[OPENMRS-DEV] Routine checkups

Support - Assistance technique
1

Hi Andrew,

It is me who is working from the DHIS2 side. I was kind of pulling part of OpenMRS model into DHIS2 and start storing individual data into DHIS2. Though my approach is kind of short sighted …

I did this because DHIS2 is strong in reporting based on frequency/period and routine data registration. On top of that for the place the house-hold system is required we have a huge install-base of DHIS2. So introducing a new system could really be a problem…

But after discussing with Paul (we meet in GOA for an integrated e-health architecture workshop hosted by HISP-India) and after looking a demonstration of a system (by a HISP-India team) I thought making the GUI in DHIS2 but maintaing 2 databases (OpenMRS for individuals, DHIS2 for the rest) in the backend could be a possible approach. But for this to happen … there needs to be some addition from OpenMRS side so that we can keep all the data in OpenMRS … but the aggregate figures into DHIS2.

Abyot.

···

On Mon, Aug 3, 2009 at 2:25 PM, Andrew Kanter andy_kanter@yahoo.com wrote:

Abyot,

We in MVP need to be doing something very similar, but I think have approached it differently. We use OpenMRS to capture individual data elements and then use CommCare or other tools by Community Health Workers to followup data entry at the home. Right now, this data is still attached to individual patients (although you can attach household observations to the head of household record). We definitely require the need to attach meta data to a household which then has a relationship to the people who live in it. There has been work done by DHIS2 to add this meta data there, and there has been work to have DHIS2 and OpenMRS to work together. In Geneva last month, we discussed having a concerted effort to get this combined system running (OpenMRS + HH data + DHIS2). In addition, there was also discussion about adding HR via iHRIS.

I have not heard a status report on this collaboration. Jorn, can you update us?

As for creating a grouper for encounters to establish an episode of care… I like this a lot. I don’t think it is critical functionality for what we are doing now, but would be for latter EHR development.

Andy

Andrew S. Kanter, MD MPH

  • Director of Health Information Systems/Medical Informatics
    Millennium Villages Project Earth Institute, Columbia University

  • Asst. Prof. of Clinical Biomedical Informatics and Clinical Epidemiology
    Columbia University

Email: akanter@ei.columbia.edu
Mobile: +1 (646) 469-2421

Office: +1 (212) 305-4842
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From: Abyot Gizaw abyota@GMAIL.COM

To: openmrs-devel-l@LISTSERV.IUPUI.EDU

Sent: Monday, August 3, 2009 6:04:47 AM

Subject: Re: [OPENMRS-DEV] Routine checkups

Hi Burke,

Yes what I need is a reporting one generated from clinical observations. And as you rightly pointed out it is more of a program-workflow. Depending on the program type we may need to record/observe the same data every month (for example in the case of Family Planning we may need to count the number of condoms or contraceptive pills given for individuals) or measure different data every month or program milestone (for example for immunization a child may be given Vaccine Type 1 for the first cycle and then get into schedule followed by treatment and observation for Vaccine Type 2 … it goes on for subsequent cycles)

My understanding from OpenMRS is that Encounters are specific incidences observed for a set of concepts (Encounter → Observation → Concept → value). And I am quite sure that this will not serve my need. What I want is to put a set of Encounters in a form and then ask my healthworkers to go and visit individuals in their house and bring me their observations. In most developing countries because there is shortage of skilled manpower, clinic or generally infrastructure a district medical officer might ask his assistants to vist a house-hold once every month and bring specific observations. For a situation like this we need to think beyond a clinic because patients might not be able to come to a clinic either because there is a no clinic in the vicinity or something else …

DHIS2 is quite strong for reporting, the encounters and the forms are loosely coupled, and I started to implement a house-hold visit module into it. I know that it is bit of a push for DHIS2 to make it regsiter individual data - OpenMRS is strong for dealing with individuals. After discussing with Paul and Saptarshi I am kind of thinking if it is possible to jump into OpenMRS and have a house-hold visit management system. The way I see it … there needs to be changes into your datamodel!

Abyot.

