Journal: Journal of the American Medical Informatics Association : JAMIA

Article Title: Principles and implementation strategies for equitable and representative academic partnerships in global health informatics research

doi: 10.1093/jamia/ocaf015

Figure Lengend Snippet: Workshop case study problems and interventions.

Article Snippet: Problem addressed: In Rwanda, the challenge of achieving sustainable local ownership and control over an electronic health records (EHR) system arose early, with a focus on maintaining software and data locally through the OpenMRS EHR platform. Although the Rwandan Ministry of Health successfully employed locally trained developers to implement the system across hundreds of health facilities, issues of reliability and system accessibility persisted. Presented solution: Country ownership of the OpenMRS EHR in Rwanda occurred early with Rwanda being one of the 3 founding countries in 2006. Local software and data control was an early priority. This was strengthened by a one-year post-graduate eHealth Software Development Training Program led by Partners in Health (PIH) and the International Development Research Centre (IDRC), that trained 34 EHR developers between 2008 and 2011. The Rwandan Ministry of Health (MOH) employed many of these developers to roll out OpenMRS in more than 350 health facilities, with help from the OpenMRS community, PIH/Inshuti Mu Buzima (PIH/IMB) and the Global Fund. A survey of 90 OpenMRS users (half clinical, half technical) in 54 health facilities in 2018 showed generally positive views of the system, its benefits and usability. Regular activities included creating or updating records, ordering and viewing lab results and reviewing alerts and reminders. However, 18% of users said the system was available only about half of the time, and 7% said “almost never” or “never”; this is notable as the system had been in use for 6-7 years and was primarily supported by the Rwandan MOH and Rwanda Biomedical Center. While large-scale external funding has helped to expand OpenMRS use in other East African countries, Rwanda has sustained and upgraded the system with less funding, using local leadership and developers along with technical partnership from PIH/IMB and OpenMRS Inc. Local development and leadership is key to local sustainability; however, systems and users can benefit greatly from international collaborations that are, in this case, North-South and South-South (sub-Saharan Africa). Insights from evaluation studies should help improve system design and use and potentially shape future funding. With the rapid growth of interest in AI and machine learning it is critical that countries can understand complete data collection pathways and software as well as access their own data countrywide. .

Techniques: Software, Western Blot, Control, Sequencing, Variant Assay