ph1l / ocemr

Open Clinic Electronic Medical Records

OCEMR - Open Clinic Electronic Medical Records

Summary

OCEMR is a web based electronic medical records system designed for the clinic environment. It is currently in use at The Engeye Health Clinic located in Ddegeya, Uganda. When looking into setting up an EMR for this donation based clinic, all the open-source solutions seemed too heavily feature-laden to work for our situation. So, we built our own!

OCEMR is designed for small clinics in rural parts of the world, this web-based EMR intends to be portable and straightforward to use.

Project Links

• Home Page
• Bug/Feature Tracking
• Wiki
• IRC channel

Documentation

• For Users:

  • User's Manual
  • CHANGELOG

• For Administrators/Developers/Testers:

  • Setup a Test Environment
  • TODO List
  • Debian Packaging
  • ROADMAP

THANKS

To the Original Team

I would like to thank Joseph Freeman, PharmD, for originally proposing the idea and pulling me into the loop with the folks at Engeye. Since graduating pharmacy school, he has been traveling to Africa to volunteer his time at different charitable organizations. He has been with the OCEMR project since it's infancy. Together, we have taken the project from a campfire discussion in the summer of 2010 to live production at the turn of 2011.

I would like to thank Carly Gielarowski, for her help and tireless support throughout this process. Her experience using EMR programs in the U.S. consumer health care industry was a guiding resource in the early and middle design stages of the project. She was also responsible for the testing and documentation in the final stages of deployment on-site. She continues to help me as we move the project forward toward our further goals of making the system more robust and applicable to other clinic installations.

I would also like to thank my sister-in-law, Kathy Z. Chang - MD / MPH, for her help in the late stages of design and implementation on the project. Her experience as a family practice physician helped to put the finishing touches on the OCEMR interface design and the Engeye installation.

To the Extended Team

I would also like to thank the following people for their input and help with the further design and testing of the system:

Stephen Po-Chedley, John Kalule, Sarah Yergeau,
Carlos Elguero, and Stephanie Van Dyke.

To the Original Financial Backers

I would like to thank the following people for their generous donations that made it possible for us to cover expenses necessary to accomplish our goal:

Mina Arsula, Nick Bausch, Connie Churchill, Tony Churchill,
Chris Edwards, James and Teresa Freeman, Joe Fuentes,
Robert Gielarowski, John Kim, John and Sue Kirkton,
Adam Kujawski, Kyle O'Brien, Anne Lynch, Maria Ruiz,
Rafael Vincente, George and Shirley Wiesneth,
Justin Winschief and more...

ocemr's Issues

Format of exam entry in encounter

Was wondering if it’d be possible to try having the body section tabs be headings with an existing free text box already available on the same page view, could allow people to tab through or click into the text box they want instead of waiting for the other window to open up, which sometimes gets lost in page reloading or stuck behind another window and they have to alt-tab to find it. I think this might speed up the access and charting process during clinical use and maybe reduce the constant refreshing requests load on server? Not sure if it would risk losing more input if the server freezes on a page when there are multiple users? (Currently each exam box saves individually)

add a med list

add a list of all previous meds from the chart. Perhaps on the side or as a separate tab
this would allow a clinician to see all previous prescriptions with dates in one place

add pulse oximetry to the vitals line

1. We need to add pulse oximetry to the vitals line (should read
   "SpO2" and the value is a "%" on "room air" or "% oxygen", such as
   SpO2 = 92% on room air.)

Can’t bill a patient for labs if no meds ordered

Was an issue they currently have a work around for, having clinicians enter a random Other med so they can bill $0 for the med and then pull up the charges for the labs to Bill and Collect.
Makes an extra step for the clinicians and is recurrently lost in the workflow for visiting docs.

Diff users Claim/Un-claim populates Dx List Multiple times

Problem with unnecessary duplicates and triplicates of dx list from different users claiming and then unclaiming patients from the patient queue.

Secure Records??

1. A secure password function for staff medical records that only I
   get. (So no one else can get into a staff member's personal record
   even though they have access to the EMR.)

Enhancement: indicate when pt. notes exist (red?)

1. Can the tab for "Notes" on the emr change to Red color when there
   is something in the box for staff to see (but this is the one that
   doesn't print out with the record). Similar to the Allergies line.
   Just so we can know there is actually something written there.

Include Parent/Family member name/contact info on Demographics page

Feature request - can we get parent's information or other family member's information onto a patient's demographics page for contacting them when needed?

Add ANC visit # labels

for use with diagnosis and service tracking: Add "ANC 1", "ANC 2", "ANC 3", "ANC 4" and "ANC 5+" as diagnosis options for Maternity services

Move site configuration into database table

Need a way for the "appliance admin" to configure settings for the system:

• Printer Name?
• Encryption keys?

