What is the objective behind developing a software such as Bahmni and how is it different from the other open source medical record system?
Currently, in the rural healthcare ecosystem, the doctor to patient ratio is relatively low and there is a dearth of high quality digital systems for patient and health records management to assist healthcare providers in care and operations management, flexible and adaptable in their usage contexts. To address this concern, Thoughtworks conceptualized and developed Bahmni- an free and open source Hospital Information Management System (HIMS), to help healthcare providers with appropriate digital interventions in low resourced clinics and hospitals – for managing health records, for labs, pharmacy, inventory, radiology, analytics etc. The platform provides healthcare providers with digital tools to better manage health records and enable better quality of work.
The objective behind this initiative was to revolutionize patient care and tackle global healthcare challenges across low-resource areas. Bahmni was conceived to be a user-intuitive, automated, effective care system customized to provide a better medical information system for patients across rural clinics with limited bandwidth and infrastructure.
Our technologists bring successful, field-tested techniques and ideas from around the globe to open source solutions. The platform also allows for unique workflows and processes based on each hospital’s needs. We support and evolve the platform that countries and implementers use to create a customized EMR system in response to needs on the ground. It’s intuitive design is simple to use at the point-of-care, with minimal training required. It can be operated at the hospital site, requiring no dependence on the Internet and can be used on a variety of devices, including tablets and laptops which makes it infrastructure appropriate and adaptable.
What changes has the open source medical record system brought in the hospitals it has been implemented in?
The end users of Bahmni are typically doctors, specialists, nurses, clinical and non-clinical staff at hospitals located in remote parts of the world, most of whom rarely use technology in their daily life. This digital divide exist even among highly educated people like doctors. Bahmni takes careful steps to bridge this divide by including features and enhancements that are designed with these users in mind.
One of the biggest challenges of public health management is the unavailability of data at the right time to conduct any analysis. Bahmni helps to manage patient charts across care services and assist healthcare providers to keep track of patients’ health and progress. The doctors have instant access to a patient’s entire history by simply entering their patient ID into the system. In addition, they can use Bahmni’s display controls to quickly and efficiently scan through the information. The report generation module allows the administrators of the hospital to generate reports based on duration, diseases, format etc. The platform enables the providers towards quicker decision making, on disease breakout, affected areas and the treatment required for it. By digitizing and significantly simplifying the process of laboratory, radiology, IPD etc the platform enables a holistic view of patient’s history and pathways. The platform also enables digital lab records which minimizes errors and saves time. In addition to the bigger challenges that the platform is solving, there are other distinct features such as observation forms and treatment flow that help users manage a sea of patients on a daily basis.
Similarly, data produced by hospitals are also of profound use to researchers. Clinical, diagnostic and patient management information are all important for effective patient care. The information that Bahmni makes accessible helps healthcare providers to improve the efficiency and quality of patient care, reduce the margin of error in clinical diagnosis, and advocate for policies related to public health in rural areas.
Can you elaborate on how the model helps in the decision support system for doctors in drug efficacy. Also, going ahead do you have any plans to build specific analytics modules on communicable and non-communicable diseases?
Bahmni has various built-in mechanisms and addons for decision support systems. It was the tool of choice for a worldwide multi-year clinical research for MDR-TB, to study, track, analyze drug efficacy. Projects with this decision support system, have done integration with WHO Hearts initiative for CVD risk assessment and care planning. In the past, Bahmni has built OSS analytics addons towards hypertension, diabetes. For disease group specific analytics support, the easy to use support system looks to draw on the capability and knowledge of the ecosystem while trying to imbibe learnings from such integrations . In many contexts, Bahmni has integrated and leveraged with national level programs/systems – e.g. integrating with DHIS2 over ADX. It often acts as “source-of-information” and provides numerous ways for the ecosystem to extend and plugin. At the same time, Bahmni enables the provider with a host of toolings, learnings and meta models that providers can leverage. In the near future, Bahmni hopes to come out with disease specific starter kits consisting of curated metadata, contents, templates and analytics and reports.
