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Regenstrief presentation: Collaborating to improve health care delivery in Rwanda


INDIANAPOLIS — Investigators from the Regenstrief Institute will demonstrate the groundbreaking Open Health Information Exchange or OpenHIE, currently deployed in Rwanda at the Healthcare Information and Management Systems Society, or HIMSS, annual conference March 3 to 7 in New Orleans. 

OpenHIE is an open source health information exchange that is being developed using a community approach organized by the Regenstrief Institute, Jembi Health Systems and Instedd. These partners initially came together to improve the national health infrastructure in Rwanda with support from the U.S. President’s Emergency Plan for AIDS Relief. This group has been collaborating together with the Rwandan Ministry of Health on the Rwanda Health Enterprise Architecture (RHEA) project initially supported by the Rockefeller Foundation and International Development Research Center.

This project delivered the first implementation of OpenHIE in rural Rwanda and aims to create an integrated health information system to improve maternal care delivery at health centers throughout Rwanda. The overarching goal is improved clinical outcomes, better health care delivery and more cost-effective health services.

The initial clinical focus for the health information system has centered on developing a shared electronic health record for expectant mothers visiting prenatal clinics in eastern Rwanda. The endeavor is intended to improve maternal care through accessible, high-quality health records for all stakeholders responsible for the care of this population of women.

The project aims to enable access to an expectant mother’s health information — including details from visits to any clinics and data obtained by community health workers — to make informed decisions at dozens of clinics across Rwanda’s geographically diverse health districts. Care provided includes active management of the third stage of labor, which is a World Health Organization-recommended technique to prevent postpartum hemorrhage, and prevention of mother-to-child transmission of HIV.

The software developed by the collaboration will be on display at the HIMSS conference, where its functionality will be demonstrated using the case of a pregnant Rwandan patient who develops medical complications and is seen across the spectrum of the health care system: at her home by a community health care worker; at a local clinic by medical staff; and at a regional hospital by medical staff. According to World Health Organization statistics, although Rwanda’s maternal mortality rate is declining, childbirth remains a major health risk for women.

“An integrated eHealth system within a constrained environment like Rwanda is a new and innovative way of thinking about health systems development. Using open source approaches to develop a national health care information infrastructure allows best practices to be available to the rest of the world in a way that encourages peer learning amongst countries themselves,” said Regenstrief Institute investigator Paul Biondich, M.D., M.S., associate professor of pediatrics at IU School of Medicine and one of the principal architects providing leadership for the Rwandan initiative. He is also co-founder of OpenMRS, the world’s leading open source enterprise electronic medical record system platform. OpenMRS currently is utilized in over 37 countries, some at national scale.

“The development of health information exchange in this low-resource environment contributes to the improvement of public health in Rwanda as it improves care of individual patients,” said Regenstrief Institute investigator Shaun Grannis, M.D., M.S., associate professor of family medicine at the Indiana University School of Medicine. Dr. Grannis directs the Indiana Center of Excellence in Public Health Informatics at the Regenstrief Institute, one of only four such centers in the nation. “Our work builds upon four decades of experience with the Regenstrief Medical Record System, the Indiana Network for Patient Care, the AMPATH Medical Record System, which we developed in Kenya, and now OpenMRS, which is in use worldwide.”