OpenMRS Oncology Platforms

[Sean L]

Hello all,

I am a second-year medical student at Harvard and am interested in learning about current and/or future implementations of OpenMRS for oncology.

So far I have been able to gather the following:

1. Partners in Health currently has some basic oncology functionality for their cancer hospital in Rwanda that is a mixture of data forms, the Reporting module, and a customization of the OrderExension module that allows for the complexity of chemotherapy regimens.
   
2. I also believe that RG Kar Hospital for Oncology and Radiation Oncology implemented OpenMRS (per Rajib Sengupta), but I am unsure of the extent to which oncology-specific functionality was created beyond adding concept dictionary terms.
   
3. Andrew Miller of University of Wollongong's Graduate School of Medicine has previously looked for others interested in using OpenMRS for oncology, specifically for radiation oncology, but I don't know if he was able to connect with any collaborators.
   
4. The Active Projects page has outlined an OpenMRS design for chemotherapy regimens.
   
5. Finally, it is my understanding that AMPATH has embarked upon comprehensive cancer care in Kenya. I would be curious to know if this cancer-related work included creating any new OpenMRS functionality.
   

Has anyone else attempted or successfully used OpenMRS for oncology? Is there interest out there in the community to have functionality for chemotherapy ordering or for other features specific to cancer-care?

There are free oncology platforms available online for cancer care currently, such as St. Jude’s POND (pediatrics) and Memorial Sloan-Kettering’s CAISIS programs, however there does not appear to be a free solution that can be integrated into a broader system like OpenMRS. In terms of coordinating, tracking, and evaluating cancer care in locations such as Haiti (where OpenMRS is already used), it seems it would be valuable to have functionality specifically for oncology -- and perhaps even to eventually have a more generalizeable module that could one day be integrated into the Reference Application, allowing for ongoing collaboration.

Looking forward to hearing about any potential work on this front or general thoughts that the community has.

Sincerely,

Sean L

[Andrew Miller]

1. Andrew Miller of University of Wollongong's Graduate School of Medicine has previously looked for others interested in using OpenMRS for oncology, specifically for radiation oncology, but I don't know if he was able to connect with any collaborators.
   

I have been unable to connect with collaborators. My interest area is in Knowledge Structure and I have found this aspect to be inpenetrable.
I have been unable to see a working implementation, it would be useful if one could be put out as a demo. This would make a big difference to see how it might be used for RO.

I did some work with a student software group devising a way for the receiver of a referral to see the medical information of the patient held by the sender of the referral. Seemed to generate equal amounts of enthusiasm and suspicion, usually in different people. Made me realise that we are dealing with Security, Privacy AND SECRECY!

I have largely withdrawn from any more effort in OpenMRS because of the lack of engagement and replies. I hope it is different for you.
 

St. Jude’s POND (pediatrics)

 never seen this, do you have a link?

MSKCC’s CAISIS

This program is not designed for clinical use but rather as a data repository for collation of data.

[Rajib Sengupta]

Sean and Andrew, 

Sorry,,  I somehow missed this email ...Thanks Saptarshi to bring it to my notice...

We (www.missionarogya.org) have tried to implement OpenMRS in RG Kar Medical College Oncology Department . We had a successful implementation and a short pilot run , it soon become defunct for various reasons. Instead of passing any judgement or opinion, I will try to explain the chronology of events : 

We started the project in 2012.The biggest roadblock was almost NO cancer/oncology specific concept was existing in any of the Concept Dictionaries. So, first we did the data modeling as much as possible and added the concepts for oncology in the MVP dictionary with help from Andy. From UI perspective, We have used couple of modules (one for file loading and one for drawing anatomy pictures), but otherwise we mostly used HTMLformentry module for the different forms (primarily for each part of the body and/or system - Dental and Oral, Neck, Thorax, Abdomen and GI, Gynaecological Exam, Urogenital and Male ext. genitalia, Breast, Lymphovascular, CNS & PNS, Vision, Endocrine, Skeletal , Skin, Soft Tissues and Limb etc). We also built forms for the radiation based treatments such as for EBRT and Brachy. But all of these forms were built from grounds up and somewhat constrained with the HTMLFormentry limitations (e.g: cannot dynamically add a new entry). As a result, the UI was not suitable for point-of-care entry - So we need to assign data entry resources - