Uganda

1. What is the nature of OpenMRS and why was it developed? Why were US universities, US National Institute of Health (NIH) and US donors involved in developing this system? 2. What were the impacts of using OpenMRS in ISS Clinic? How did the healthcare system improve? 3. What were the problems encountered in using OpenMRS? Discuss the battle of forms and why there were disagreements about what forms to use. Make a distinction between research vs. clinical objectives, US researcher vs. local objectives. 4. Why the OpenMRS project is in danger of failure? Why did the clinicians at ISS clinic say that “we didn’t ask for it.
It is your problem”? Why MOH and US researchers are at odds about the value of OpenMRS? 5. What can be learned from this experience when implementing IT projects in developing countries? Do culture and world politics have a role? Why? 1. The OpenMRS is an electronic medical record system (EMRS) that was developed to track of patients medical records across a variety of different countries to be used in different types of clinics. Having the software as open source also meant that the source code could be assessed by anyone and customized to fit their particular need.
In the ISS Clinic in Uganda it was used for patients being treated for HIV/AIDS. The system was developed to replace paper records which would make the work of researchers and clinic workers easier. The EMRs was used to track patient progress and track the inventory of antiretroviral drugs. US donors were most interested in the system as it made the retrieving information on patients that is needed for their research on AIDS, antiretroviral treatment, and other disease research much more accessible. 2.

The impact of using OpenMRS was that it had greater storage capacity than Microsoft excel and it could be customized for their own particular use. Using the new system clinicians were able to able spend less time reviewing patient data and more time with patients as well as reducing wait times. Since patients usually did not see the same clinic staff. The data also allowed them to analyze patient trends and reduce the instance of drug stock outs. They could also use the data base to generate random samples for new research studies. 3. The problem with the Open MRS system is that not everyone in the clinic was on board.
Clinic workers generally thought of the system as more for the US researchers. Clinicians did not have much access to the system either as their primary tool was still paper forms. Another bump in the road was the Ministry of Health standardizing all forms for HIV clinics meant that ISS needed to redo their system to match the new forms, which also were lacking room the for the additional data needed for UCSF and MGH research. The Ministry of Health in Uganda was concerned with making the reporting of HIV treatment standard for all patients across all the different health platforms, public or private.
For the US researchers they wanted to include additional data for their various studies. Both the clinic and the researchers goal was to better and more efficiently treat the AIDS epidemic, however for the researchers they also needed to report back to their grant funders and publish studies in order to keep the program running. 4. The OpenMRS system was in danger of failure in 2010 because there was not enough financial support to cover the operational cost of the program. Funding was being stretched thinner and thinner and one of the clinics big grants was about to expire.
The Ugandan Ministry of Health was also not willing to cover the gaps as they did not see the value in the system for their own objectives. The Clinicians didn’t see the immediate value of the system for themselves because they thought of it as a tool of the US researchers (US Researchers were the only ones publishing papers using the data) not thinking about how it’s effect on the day to day operations of the clinic. 5. I think that there is definitely a cultural element to the problem in developing support for the OpenMRS project. The US stakeholders seemed to come in and set up shop without any input from the local people or government.
They thought that the government should automatically throw their support behind their efforts. The US stakeholders should have really engaged the local people more with the project, getting them more involved in developing the system and training them to use the system and showing clinicians why it is important for them. The Americans should have also gotten Ugandan researchers involved in using the system to publish their own papers. Having more of a local participation in the project and making it a collaborative effort would have made Ugandan government and workers see the system as their own.

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