Summary

The Kibera Medical Record Initiative (KMRI) aims to introduce an open-source cloud based electronic medical record system in the Kibera slum of Nairobi (one of Africa’s largest peri-urban settlements), in order to improve access to outpatient medical care, encourage a referral system across clinics, and enable the evaluation of disease trends in the setting of a mapped out environment.

The expansion of the project is supported by a social enterprise that enables new features and new clinics entering the system. The end result will be a more holistic, integrated and agile health delivery system for one of the most at-risk populations in the world.

The Story

The Kibera Medical Records Initiative (KMRI) is a program designed to promote the responsible and secure use of electronic and mobile health programs first in the Kibera slum and then at a national level throughout Kenya. The first objective of the project was to validate that a cloud-based Electronic Medical Record (EMR) application could be developed for and deployed in Kibera, the second largest slum in Africa and a community of nearly one million people. This validation was completed in 2015 and scale-up of the OpenMRS platform was approved by the Kenyan Ministry of Health for a national deployment.

During the initial evidence gathering phase of developing a model of sustainability to address the health record needs of vulnerable communities, ICChange identified several other EMR software solutions in use throughout Kenya that focused on disease surveillance, acute or hospital-centric care, pharmacy and drug management, or patient registration. Through this analysis, ICChange and its partners recognized that there was a definite need for a centralized electronic health platform that starts in a primary care context and can enable the mobility of patients between healthcare providers through the secure sharing and availability of a health record database between facilities.

Choosing an open source platform already in use in Kenya prevented duplication of efforts and further confusion in the EMR community and allows the KMRI team to contribute software and code back to the OpenMRS community that can be reused and reconfigured for EMR deployments worldwide. To date there have been several major releases of the KMRI EMR that have added primary care patient registration, disease codification, drug prescribing and inventory, cashier functionality, GIS disease surveillance, DHIS2 reporting output, and lab capabilities to the software.

With the successful pilot, production deployment, and open source availability of a primary care EMR now complete, ICChange is working to take its competency in electronic and mobile health and expand services to target critical gaps in electronic health services that the private sector would not typically address. This has meant the creation of a social enterprise to manage this competency (Babyl Solutions) with several projects targeting trauma registries and community health worker based disease surveillance via SMS.

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Need

Without access to a persistent medical identity there is an increased risk of complications from chronic disease, limited data on disease epidemiology, a reduced capacity to respond to outbreaks of communicable diseases, and reduced efficiency of the healthcare system as a whole. These challenges are only amplified in a peri-urban or slum environment.

Idea

To empower people in vulnerable communities by creating a system that gives them a persistent medical identity while improving the delivery of health services and public health initiatives.

Vision

Our vision is to develop and implement electronic and mobile health solutions that solve real problems identified by people working to provide improved patient care and treatment while evaluating community health, epidemiology and disease trends in novel ways.

The Results

2011
The ICChange and KMRI team successfully completed a preliminary assessment to better understand the environment within which the EMR would be deployed. This included multiple stakeholder meetings with government, health clinics and community leaders and members.

2012
The first iteration of the EMR was deployed in two partner clinics in Kibera. The software focused on primary care services and introduced a referral system between clinics – a new feature that had never before been used in Kibera

2013
Focus shifted to raising awareness about KMRI and the benefits of the system to clinics and patients alike. This included engaging residents by hosting monthly health segments at a community radio station, as well as launching an education and communication campaign to raise awareness about health issues and the benefits of the KMRI EMR system throughout Kibera.

2014
A system upgrade was introduced with brand new and expanded EMR features, including a simple report-generating feature, a cashier/billing module and a pharmacy module.

With strong support from the Kenyan Ministries of Health, AMREF Kenya, and our implementing partners, we are moving towards expanding functionality to the software and enhancing education and raising awareness about electronic medical record technology within the community.

2015
With support from IDRC, the KMRI team introduces an open source Geographic Information System (GIS) module for the OpenMRS platform to help track community disease trends.

2016
The software development team at ICChange is expanded and the social enterprise Babyl Solutions is created to house the electronic and mobile health competency created during the KMRI project. A DHIS2 reporting integration module is created to allow large dataset reporting at the local, sub-county, county, and national/international level.

2017
A new Lab module is launched by the team for the OpenMRS platform and collaboration with other electronic health groups increases. Electronic trauma registry projects are started or expanded in Uganda and Kenya as a cross-over competency project with the Kenya Trauma and Injury Project (KTIP) at ICChange. Plans are developed to support AMREF and the Ministry of Health in Kenya with a mobile health project for use in community health projects in remote and peri-urban communities.

News

Show Your Work! Two Papers from the KMRI Project

ICChange believes in sharing the lessons we have learned and the successes we have earned working alongside our partners. In that spirit, …