For decades, clinicians and researchers working in sub-Saharan Africa relied on a paper-based system of medical records that was time-consuming and often inaccurate. In 2001, Dr. William Tierney of Indiana University and his team created the first ambulatory electronic medical record system in the region, the Mosoriot Medical Record System or MMRS.
Though MMRS - and a further modification, the AMPATH Medical Record System (AMRS) - contain more than 4 million visit records supporting urban and rural primary care and HIV clinics in Kenya, Dr. Tierney faced a number of challenges when he first began work on MMRS in 1998 with a small grant from Fogarty. Establishing reliable computer service in an area with a meager supply of electricity and training local health workers who had little or no experience with computers were just a few of the obstacles they encountered.
Photo by Dr. Bill Tierney
A patient in Kenya holds her identification card
for the Mosoriot Medical Record System (MMRS),
which Dr. William Tierney of Indiana University
and his team created with support from Fogarty's
Informatics Training for Global Health (ITGH)
Prior to the establishment of MMRS, the Mosoriot clinic had collected data on paper that was sent away to health authorities, never to be used again, and patients had no unique identification number to facilitate registration.
MMRS, which was developed in Microsoft Access, changed all of this by allowing the clinic staff to store data electronically and use it in ways they had never imagined. Within a few years, the Mosoriot clinic has doubled its patient and visit load with no additional staff. A formal study at the time showed a ten minute reduction in the duration of patient visits, freeing up 15 to 46 percent of the providers' workday.
The new system gave the staff the ability to identify villages where too few children had been vaccinated so they could administer vaccines to the children who had been overlooked. In another case, a rabies cluster was identified and the rabid animal was found and exterminated. The MMRS also allowed the Mosoriot clinic to send in its monthly reports the first day after the close of the month, making it the premier health center in Kenya.
Dr. Paul Biondich of the Regenstrief Institute, the current primary investigator of the Fogarty-funded Informatics program grant to Indiana University, later went on to play an instrumental role in the creation of both the AMPATH system in Kenya and OpenMRS, an open-source medical record system used in HIV/AIDS clinics in Tanzania and Uganda. Drawing from their experiences with MMRS, the AMPATH team, with a group of collaborators from other institutions, chose tools that were freely available and open source when designing OpenMRS, guaranteeing that the overall project would remain low-cost and easy to update. Since then, OpenMRS has grown beyond expectation, having been implemented in more than 40 countries on five continents.
Funders for the two systems included Google, CDC, the Medical Research Council of South Africa, IDRC, WHO, the Rockefeller Foundation and other organizations. Additionally, AMPATH (now known as the USAID-AMPATH partnership) and the systems using OpenMRS were also funded by PEPFAR.
The development of MMRS showed that the digital divide could be bridged by an inexpensive and reliable electronic medical record system. According to Dr. Tierney, had it not been for the initial funding provided by Fogarty, MMRS and its successor OpenMRS would never have been conceived.
Fogarty's Informatics Training for Global Health (ITGH) program supports partnerships between U.S. and low- and middle-income country (LMIC) research institutions to increase the capacity of LMIC scientists and medical professionals to design, access and use modern information technology in support of health sciences research.