OpenEMR Success Stories

Overview

This page is part of a new project to list and describe successful deployments of OpenEMR. For more details on submitting entries, please see the Discussion page.

Siaya District Hospital in Kenya Goes Live With OpenEMR in April 2012

We are a start-up in the Bay Area of California called MediGrail LLC. We think of our company as having a profit and a non-profit side. The OpenEMR implementation described below is a part of the latter.

Application Custom reports have been developed for the user and SnoMED and ICD 9 databases are installed. The current project is converting to ICD 10 codes and is experiencing some issues with it. Populated the pharmacy and are printing patient payment receipts. It is tracking inventory. Auto-incrementing patient ID is also configured. The application team's biggest challenge was to define ACLs for each department and their heads.

Goal The whole team including management has been very clear on the overall goal that everybody is working towards. Last year the facility saw roughly 120,000 patient encounters and the goal of the automation is to double that!

Team-building We set user expectations, provided role definitions, and helped in team formation.

Training The user-base is not trained in computing technologies other than extensive use of cell feature phone SMS. The support team at Siaya also needs formal systems and applications training. Before going live, the application team engaged in "Train the Trainers" (TOTs) activity. The TOTs then engaged in training the staff while the support staff made themselves available to answer questions.

Installation time-frame December 2011 to January 2012

Location Western, rural Kenya and the government facility is called Siaya District Hospital

Contact Dr. Omoto Jackton, telephone +254-721-761484, Yudhvir Singh Sidhu, 408 677 7660 cell

• We encourage you to call the team in Siaya during our daily morning staff meetings 8 - 9 am EAT.

• They are 10 hours ahead of PDT. It is 10 pm in California when it is 8 am in Siaya.
• There is a USA phone number - area code 408. Please contact Yudhvir to coordinate. We want you to know the names of the staff and have you scheduled in the meeting.

Address Medical Superintendent, Siaya District Hospital, P. O. BOX 144 Siaya, Kenya, Postal Code 40600

When Siaya District Hospital goes live 13 April 2012

What Automated a 220-bed hospital - network, workstations, servers, and UPS

Who Created a team split in 4 groups: the systems administrators, Facilities manager, IT manager, and applications administrators. This team consists of Siaya people and the MediGrail staff members.

Equipment

• An Intel Atom Supermicro server with 4 GB RAM and a 32 GB SSD drive which is the firewall and a Linux boot server - running pfSense (pfsense.org)
• An Intel Atom Supermicro server with 4 GB RAM and a 2 TB drive which is the file server, IM server and future inter-department phone switch running on Ubuntu Linux and mounting user directories via sshfs.
• Intel Xeon Sun server with 6 GB RAM and two drives which is the application server during the day and backup server at night. The application is ofcourse OpenEMR (open-emr.org) and bacula.org for backups.
• The backbone is provided by HP Procurve 9078a 24-port Gigabit switches connected via Fiber Optic cables
• Currently 40 Panasonic toughbook laptops
• Inverting Opti-ups UPS and APC UPS

Network The systems administration team laid over 9,000 feet of network cabling in conduit and terminated all the endpoints. Installed 3 switches and connected them via Fiber Optic cable runs. The network will expand to 5 switches and each will be protected by voltage regulators and UPS.

Workstations We had to change our original thin-client stand-alone workstation design to laptops because you cannot reliably ship equipment to Kenya. The equipment went with us on the airplane. The workstations have a minimum of 512 MB RAM, no hard drive and no battery. This is intentional given the sensitivity of the data. Laptops boot off the network into a very small 55 MB footprint Linux distribution called Slitaz. It contains Abiword, Gunmeric spreadsheet, Firefox browser, a PDF viewer, and a file server mount utility called sshfs.

Power Creating a stable and clean power source is a major challenge at the facility and one which we are currently struggling with. An additional challenge is that the user expects at-least the phones to work during an outage. While the staff was being trained, the workstation power cables started to melt from the excessive voltages and voltage fluctuations. We have learned the hard way that power cables from the US are rated only at 130 VAC and perform poorly at the higher 230 VAC continuous loads.

Backups The application is backed up on an aggressive schedule using automysqlbackup. The file server is backed up using Bacula and the firewall is backed up via a shell script.

Monitoring The servers report their status to a private Twitter account on an hourly basis.

Please Contact Yudhvir at sidhu@medigrail.com if you have questions about the project.

Siaya District Hospital in Kenya Update 11 Jun 2012

We went live 13 April 2012 and since then have seen over 7,500 patients. The servers and networks have stabilized and the administrators have done a good job in training the staff on using the application and diagnosing workstation issues.

We are sending more network switches, fiber optic cables and laptops. We have also sent Linux and BSD books to be followed by systems certification materials.

MediGrail LLC, Siaya Disctrict Hospital Solutions Provider, Goes for $250K CHASE Grant

MediGrail, LLC is a small grass roots-California based health information technology (HIT) start-up. We are developing free applications that help patients take charge of their health and well-being. We also provide free services and implementation of free open source electronic medical record systems, to improve access to health care in rural areas both within and outside of the United States. This company's primary focus is to improve education and access to quality and safe healthcare across the socioeconomic strata.

To continue doing our work, we need your votes by June 30th to be eligible for a Chase Grant. The company plans to broaden these programs to more areas and add services and functionality to mobile platforms. Please vote and request your friends and family to vote for MediGrail by following these simple steps:

1. Go to https://www.missionsmallbusiness.com/ 2. Click "Log in and Support" under "Log in with facebook to support your community." 3. Login with Facebook 4. Enter information below and enter Search a. Business name: MediGrail b. State: California c. City: Morgan Hill 5. Click on Vote for MediGrail

Thanks for voting and spreading the word for us !!

MediGrail LLC Seeking Used Laptop Donations 26 June 2012

MediGrail LLC is putting out a fervent and immediate call for LAPTOP DONATIONS! A team of high school students is leaving for a trip from the West coast to Kisumu, Kenya in mid-July 2012. We have a window of opportunity that should not be missed.

The laptops are to be put to immediate use at Siaya District Hospital, a 220-bed government facility in rural Kenya, to access medical records. The complete hospital medical records system has been setup by MediGrail LLC, a Bay Area startup on a non-profit basis. The founders of MediGrail have spent over $50K of their personal funds on this project and continue to donate their time DAILY.

The laptops deliver incredible value to the staff and increase facility productivity. MediGrail loads them with these open-source applications:

• Word processor and spreadsheet which can read the latest Microsoft file formats
• Network file server access, printing capability, chat utility and PDF viewer

To date, the system has seen about 15K patients since the system went live in April 2012. Staff is able to submit reports to the central government and check their pay stubs on-line – saving them much time. They are able to quickly retrieve patient records without the patient making an extra trip to the records department. They are able to look at patient history beyond the currently limited new year date. They are able to print payment receipts easily. This has lowered the costs and increased the quality of care.

And more can be done... the project is already a success, it can become a huge success with your TIMELY donation. We need 15-inch laptops in working order with batteries and a minimum of 1 GB of RAM. Hard drives are optional. Please ship immediately to Yudhvir Singh Sidhu, 16605 Trail Drive, Morgan Hill, CA 95037