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ISDS 2018 Conference Abstracts

Public Health Decisions Using Point of Care Data from 
Open Source Systems in Africa
Burke Mamlin*1, 2 and Theresa Cullen1
1Regenstrief Institute, Indianapolis, IN, USA; 2Indiana University, Indianapolis, IN, USA

Objective
We demonstrate an architecture for driving regional public 

health decisions with automated and semi-automated data collected 
from open source point of care systems in resource constrained 
environments.

Introduction
Ministries of Health in Low and Middle Income Countries (LMIC) 

are making or trying to make public health decisions for infectious 
disease conditions like HIV using data garnered from sentinel events 
and disease tracking in the community. The process of gathering 
and aggregating data for these case-based reports for is, in all too 
often a cumbersome or paper-based process. The Center for Disease 
Control (CDC) was interested in prototyping and piloting approaches 
that could improve the efficiency and reliability of case reports in 
resource-constrained environments. One of their primary goals was 
to demonstrate how electronic data gathered in the front lines of care 
could be leveraged to automate and improve the reliability of data 
within case reports driving public health decisions at regional and 
country levels. OpenMRS is an open source medical record system 
platform often used in resource constrained environments.1 Since 
OpenMRS is used as an electronic medical record system in several 
African countries and has been connected to regional or country-level 
health exchanges, the CDC was interested in building a working 
solution for electronic case based reporting using OpenMRS and a 
health information exchange.

Methods
Working closely with the CDC, we developed a Case-Based 

Reporting (CBR) module for OpenMRS, using HIV as an initial use 
case. Trigger events were defined based on sentinel events and key 
clinical monitoring conditions and these were mapped or added to 
standard terminologies. We use Health Level 7 (HL7) messaging 
standards to deliver case reports from OpenMRS to the health 
information exchange.2 We used existing manual workflows and 
EPI officers to define the needs for a surveillance officer role and 
the requirements for the CBR module. The module was developed 
as open source using agile methodologies. OpenHIE (ohie.org) was 
selected to demonstrate the ability of OpenMRS module to submit an 
electronic case report to a health information exchange.

Results
We have a working, open source case-based surveillance module 

for OpenMRS that comes with nine pre-defined HIV-specific triggers:
● New Case
● New Disease
● New Treatment
● Evidence of Lack of Monitoring
● Evidence of Treatment Failure
● Switched to Second Line Regimen
● Treatment Stopped
● Lost to Follow Up
● Patient Died
We have been able to demonstrate the automatic creation of HIV-

based case reports based on data within an electronic medical record 

system, placement of these proposed case reports into a work queue 
for a surveillance officer, and successful electronic submission of 
these case reports into a health information exchange.

Conclusions
This work demonstrates the ability to develop open source point 

of care software solutions for LMIC that can be used for sentinel 
awareness as well as longitudinal monitoring of individual patient 
care. The current scenarios, trigger identification standards, and 
messaging specifications are easily accessible and published on the 
OpenMRS Wiki.3 Our incorporation of user centered design through 
EPI officer engagement helped ensure that our solution is responsive 
to the end user. The CDC is able to use this solution to demonstrate 
the feasibility of incorporating electronic case reporting in LMICs and 
to demonstrate the benefits and promote the adoption of electronic 
medical record systems and health information exchanges in resource 
constrained environments. In the next phase of this work, we will be 
working with the CDC to identify sites within Africa for deployment 
and refinement of the CBR module.

Keywords
Open Source; HIV; Case Reporting; Africa

Acknowledgments
This work is supported by the Centers for Disease Control and Prevention. 
Its contents are solely the responsibility of the authors and do not 
necessarily represent the official views of the Centers for Disease Control 
and Prevention. We would like to acknowledge the guidance, assistance, 
and hard work of Eric-Jan Manders, Lisa Murie, Wyclif Luyima, and 
Jamie Thomas. This work was also made possible through the OpenMRS 
Infrastructure, which is supported by XSEDE’s Jetstream project.

References
1. Mamlin, B. W., Biondich, P. G., Wolfe, B. A., Fraser, H., Jazayeri,

D., Allen, C., et al. (2006). Cooking up an open source EMR for
developing countries: OpenMRS - a recipe for successful collaboration. 
AMIA Annual Symposium Proceedings / AMIA Symposium AMIA
Symposium, 529–533.

2. HL7 CDA® R2 Implementation Guide: Public Health Case Report,
Release 2 - US Realm - the Electronic Initial Case Report (eICR).
Available at http://www.hl7.org/implement/standards/product_brief.
cfm?product_id=436.

3. OpenMRS documentation on proof of concept for Case Based
Reporting. Available at https://wiki.openmrs.org/display/docs/
Case+Based+Reporting+Module.

*Burke Mamlin
E-mail: bmamlin@iu.edu

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 10(1):e57, 2018