DRC Hospital Implementation

Together with my colleagues, we are in a close collaboration with a hospital in Lubumbashi (Republic Democratic of Congo) specialized in neurology. They are currently managing their activities using Excel sheets and paper. We are now working together to find a sustainable solution to manage their activities. We have been researching on the different opportunities where our conclusion lead us towards OpenMRS. After getting some online information and on the OpenMRS community, we would be interested by modules such as: 1) appointments/registration, 2) Billing, 3) Pharmacy/inventory management, 4) Visit management/diagnoses/Treatments, 5) Lab and of course some other standard features such as printing, reports, etc.

We are contacting you,community, hoping you could share your experience with OpenMRS and maybe give us some advise. . Questions we have: a. Feedback on its use: Would you recommend OpenMRS? What works well? What are the Limitations/Disadvantages? b. Infrastructure: Considering they do not have a continue access to power, would you have some recommendation how best to set it up? c. Timelines: how long did the implementation of the software took (including the requirements phase, setup/development as well as the testing phase? d. Costs: how much In development and material costs would you expect to have to plan to put an implementation in place? e. Developers: for the cost above, How many developers and from which experience/skills did they have? f. Languages: how easy would it be to have it in multiple languages (e.g. French and English) g. Authentication: one of the points mentioned was the difficulty sometimes to identify patients. Would you happen to know a little about finger print authentication and its ease of implementation?


Hello Ester I’m Ethical from Juba, i will answer on some of your questions before i will tell that : OpenMRS is a collaborative open source project to develop software to support the delivery of health care . OpenMRS is founded on the principles of openness and sharing of ideas, software and strategies for deployment and use.

a. Feedback on its use: Would you recommend OpenMRS? //////////////////////// For the feedback OpenMRS has a lot of feedback and all the developers are ready to help you and further you can have many information with live chat and forum where you can ask all the question from beginning to expert . follows this link https://wiki.openmrs.org/

b. Infrastructure: Considering they do not have a continue access to power, would you have some recommendation how best to set it up? //////////////////////////// For the Infrastructure you need to discuss with your administration ask find out if there is a empty space that they can turn as a Server room on builds a building. For the the electricity your a backup as backup supply i mint Generator, solar panel, or Ups for the price you will check will anay company in RDC.

c. Timelines: how long did the implementation of the software took (including the requirements phase, setup/development as well as the testing phase?/////////////////////////// The implementation and test can take you at least 3 Months (1 for implementation of network , 1 for deploying the software and the last one for test) PS: that my point of view.

d. Costs: how much In development and material costs would you expect to have to plan to put an implementation in place////////////////////////////////////// for the costs you make sure that you bought et original Server a networking accessories materials to avoid the twice expends. yo will needs laptops or desktops machines, ,Servers machines you can design your server as you want but you must know that all your data will be threat by him and store inside it too. you must also need a NAS backup in case of disaster.

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Hi @estelle - You have asked some good questions about implementation. Unfortunately, these are not questions that are easily answered since it all depends on the context and the requirements to meet the needs of that context. But I do have a couple of thoughts based on my experience implementing OpenMRS and other health information systems around the world.

  1. Part A - Advantages - Not locked into a vendor. Local ownership of the system and the data held within it is wholly available for use by the governnment or organization that implements and/or uses the system. Since the system is open source and you will have the full code base, you can either customize the product or build custom interfaces or products on top of it to meet the needs. Long term sustainability can be achieved through building software development, implementation, administration, and data use capacity locally through interactions with the larger global community.

  2. Part B - Limitations/Disadvantages - Unless you use the reference app or a distribution like Bahmni, it really does require a software developer to set up OpenMRS for an implementation. If you want to customize anything in the reference app or Bahmni, that also would require a software developer. Also, free license does not mean that it is cheap to properly implement. Implementation requires a lot of work - especially if you are customizing the application - so will still need the human resource costs figured in to be successful.

  3. Infrastructure - power reliability is a common issue in places that OpenMRS is implemented. Some sites have mitigated this by using laptops with long-life batteries and conducting retrospective data entry (after the clinical visit), while others have resolved to use generators or solar power or other power sources as failover during power outages. It all depends on your resources and needs.

