Below are the notes I gathered from reflections of folks who visited the different Clinical Sites during the site-visit component of the OpenMRS '24 conference. All sites were using O3 in some way.
But if you donât feel like reading my notes⊠listen to this short, engaging podcast I made, using AI via Googleâs NotebookLM! (How: I literally just gave it a Google Doc file with all the same notes as you see below.)
Podcast Audio File
Notes: Report from Site Visits @ OMRS â24
Detailed observations, insights gained, and potential areas for improvement.
Context: In Sept 2024 through the OpenMRS 2024 conference, attendees were able to attend one of the following sites. The following notes are some of our key takeaways from these site visits across Nairobi Kenya.
| Facility / Site | Profile | |
|---|---|---|
| Kariobangi North Health Centre | Level 4 | Profile |
| Machakos Hospital | Level 5 | Profile |
| Uthiru Muthua Health Center | Level 3 | Profile |
| St. Josephâs Health Center | Level 3 | Profile |
| Coptic Hospital | Level 5 | Profile |
- Point of Care is very much the norm or the trend.
- Where âjust enter a formâ or âuse a register as a backupâ used to be the norm, this has significantly changed.
- Along with this, clinicians seem to have some minimal expectations about CDS helping them in their day-to-day decision making: E.g. they expect the system to flag key patient information, highlighting drug-drug interactions.
- Unexpected Impact of HIE system integrations:
- Integration with National Client Registry added significant number of fields to the Registration Clerkâs view, which adds time to the registration process due to scrolling.
- Opportunity: Optional, non-essential fields should be auto-collapsed.
- Integration with National Terminology Registry (NHDD) added thousands of options to the Diagnosis List clinicians must pick from. E.g. searching for âdiarrheaâ gives a list of 100+ options. Clinicians find this list very time consuming to scroll through to find the correct diagnosis.
- Opportunity: As a community, we need a mechanism for a Concept Set or Value Set (something like SNOMED Core) that contains the most clinically relevant diagnoses. One approach could be: Diagnosis lists should have a filter for more common options, to save substantial clinician time.
- Registration clerks were observed consistently using âDate of Birth: Unknownâ to fill the registration form more quickly, as this is fewer clicks than completing a full date of birth. This results in all patients registered having a birth date of Jan 1st. This could quickly become a problem for purposes of de-duplication.
- Opportunity: Discuss with community UX design group. Consider warning prompt when âDate of Birth Unknownâ option is selected; and, consider a way to make it easier to put in the DOB than not!
- Integration with National Client Registry added significant number of fields to the Registration Clerkâs view, which adds time to the registration process due to scrolling.
- Impact of Community Work:
- We were pleasantly surprised to see work from the community, released as little as 6 weeks prior, already incorporated to the production systems at some sites!
- Opportunity: This further highlights the importance of the Code Test Requirements and Pre-Release QA being enacted by the Global Support Team.
- We were pleasantly surprised to see work from the community, released as little as 6 weeks prior, already incorporated to the production systems at some sites!
- Pediatrics: The system is absolutely being used to care for children of all ages.
- Opportunity: Multi-prong approach to making the system pediatric-appropriate, from Age-Based Ranges to Weight-based dosing to Age auto-calculation and more.
- Overall Layout Feedback:
- Clinicians with more weeks of stable experience using O3, in both OPD and CCC/HIV areas, reported and demonstrated strong familiarity with how to use the system. They loved the split-screen layout on desktop. Those still using registers expressed they had a concrete plan to discontinue combo system-plus-register use within the next few weeks.
- Opportunity: These Clinicians expressed they would like a line-list view of Lab Results, in addition to the existing trend views. Fortunately this view is already included in Septemberâs O3 Community EMR Distribution release!
- Clinicians with fewer weeks of experience using O3 and/or unstable system expressed and demonstrated more difficulty navigating the system; however, this appeared compounded by training delays, incomplete system rollout, and local hardware implementation problems. We noticed Clinicians with the most issues were the ones missing some kind of one-stop-shop view; and, that a significant number of programs had been added to their Left Navigation menu.
- Opportunity: Improve Patient Summary: Clinician view with âThis is most of what I need to be looking at right now.â CCC/HIV Clinicians reported and demonstrated the usefulness of the âCare Panel & Enrollmentâ views developed in KenyaEMR. OPD Clinicians would benefit from a similarly dense, easy-to-skim summary in the O3 EMR.
- Clinicians with more weeks of stable experience using O3, in both OPD and CCC/HIV areas, reported and demonstrated strong familiarity with how to use the system. They loved the split-screen layout on desktop. Those still using registers expressed they had a concrete plan to discontinue combo system-plus-register use within the next few weeks.
- Drug Ordering: Clinicians showed that currently when a user searches for a drug, the combination options appear at the top of the list, instead of the single-molecule options. This means that to order a common drug like Paracetamol, the clinician must scroll through many drug combinations before finally reaching just, simply, Paracetamol.
- Opportunity: This can be fixed in the O3 Community EMR Distribution, such that combination options appear secondarily when searching for a drug to order.
- Opportunity: Clinicians (esp OPD) voiced strong interest in the designed (not-yet implemented) âPinned/Frequent Ordersâ feature. Consider implementing in community EMR distribution.
- Orders: One clinician newer to O3 didnât figure out how to write a prescription. Meanwhile, a clinician familiar with O3 seemed to have gained familiarity with the Order Basket button. We think this latter clinician may have become more familiar with the Order Basket because the standard OPD form used at her site auto-opens the Order Basket for her, which would reinforce the Order Basket UX.
- Forms: Clinicians would like a âSelect allâ option for questions with multiple answers.
- Opportunity: This can be accomplished as a community ticket.
- Pharmacy:
- Printing Rxâs: One site was not yet using the Dispensing feature, but strongly wanted to. This was because the Pharmacy needs to be able to convert a digital Prescription from the Clinician into a Printed Rx, because if the ordered drug is not in stock, they need to send the patient off-site to a different pharmacy with the printed Rx.
- Opportunity: Encourage Dispensing squad to add a Print feature to print the Prescription.
- Stock Management: All pharmacists we met absolutely loved the simple stock management functionality, because tracking their stock is such a moment-by-moment requirement of their work.
- Printing Rxâs: One site was not yet using the Dispensing feature, but strongly wanted to. This was because the Pharmacy needs to be able to convert a digital Prescription from the Clinician into a Printed Rx, because if the ordered drug is not in stock, they need to send the patient off-site to a different pharmacy with the printed Rx.
- Laboratory:
- A lab tech interviewed was using the new âlightweightâ lab order receiving / result entry process and finding it very quick to use.
- Forgot Password workflow needs more attention.
- Multiple clinicians voiced wanting to use Tablets instead of desktops.
