Midwife EMR

Midwife-EMR (Midwife Electronic Medical Record) is custom patient management software for large charity maternity clinics in the Philippines serving the low income community.

Phase one of the application focused upon upon prenatal care. It was installed in February 2015 in one large clinic and is currently being used on a daily basis in the central facility. Design and development for phase two, which includes post-prenatal care (labor, delivery, and postpartum), is ongoing at the current time.

Features at a glance

• New patient setup
  • Any number of patients allowed.
• Prenatal history
• Prenatal questionnaire
• Prenatal examinations
  • Lab results
  • Vaccinations
  • Prenatal measurements/notes
  • Referrals
  • Medicines administered
  • Health Teachings
  • Progress notes
• Patient Search
  • exact and wildcard
  • search by priority number (scanning the priority badge/tag)
  • search by scheduled appointment day
  • search by date of birth
  • search by Phil Health ID or DOH ID
• Reports
  • To date these are reports required by the local government
    • Tetanus Reports 1 through 5
    • Iron Given Reports 1 through 5
    • Deworming Report
    • DOH Master list
    • Phil Health Daily Report
    • Inactives Report
    • Summary Report - everything about one patient in one report.
  • Reports produce PDFs for storage, printing, etc.
  • Report input includes to and from dates, type of report, etc.
• Priority number scheduling
  • Barcode generation system to allow scanning priority badges/tags for faster and efficient patient processing
    • Generator script creates PDF of barcodes
    • Barcodes can then be permanently attached to priority badges/tags that the patients use when they arrive. This is done once to setup the priority badges/tags.
    • The queuing system uses priority badges/tags and scanners can be used to quickly access the patient's records as they proceed through the exam processes.
    • Administration screen allows administrator to easily download barcode PDF to create badges, etc.
• User management (staff, etc.)
  • Roles
    • Supervisor
    • Attending
    • Clerk
    • Guard
    • Administrator
  • Permissions and ACL based upon roles
  • Any number of users/staff allowed.
• Web browser and mobile browser compatible
• Full logging of all changes to the database
  • All historical medical changes reviewable by supervisor role.
    • Allows supervisor to traverse forward and backword "through time" viewing the screens as they appeared across all pages of the application, or review only changes that occurred on a specific page.
    • Shows who made what changes at what time.
    • Is completely read-only, reviewing historical changes does not change data.
    • Fast - uses SPA technology so that reviewing changes are quick and simple.
• HTTPS (HTTP redirects to HTTPS)
  • Allows HTTP only if configured as such, though not recommended.
• Tests (152 to date)
• GPLv3 license

Some Additional Documentation

See the wiki for more detailed user and system documentation.

The Setting

The clinic for which the application is designed and is being used performs over 20,000 prenatal exams and delivers approximately 1600 babies each year. In the Philippines, this type of maternity clinic is called a lay-in maternity clinic. Our hope is that Midwife-EMR might be of use to many other lay-in maternity clinics not only in the Philippines but elsewhere where high-quality, free or low-cost, maternal services can be offered to those most in need.

Due to the relatively frequent power outages at the current location of the clinic, Midwife-EMR is currently running on an ODroid XU3-Lite single board computer. This allows the wireless router and the server running the Midwife-EMR application to stay operational for 5+ hours during a power outage while running on a 600 watt UPS. The application itself is accessed using 7 inch tablets, some smartphones, laptops, and desktops. It is normal for 12 or so users to be using the application, which is itself running on the ODroid XU3-Lite, at any one time without any issues or any hint of performance degradation.

A few facts about the specific XU3-Lite setup that we are using.

• 64 GB eMMC card
• 64 GB class 10 SD card
• Built in ethernet port, not using a WiFi module.

The SD card is solely used for automated backups. Additionally, encrypted backups are automatically stored on a remote VPS.

Note that as of this time the ODroid XU3-Lite is being retired by Hardkernel in favor of the XU4.

Status

Beta - initial pilot for prenatal exams was hugely successful. Midwife-EMR continues to be used on a daily basis since the pilot.

Phase two which includes labor, delivery and postpartum is currently being designed and developed.

Technology Used

• Nodejs - version v6.x.x
• MySQL
• Nginx - reverse proxy for the application (optional)
• Socket.io
• Elm

Web based and compatible with tablet browsers.

Future Plans

These are the ongoing, high-level plans for the project.

• Implement labor, delivery, and postpartum.
• Refactor the application for SPA clients.

Contributions

Contributions, comments, suggestions, issues and pull requests are welcome.

License

Copyright (C) 2013-2017 LightSys Technology Services, Inc.

This program is free software: you can redistribute it and/or modify it under the terms of the GNU General Public License as published by the Free Software Foundation, either version 3 of the License, or (at your option) any later version.

This program is distributed in the hope that it will be useful, but WITHOUT ANY WARRANTY; without even the implied warranty of MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the GNU General Public License for more details.

You should have received a copy of the GNU General Public License along with this program. If not, see http://www.gnu.org/licenses/.

See the file named GPLv3.txt for license details.