Once an EMR has been chosen and designed, it needs to be implemented at project sites. This process can be fairly complex, as it involves distinct components:

• Deployment
• System requirements
• Determining data to be collected in the EMR
• Designing protocols for data collection and reporting
• Hiring and training personnel

Deployment

PIH collaborates as much as possible with the appropriate level(s) of government to assess the area of deployment. It is important to understand their concerns and requirements when implementing an EMR so that it will serve the needs of the wider community for clinical and reporting purposes. PIH also collaborates with other NGOs working in the area. By sharing common areas and agendas, we can strengthen the care we are providing.

Understanding and incorporating the system currently in use is also important. While the PIH- EMR system may be more comprehensive than the one already in use, we discuss both systems, incorporate effective strategies into the new EMR protocols and plan a transition period before deployment. This helps to increase the support of current employees and make for a smoother transition.

Power sources

 

Availability of a reliable power source is necessary for the effective deployment of an EMR. If no grid-based power is available in proximity to a site, PIH recommends looking into alternative energy solutions, such as solar, hydro, or wind power. In Haiti, PIH has traditionally relied on generators with good Uninterruptible Power Sources (UPS) to provide back-up. Power spikes can seriously damage equipment and sometimes occur when power vacillates between the grid and generator.

The amount of power required to run an electronic medical record system is based on the type of equipment/hardware that is used. Some examples of power usage for typical computing equipment are:

Other considerations during infrastructure planning include:

• Non-computing devices, such as printers, lights, laboratory refrigerators, and other testing equipment also need to be considered during planning for power sources.
• Future expansion requirements for clinics or hospitals.
• Desktop workstations and servers as well as laser jet printers are not recommended for off-grid power solutions and systems that require batteries for energy storage. They consume more energy than laptops and are very sensitive to changes in power supply.

Computing equipment and supplies

In order to run OpenMRS where internet connectivity is not available or reliable, PIH ensures that at least one machine has the following requirements:

Server Operating Systems

• Linux
• Mac OSX 10.2 and later
• Windows 98
• Windows 98 SE
• Windows ME
• Windows NT 4.0
• Windows 2000
• Windows XP (Recommended)
• Windows Vista
• Unix

Hardware

• Pentium 233 MHz (Recommended: Pentium 500 MHz or greater)
• 512 MB RAM (Recommended: 1 GB RAM or greater)
• 100 MB hard drive space (Recommended: 500 MB+)

Software

• Java Runtime Environment (JRE) 1.5+
• Tomcat 5.5+
• MySQL 5.1+
• Microsoft Office 2003+ (for InfoPath. Microsoft InfoPath is required for form creation and editing)

Optional software

• Apache 2.0+ (Used to handle SSL / static content requests)
• Apache-Tomcat connector (mod_jk 1.2.X)
• SQL admin / query tool
• CAB extraction and creation tools
• OpenMRS modules (modules.openmrs.org)

Workstations
All other computers that connect to an OpenMRS server have the following requirements:

Operating Systems

• Linux
• Mac OSX
• Windows 98
• Windows 98 SE
• Windows ME
• Windows NT 4.0
• Windows 2000
• Windows XP (Recommended)
• Windows Vista
• Unix

Minimum Hardware

• Pentium 233 MHz (Recommended: Pentium 500 MHz or greater)
• 64 MB RAM (Recommended: 128 MB RAM or greater)
• 52 MB hard drive space

Required Software

• Web browser: (Recommended: FireFox 1.5+; Internet Explorer 6+)
• Microsoft Office 2003 (w/ InfoPath)

Other equipment
At PIH sites, all computers are connected to a network either over wireless or Ethernet. This requires additional equipment:

• wired routers
• cat5 (RJ45) cabling
• wireless routers
• wireless adapters

The PIH-EMR is based on Java and other computer standards that are not likely to need replacement. Over time, it is likely that small upgrades to the computers, such as adding more memory or faster network cards will be necessary.

Data back up

The database for each PIH project site is backed up on a server in Boston every night; we recommend backing up all data on a secure, reliable, off-site server whenever possible. However, when this is not possible, saving data to an external hard drive and a flash stick every night is a good alternative.

When electricity fails, back-up batteries are essential. We recommend batteries that last 8-10 minutes, allowing staff to completes tasks at hand and save to a local server.