On Mon, Aug 3, 2009 at 7:15 AM, Burke Mamlin bmamlin@regenstrief.org wrote:

Abyot,

It sounds like your looking more for a reporting tool than a clinical one – i.e., you’re talking about a process that would occur periodically to organize/relate existing data rather than periodic visits from a patient, right? Usually, observations are made when the patient is present – i.e., during an encounter.

Creating new encounter types seems fairly clean; however, if you are not collecting new observation and, rather, organizing existing observations, then these new encounter types would end up duplicating observations and could confuse any other attempts to understand the data (e.g., a patient’s weight might appear in the original encounter, again in the auto-generated weekly encounter, and then again for the auto-generated monthly encounter). Trying to sort out actual observations vs. copies would be messy.

It sounds like you want something slightly above encounters – i.e., an episode of care – that could span multiple encounters (e.g., TB treatments that takes months and multiple encounters). The program-workflow “state” machine has some of this capability; however, I’m not sure it fits perfectly with your needs. We’ve been considering the “episode of care” idea as well as loosening the coupling between encounter & form (allowing many-to-many relationships between forms & encounters). But these are not small changes.

How about an episode-of-care module that adds it’s own table to link m

ultiple observations and/or encounters into episodes of care? This might be a way to experiment with candidate changes to the core data model. :slight_smile:

-Burke

On Aug 3, 2009, at 12:59 AM, Abyot Gizaw wrote:

On Mon, Aug 3, 2009 at 12:09 AM, Ben Wolfe bwolfe@regenstrief.org wrote:

Can you have a new Encounter Type for the different period types?

Yes that could be possible.

Or the slightly hackier solution would be to have a “Period Type”

Concept with answers of Daily, Monthly, etc, that is stored in an Obs
for that encounter.

Emm that would really be a “hackier”, I mean the item we are collecting and its frequency/time_axis should be kept separate.

If we had encounter_attribute + encounter_attribute_type, the solution

would be obvious.

Ya, that will make much more sense. Or else making encounter, period, period_type,… attributes of a new object for example form or registry or something like that.

Ben

On Sun, 2009-08-02 at 09:33 +0200, Abyot Gizaw wrote:

On Sun, Aug 2, 2009 at 7:42 AM, Saptarshi Purkayastha > > > > > sunbiz@gmail.com wrote:

    Checkups as such are Encounters in OpenMRS and these checkups
    can have one or more observations (Obs in OpenMRS)

Yes that was the closest I could come from OpenMRS. The timing with

Encounters (in OpenMRS) is more of an instance - recording the
datetime where the Encounter has happened. And this is ok as far as an
“ecnounter” is concerned. But what I want is more of a routine

periodic observations. It is like pulling out a medical record form
every month/week/…and then recording specific
observations/encounters together with their time of incidence
(datetime in openmrs). The medical record forms can uniquely be

identified by the registering clinic/facility (I think Location in
OpenMRS) and the reporting period.

    But when you talk about a plan or something that will happen

    in the future, it is considered Orders. Providers orders
    (medications, plan, etc.) and this can later result in an
    Encounter

    Hope that answers your question.

not sure … may be something like a “Recoding Form” object having
Encounter and Period as its attributes among other things is what I
want. Period also needs to have period types (like daily, monthly,

quarterly, yearly,…). You can say I can run cohort and bound
Encounters within a specific time frame and relate it with my period.
But reporting in HMIS, of course together with local use of

information, are critical and need proper modeling or something like

that.

Thank you
Abyot.

    ---
    Regards,
    Saptarshi PURKAYASTHA
    Director R & D, HISP India

    Health Information Systems Programme

    My Tech Blog:  [http://sunnytalkstech.blogspot.com](http://sunnytalkstech.blogspot.com)
    You Live by CHOICE, Not by CHANCE

    2009/8/2 Abyot Gizaw <abyota@gmail.com>

            Hi All,

            Can any one explain me how routine checkups are

            treated in OpenMRS? Say for example if a patient is
            going to have a weekly/monthly/.../periodic checkups
            is there any object in openmrs to handle this?

            Thank you
            Abyot.

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