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OpenMRS for oncology

OpenMRS for oncology - create regimen form

Collaborative work with Partners In Health, Hôpital Universitaire de Mirebalais (Haiti), Uganda Cancer Institute, University of North Carolina, and the OpenMRS Community on an oncology module for OpenMRS.

Mission: Create an oncology module for OpenMRS

Cancer crisis in LMIC

There is a silent growing cancer crisis in low- and middle-income countries and less than 30% of them have cancer treatment services. Hospitals that provide cancer care store most of the information on paper.

Medical records in one of the hospitals in LMIC
Medical records in one of the hospitals in LMIC

Recording of all the information about cancer treatment is critical. Some of the chemotherapy drugs have a lifetime dosage and losing information about admissions can lead to the death of patients. On the next picture, Johnblack is holding a sheet of paper "OpenMRS for cancer care". He is a medical officer and in 2017 he participated in OMRS conference where he talked about how important it is to build an oncology module for OpenMRS. OpenMRS is a collaborative open-source project to develop software to support the delivery of health care in developing countries. It provides many modules that allow hospitals to keep important inforamtion in one place but it still doesn't have a module that would help to treat cancer.

Johnblack talks about OpenMRS for cancer care at OMRS conference in 2017
Johnblack talks about OpenMRS for cancer care at OMRS conference in 2017

OpenMRS for cancer care

Partners in Health and IBM decided to solve this problem together. In 2018 a team of IBMers came to Boston to work on an oncology module for OpenMRS and I was a part of this team. We all joined a program called IBM Health Corps, it's a global pro bono program focused on tackling health disparities.

We arrived in Boston to work with Partners In Health, it is a Boston-based nonprofit health care organization founded in 1987. It builds hospitals and other medical facilities, hires and trains local staff, and delivers a range of healthcare, from in-home consultations to cancer treatments. This movie is the first thing that our new colleagues showed us, it tells an incredible story about this wonderful organization and the people who work there. I really recommend to watch it.

As-is scenario

We knew that we have only 3 weeks to work on this project and therefore, we started doing research in advance. Together with our UX designer, I participated in a couple of interviews with nurses that have experience in treating cancer in LMIC. We've built an "as-is" scenario and identified the main pain points. In our case, we called them "death" points, because some of the steps of the current process were so risky that any mistake could lead to death.

Doctor receives lab results
1/14 - Doctor receives lab results
Doctor determines patient’s Chemo regimen
2/14 - Doctor determines patient’s Chemo regimen
Patient comes to the hospital 3/14 - Patient comes to the hospital
Nurse asks control questions and measures BSA (Body Surface Area)
4/14 - Nurse asks control questions and measures BSA (Body Surface Area)
Nurse checks all previous Chemotherapy cycles
5/14 - Nurse checks all previous Chemotherapy cycles
If the nurse misses any important information, it can lead to the death of the patient
6/14 - If the nurse misses any important information, it can lead to the death of the patient
Nurse calculates the amount of the drug and asks for approval
7/14 - Nurse calculates the amount of the drug and asks for approval
If the nurse makes a mistake when calculating the dosage, it can lead to the death of the patient
8/14 - If the nurse makes a mistake when calculating the dosage, it can lead to the death of the patient
Nurse mixes drugs
9/14 - Nurse mixes drugs
She can mix drugs for several patients simultaneously
10/14 - She can mix drugs for several patients simultaneously
If the nurse makes any mistake on this step, it can lead to the death of the patient
11/14 - If the nurse makes any mistake on this step, it can lead to the death of the patient
Nurse makes notes about any reactions while the Patient takes the drugs
12/14 - Nurse makes notes about any reactions while the Patient takes the drugs
Doctor re-evaluates Chemo regimen
13/14 - Doctor re-evaluates Chemo regimen
Nurse schedules the next appointment
14/14 - Nurse schedules the next appointment

Design and Developemnt

Our team consisted of

We decided to focus on the very first step of the process - recording a regimen and tracking patient visits. The first week I was working together with our UX designer on mockups that we were reviewing with the stakeholders. At the same time, 3 software engineers were digging in the source code of the OpenMRS core modules. After the first design iteration, I switched to front-end. Together with my colleague we've created basic layouts and prepared everything for integration with REST API.

Our backend team was in an extremely difficult situation. They had to come up with a solution that the OpenMRS community will be able to pick up and continue building after we leave. After a lot of calls and discussions, we finally reached an agreement and our software engineers created a branch with all required changes to the core modules. Last week we were integrating all pieces of the puzzle.

Results

Here is a demo video that shows the results of our work.

Check out all our deliverables here. Currently, our proposal is waiting to be incorporated to the source code of the OpenMRS core modules. I hope one day it will be used to help treat cancer in LMIC.

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