  4. Timelines - I echo @ethical’s statement about 3 months for the actual implementation, but would add a couple of thoughts. I would recommend your timeline include some additional “learning curve” time for your team, since this would be their first implementation. I’ve created some implementation tools for some teams in Mozambique to use to formulate their timeline that I’m happy to share with you here: http://www.esaude.org/implementation-packet. Let me know if you have questions about those or if they are helpful at all. I’d love feedback for how to improve upon them. Also, that 3 months that @ethical recommended does not include requirements gathering, customization, software testing and user acceptance testing, extensive training or monitoring, or any additional tasks outside of the in-the-field implementation tasks.

  5. Costs - That a challenging question. It all depends on what the requirements are. We did a costing evaluation in the national implementation of KenyaEMR, which is point of care use, and found that the average price of implementation for each health facility was approximately $10,000 USD. That included calculations for customization, equipment, training, support, etc. Again, that was specifically for point of care installations. For retrospective, you could shave some of that off because the equipment needs would be reduced somewhat. I’ve also heard of some folks moving to a centralized server with remote access from health facilities, which reduces costs of server equipment, but increases costs for some of the other infrastructure aspects. Centralization can also improve the power situation, reliability from the server aspect, and can reduce maintenance costs, but increases costs for the type of hardware you need as a server and infrastructure in your data center and may be less accessible for your health facilities. Many countries go with a mixed model when considering centralization - some remote access where able, others locally installed. With the upgrade of Sync module 2.0 this may be more feasible soon.

  6. Developers - depends on the capacity within your country. Generally, I look for developers that have at least 2+ years experience in Java and scripting languages, hopefully some healthcare experience (but not a requirement). For more advanced development and customization (such as a new point of care interface), I look for 5+ years experience. I often assume I will have to mentor the developers in the health informatics aspect, so focus on strong programming skills in my recruitment.

  7. Language - fairly simple to have multiple languages, just need to account for translation costs if you are veering outside of what is already available.

  8. Authentication - lots of discussion here on Talk regarding biometrics for authentication. Lots of folks have been experimenting with and using fingerprinting. I would just give the caveat that biometrics are not the complete answer to patient identification, but rather just an additional attribute to increase specificity during identification. Human processes to identify person still need to be standardized and implemented, alongside any technical solutions. There is a whole science behind identification, and it would be worthwhile understanding how the different approaches are used in relationship to each other - identifier numbers/codes, demographics and contextual attributes, physical devices or identification papers (like a driver’s license or a patient ID card or smartcard), and biometrics (fingerprinting, iris pattern readers, etc). In addition, each type of identification solution has it’s positives and negatives, and has specific use cases where it might be more successful than in other use cases. For just understanding more about the technical solutions that have been used for OpenMRS, I would recommend doing a search on the Talk forum for “fingerprinting” and “biometrics” and “patient identification/identifiers”.

Hope that was somewhat helpful and not too overwhelming! I know it’s a lot to think about and a complex project. :slight_smile:

Hi @estelle , I also think and appreciate that you are asking a number of fair questions ahead of a possible implementation, none of which can be answered unequivocally as @janflowers hinted.

Given your high level requirements you should definitely look at Bahmni though. Being OpenMRS-based Bahmni is also discussed right here in the same forum :wink:

I would like to weigh in on one point quickly, I would need more time to answer all your questions in details (and it’s late here right now…)
Gathering actionable requirements is not straightforward and that sole process can easily take more than 3 months and will already consume resources. So again yes, factor that one in. Starting off inappropriate requirements will only result in a loss of time and money.

Another point, perhaps obvious to you but actually not obvious at all in most setups: someone must own the project on your side. I mean by that that you may go ahead, find yourself an implementer/service provider and “let them do the job”. Wrong, you need a project manager in-house to own the implementation process, drive it forward and be the focal point between the implementer/service provider and your organisation/facility.

The success of an implementation lies a lot (and yet not only) on 1) appropriate requirements + 2) in-house vision and project ownership.