AWS Public Sector Blog
How an open source EMR system has transformed patient healthcare in more than 50 countries
This is a guest post from Thoughtworks, a leading global technology consultancy and AWS Partner.
In countries where demand for healthcare outweighs available resources, and populations are spread out in remote locations, open source technologies using Amazon Web Services (AWS) can transform providers’ and patients’ experience.
Bahmni, an open source electronic medical records (EMR) system is one that we have pioneered. It gives doctors rapid access to up-to-date health records and test results so that they have better information and more time for patient care. A system that started in a single hospital in a remote part of central India is now used by more than 500 hospitals in 50 countries.
Digital public goods
As an open source, modular solution with global applications, Bahmni aligns with the United Nations’ plan for the creation of digital public goods for a more equitable world. In time, hospitals can use this digital public infrastructure (DPI) to improve public service delivery at scale.
The Thoughtworks team first created Bahmni in 2012 for a charitable hospital in a remote part of central India, Jan Swasthya Sahyog (JSS), through our social impact program.
JSS was the only healthcare facility in the area and patients would sometimes camp nearby for days to see a doctor. JSS wanted to improve patient care by spending less time on paperwork, and so reduce those wait times and see more patients.
Doctors needed a standardized EMR system to access accurate patient information instantly. The hospital also needed a more efficient method to manage test results and pharmacy billing. Budget limitations and unreliable internet connectivity hampered its aims.
A sustainable solution
We built on top of existing open source tools such as OpenMRS (for clinical records), OpenELIS (for lab management), odoo (pharmacy and billing) and dcm4Chee (for Radiology). This eliminated costs, such as proprietary software license fees that weren’t needed. The open approach also maximized opportunities to connect Bahmni with existing hospital systems, and allowed other developers to take the software and modify, enhance, and expand it for more hospitals.
As infrastructure in remote locations can be patchy, we designed Bahmni to function in low resource settings, including poor internet connectivity and unreliable power supplies, yet to be ready to run in the cloud at the first opportunity. It’s also streamlined for doctors to use, for example through touchscreens for rapid data entry or one-click shortcuts to prescribe routine medication.
Global reach
As news spread about JSS, other charitable hospitals and health organizations got in touch, including Médecins Sans Frontières (MSF). To support the growing community and its needs, Thoughtworks formed the Bahmni Coalition of open source developers and implementation partners. Members include MSF, SNOMED International, a not-for-profit organization that supports the safe and accurate exchange of information to improve healthcare around the world, and the Koita Centre for Digital Health at the Indian Institute of Technology, Bombay
We began to work with CURE International, a non-profit organization that provides free surgery for children living in poverty with treatable disabilities such as cleft palate, bowed legs and epilepsy.
CURE has rolled out Bahmni across its hospitals in Africa to create standardized operations, which can be adapted for country-specific elements including language.
Managers can identify bottlenecks and improve efficiency and patient experience through centralized reports and rich operational data. Each hospital can provide comprehensive reports on patient visits and treatments, which allow CURE to improve planning and procurement.
On top of Bahmni’s existing clinical and outpatient capabilities, CURE wanted to extend the system’s use to inpatient care. It is open source and modular, thus Bahmni allows customizations that are specific to an organization’s needs. Thoughtworks consulted CURE’s nurses and doctors to develop an inpatient module, which gives an optimized ward view of records and an inpatient dashboard view. As CURE’s head of technology, Kevin de Smidt, explains, “We built out a ward view and an inpatient dashboard view. All of these really needed to be tailored to the specifics of how nurses and doctors work within an inpatient environment. To be able to craft a system that really matches the way that a medical team works has been very exciting.”
It’s important to have a digital system that supports cloud access and on-premises hosting. As connectivity can be a challenge in remote areas and so where there’s unstable internet access, CURE hosts Bahmni on-premises. De Smidt aims to move to the cloud as soon as possible to reduce costs and improve data and IT management.
The CURE Zambia experience
Each year, one of CURE’s operations, CURE Zambia, sees around 20,000 children and performs 3,500 surgeries across three departments: ear, nose, and throat; orthopedics; and plastic surgery. Its clinics see around 40 patients daily, of which 15 to 20 are new.
Before Bahmni, paper archives were costing thousands of dollars per month to create, store, and manage (the law in Zambia prevents medical records from being discarded). The cost in doctors’ lost time was even more significant.
The savings from records and process digitalization have been reallocated to other areas of patient support. This means CURE Zambia can now treat more patients and, because doctors have time to review cases beforehand, they can deliver a higher quality of care.
Our work with CURE demonstrates the power of open source and the impact that digital public goods can have. CURE is delighted that the progress we have made together will benefit other low resource hospitals around the world as well. By working with the open source community and building on top of tools that already exist, we optimize the resources and the funding that’s available to create much broader impact than is possible in proprietary systems: everyone benefits.
The Bahmni solution won the Open Source Creation Award at the 2023 Future of Government Awards, sponsored by AWS. Thoughtworks developed it on AWS using Amazon Elastic Compute Cloud (Amazon EC2), Amazon Elastic Kubernetes Service (Amazon EKS), Amazon Relational Database Service (Amazon RDS), Amazon Virtual Private Cloud (Amazon VPC), and Amazon CloudWatch,