Lab cancel button too close

Too easy to accidentally hit the cancel button for labs when trying to start results.
Similar issue with Undo-seen on patient queue.
I can see how some orders or patients go “lost” or missing.
Is it possible to extend the space farther right to give them a bit more space?

add a subtitle for patient notes tab

from @kzcbum :

ie. "this tab is for internal communication only, does not print out on patient's visit notes." ?

related to #19

Add Maternity tab

To allow for 1 page that tracks all pregnancy basics data, allowing data to be added onto with each subsequent pregnancy, so every "episode" of pregnancy does not require a new page, but this Maternity tab would be updated ongoing moving forward. This could also hold patient's past pregnancy data, as that would be entered at their pre-delivery antenatal care (ANC) visit for any past pregnancies.

This would summarize delivery related data and outcomes. Routine antenatal care visits would be under regular outpatient clinic visits, to allow for lab and med orders and billing per usual workflow. Admissions for labor and delivery would be tracked on paper until discharge, then discharge information to be entered per local standard format into a routine visit, with discharge summary information and meds/billing collected at the end. This would print as a normal clinic visit as their discharge summary.

Will attach sample page layout/data points of this Maternity Tab as an example.

Reverse lab order

lab queue is coming up in reverse order (newest at top) can it go
the other direction?

Update run on django 1.11

django has had many major releases with breaking changes. Debian 9 (Stretch) the most recent stable has either v1.10 in it's repos or 1.11 in backports. 1.11 is also currently in sid.

Daily patient queue date search

1. Daily patient queue date search function that is easier than
   clicking one day at a time through the daily lists.

Consider updating from jQuery 1.4.2

It was released in 2010. jQuery 3.3 was released in January.

Add link to Admin Interface.

There is currently no link from the interface to allow users to get to the admin interface.

For users that have the permission to use the Admin interface, we should display a link from somewhere...

Remove Immunizations and Vaccinations tabs

staff are not using these tabs and this would clean up space to have the Maternity tab

Daily Record -- pt # of month problem

1. The December 2011 daily record is not keeping an accurate "Pt # of
   month" line, it's just restarting the count with every day. I just
   noticed this and went back to November, where it's fine.

Medication name changes, and inactivation of meds, or addition of new meds.

1. Medication name changes, and inactivation of meds, or addition of new meds.

Update test documentation

I was trying to set some of this up for to see if I could get the web application running.

@ph1l - could you update some of the documentation based on your recent setup of a test server?

Some of the issues I encountered:

• util/make_version.sh does not exist
• Needed to install gpg (I am on a Mac)
• I got errors at: ./util/initialize_test_db.sh (see below)
  • eliminated many by downgrading to django v1.4 (used conda create -n ocemr django sqlite matplotlib python=2.7 and then downgraded django using pip install django==1.4)
  • Missing source_data directory
  • Missing version (see error below)

AttributeError: 'module' object has no attribute 'OCEMR_VERSION'

immunizations

I'm attaching the immunization record page that is most relevant
for the immunization tab we have. I'll attach the other pages of the
government card for your information on another email.

Admin Site for adding New Users

1. Admin site for adding new users - any way to have a set user
   permissions package for these visiting medical people (only the
   "ocemr" functions, no admin or auth or other sessions etc. functions)?

add a previous labs section

This would allow a clinician to see all previous labs in one place with dates and results

diagnoses not showing

still having some diagnoses not showing up when searching
for them, most notable one is "pregnancy"....even though it's in the
admin list, we can't choose it.

patient daily report and total number of diagnoses in the diagnosis tally report

also am a bit confused by the patient daily report and total number
of diagnoses seen in the diagnosis tally report. It seems like every
time the meds are ordered, the computer is counting the number of time
the diagnosis is used (as in recounts it for every med) so it throws
off the diagnosis count? Can you take a look at that if you have the
time?

Search for a Patient Id.

Need to search for a patient ID.

Check that print wraps long lines. via enscript and mozilla

1. Printing still needs to wrap long lines.

Debian Packaging

Build a Debian Package to install the software.

Accounting function

1. Accounting function, having the cost per unit for meds that we can
   input, then also including lab costs.

HMIS monthly reporting bug fix - new e-form

To fix or replace the current "HMIS report" option that gives incorrect results (that are inconsistent with hand-tallied numbers).

Pending updated electronic Excel version of current 2018 reporting form.

Patient Notes History/Attribution

Devise some way to discern the history and attribution of patient notes rather than have a free form text area that anyone can edit.

Another thing is that it would be nice to know who entered information
into the "Notes" tab, since it's an editable box, not sure how you'd
be able to do that, but one of the previous teams had some people
writing all sorts of non-applicable things there (in the wrong place)
and it's hard figuring out who wrote them.

backup / restore is broken

Looks like management stuff changed around a bit, and backup and restore functionality is broken...

Allow users to change their passwords via user preferences page.

There is currently no way for a normal user of the system to change their password.

Village misspellings!

tability to merge villages.. Wrong spelling -> correct.

track wrong spelling to auto-correct.

scanning outside data

could a scanner option be incorporated? this would allow a scan of outside documents to tie to the chart. (requested by clinicians, but I believe the data size and complexity would be an issue)

Hide Reports from non-staff users

can we hide the reports function from users? Really John, Kathy or
I would be the only ones to need to do them. Staff have access to
reports and they are curious about cashflow etc. . .

Database restore functionality

web-based admin function to restore from a backup.