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 will be supported by a social enterprise that supports 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. The KMRI EMR is based on the OpenMRS platform that is approved by the Ministry of Health as an EMR platform in Kenya and is developed around the Free and Open Source Software (FOSS) philosophy.

 

During the initial evidence gathering phase of developing a model of sustainability to address the health record needs of vulnerable communities, ICChange identifed 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 three major releases of the KMRI EMR that have added primary care patient registration, disease codification, drug prescribing and inventory, and cashier functionality to the software. A Geographic Information System (GIS) module that will enable location-aware medicine is targeted for a May 2015 release.

The growing vision for KMRI is that, as more and more clinics are added to the EMR network, access to quality longitudinal care for this vulnerable population will also increase. In addition, as new cutting-edge functionalities, such as GIS mapping capabilities, are developed for the KMRI software, enhanced care can be offered through other modalities, such as outbreak-targeted public health interventions and point-of-care diagnostic services.

Eventually, ICChange hopes that a sustainable KMRI clinic will serve as a model for implementation of similar EMR-based clinical networks in slums and densely population low-income communities worldwide.

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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 simultaneously improving the delivery of health services and public health initiatives.

Vision

Our vision is to develop and implement a cloud based patient medical record system for Kibera; providing improved patient care and treatment while evaluating community health, epidemiology and disease trends in the setting of a mapped out environment.

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.

To date, the KMRI software has been deployed in two clinics in Kibera, with an additional 2-4 clinics set to join the network in 2015. With strong support from the Kenyan Ministries of Health, AMREF Kenya, and our implementing partners, we are moving towards adding more clinics, expanding functionality to the software and enhancing education and raising awareness about electronic medical record technology within the Kibera community.

The next software release will add a Geographic Information System (GIS) module to help track community disease trends, a reporting module allowing clinics to instantaneously generate government reports, and a laboratory module to process investigations and results.

News

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