How Hospitals in Afghanistan Can Become Smart: A Comparison of Electronic Medical Record System
Hospitals and clinics in Afghanistan have medical record systems with poor accuracy, in which errors of clinicians are not captured.
Hospitals and clinics in Afghanistan have medical record system with poor accuracy, in which errors of clinicians are not captured. Since, surveillance and research in hospitals are heavily reliant on collecting accurate data on processes and outcomes of care, substantial improvement is needed in medical record accuracy.
Dozens of consultations are carried our each month in these clinics and hospitals, however, patient data is recorded manually, then stored by the medical record section in physical folders. Often times the medical record department loses the physical records or in some cases the patients take original physical files without a copy handed over to the medical record department of the clinic or hospital . Based on JS Consultancy Services visits of hospitals and clinics in Parwan and Kabul provinces, it's found that patients’ data within clinics and hospitals is not used for decision making, research and learning purposes. The main reasons identified for such lack of usability of patients's data are difficulty in retrieval, due to huge number of physical records, and improper recording of data.
In this article I am going to introduce three open source Electronic Medical Record (EMR) systems with their pros and cons. These systems can help clinics and hospitals save resources, have a centralized EMR system, improve services by modifying processes and make future decisions based on data available at their computer screens.
With an average of 4,000 to 4,500 downloads per month, OpenEMR is one of the most downloaded open source electronic medical record applications. The application can be installed on Windows, Linux, Mac OS X, and many other platforms. OpenEMR is supported by a strong community of volunteers and professionals all with the common goal of making OpenEMR a superior alternative to its proprietary counterparts. OpenEMR is ONC certified and is one of the most popular open source electronic medical records in use today.
The strong support from the open source community is considered as one of the major plus points of OpenEMR. Issues and questions related to installation and configuration can be directly shared with the community to get further support. In addition, the clinic or hospital IT tech support can easily customize the application for new futures and add ons.
Unfortunately, while OpenEMR is ONC Complete Ambulatory EHR certified, it is not yet fully Stage II certified for Meaningful Use. It received part of stage II certification however the project is currently seeking donations to complete Stage II certification. Additionally, the UI is a little dated compared to the freemium and ad-supported options referenced above.
2. Open MRS
Open MRS is another open source electronic medical record application that has been in the market since 2004. The application is developed by a group of volunteers and has been adopted in several developing countries. It was first developed to scale up the treatment of HIV in Africa however in later versions additional features were added to the application. 
The application is easy to install on windows, mac and linux platforms. It can be customized by tech support to meet specific needs of the clinic/hospital. It's an ideal system for developing countries as it doesn't require adding insurance information (which is required in most developed countries). It has a ton of add-on modules that's available on the OpenMRS website. OpenMRS requires an upfront investment to create a customized EMR. Additionally, while programming knowledge is not required to create the EMR, in-depth medical and systems analysis knowledge is.
Bahmni is named after a village in Bilaspur, India, where the application is pioneered and implemented in one of the village hospitals. It's is an easy to use, open-source EMR and Hospital Management System for healthcare providers in low-resource settings. Its goal is to provide an out-of-the-box solution for hospitals and large clinics, that can be configured with zero programming.
The application is a combination of open source solutions, EMR is done through OpenMRS, Odoo is used for billing and accounting purposes while the laboratory is managed through OpenELIS. The main focus of the solution is EMR. The solution has been pretty new and is implemented in only few hospitals and clinics in India and Nepal. The organization is approaching more hospitals for implementation purposes.
Luckily JS Consultancy Services provide support for two out of the three solutions listed above. JS Consultancy Services is official partner with Odoo and has been promoting OpenMRS for last two years in Afghanistan. By adopting an EMR system, the management of hospitals and clinics in Afghanistan can bring efficiency in day to day work, store medical record data in a centralized system, improve processes and make future decisions based on data accessible at their computer screens.
Broughton EI, Ikram AN, Sahak I. How accurate are medical record data in Afghanistan’s maternal health facilities? An observational validity study. BMJ Open 2013;3:e002554. doi:10.1136/bmjopen-2013- 002554