.

We would be happy to share our experiences doing this, in summary our model is:

  • Centralized development team that manages the concepts using CIEL as the first source of truth followed by custom concepts as needed
  • Architecture builds on top of Reference Application adding only data collection tools and reports (all workflows and features are added downstream)
  • Training is focused on regional level partners, who then cascade it down to facilities
  • Implementation, maintenance and support provided by regional partners with support from the center
  • L1 support partners, L2 and L3 by the UgandaEMR team
  • Currently over 1,300 personnel at different levels trained to use the EMR
  • Implemented across ART Care, HIV Exposed Infants, TB, VMMC, ANC/Maternity/PNC service areas as well as outpatient
  • Q4 of 2019 brings point of care and revised national tools

@slubwama @jmpango @dbaluku @solemabrothers @dsemujju

Stephen, I am not sure the current status of the UgandaEMR concept dictionary and what the health is of the custom dictionaries. Are they currently using another tool besides OCL to manage the concepts taken from CIEL? There is still the question about management of updates to the CIEL concepts and code mappings, etc. Perhaps this would be a good time to discuss on the design call next week?

Cynthia, I think I can make that (1pm Chicago time) on the 11th.

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@akanter we pick out only those concepts from CIEL that we want to use at a time and we use a tool @ssmusoke created in intelij to export them as XML and import it as metadata using the metadata import option. Sofar Its been quite helpful

So if there have been changes to the CIEL concepts after you have done the import, you wouldn’t know about them… There aren’t that many, but a more robust solution (using OCL for OpenMRS) would be a good way to do so. Perhaps I could see which concepts have been added to the CIEL concepts from your servers?


@akanter Unfortunately OCL is still work in progress and not yet production ready … Chicken and egg problem

Shouldn’t updates to existing concepts be published as a separate update file, I know this is quite a bit of work, but there is no “easy” way to know what changes have been made

Unfortunately we are not able to manage the manual task of creating update files. OCL will be released this month and it would be great to have your team take a look at it for testing. Also, it really would be good to “migrate” existing custom concepts to a CIEL ID, so if there was a way to share those additions, it would be good. Are all clinics on the same dictionary or does every clinic have the capacity to add custom concepts?

Thank you for the feedback. Bright is a member of my team and we have been working together to get a better product. Your response has deeply created a pointer to our next level.

Kind regards.


In UgandaEMR the whole country is on a single dictionary we can only look into testing OCL towards the end of the year as we have a couple of very tight deliverables most of which openmrs platform and ref app are lacking so we have to do all the heavy lifting on our end …

@brightoibe basing on this design call, what did you decide upon as the way forward for Nigeria?