Bahmni integrated with Ayushman Bharat Digital Mission (ABDM) . How is it going to help and evolve health services in rural areas?
The Ayushman Bharat Digital Mission (ABDM) has been at the core of integrating the digital health infrastructure of the country and connecting the digital health solutions of hospitals across the country with each other. Under the ABDM ecosystem, patients can create their unique identification ID called ABDH ID through which they can link and access their medical records, thereby reducing the burden of carrying physical documents. Bahmni is ABDM compliant, as a result of which, with this open resource EMR, provider can capture and verify the ABHA ID and fetch the demographic information of the patient. Additionally with this, the facility can act as a HIP, i.e. create medical records which can be shared digitally, and as an HIU, i.e. request and view patient’s records in the software. Since Bahmni is a Health repository provider (HRP) which is an ABDM compliant software provider, it has the power to register multiple HIPs (facilities) in the ABDM ecosystem.
What are the next steps of integration you will be exploring in Bahmni and how its going to improve the public health and small medical practitioners at small places?
Going forward, Bahmni will have integrated solutions for health centres using Internet of Things, and will look to expand and build towards integrated solutions, from converged Medical Infrastructure, to Health Analytics, IoT, Cloud Native support and integration with ecosystem. We are working with IIT-Mumbai in AI/ML driven OCR (Optical Character Recognition) for scanning lab results and integrating with clinical records As a result of the impact of the product initiative, Bahmni was recently listed as a digital public good, with a potential to serve as the open-source reference EMR application globally, and will play a key role in achieving UN’s sustainable development goals. As a digital public good, this open resource EMR will enjoy increased visibility and support in tackling global challenges
Today, it is implemented in more than 500 hospitals across 50 countries, benefiting millions of patients around the world, and revolutionizing patient care across rural areas. We are expecting the number to grow further as the impact spread across countries.
We are working towards creating a India specific ABDM compliant distro that can be adopted by small single practitioner clinics, polyclinics besides hospitals. To leverage the power of the ecosystem, Bahmni is aggressively working on further enhancing its HL7 FHIR interoperability support – towards a vision where it can be a platform where fit for purpose, contextual apps/extensions can be built independently by the ecosystem.
In future, Bahmni’s India distribution will also look to integrate and provide support towards ABDM’s upcoming “Unified Health Interfaces” and “Health claims exchange” protocols, so to provide comprehensive OSS stacks for integration with larger ecosystem for accessibility, reach, discovery and service delivery.
How is open source Hospital Information Management System (HIMS) advancing in the healthcare domain? Any challenges you face while implementing them? Is the open source model sustainable?
The focus of the initiative has always been on offering an opensource alternative to commercial options for hospitals, clinics, health departments in different locations. The initiative is empowering medical practitioners at small places and are helping doctors build a system where they improve patient care and potentially save more lives
There was a challenge in building a feature-rich hospital management system for users unfamiliar with technology. The system needed to work for low-resource (including monetary, infrastructure, and human resources) environments. The key to addressing these challenges and meeting the needs of end users, is to intricately understand their situation, empathize with their lived experience, and validate ideas with users.
On implementation side, the common challenges that we keep on facing are lack of understanding for digital interventions adoption and change management. Investment towards evolution of an implementation is another challenge. Sustaining an open source community driven platform is a significant effort and we can do with a lot of help – in boosting capacities and capabilities, and of course funding.
Open source model is surely becoming an alternative for many providers. While organizations often choose FOSS solutions for financial reasons, other significant benefits like transparency and trust, ease of adoption and use, harnessing the cumulative knowledge and power of worldwide community, security, interoperability and openness are becoming more apparent to healthcare providers. Even to system integrators or niche service providers, OSS solutions are a strong alternative than to get into complex contracts with COTS vendors. We believe a true community driven OSS solution can have widespread impact on high quality health care delivery and management and potentially jump start India’s digital health journey.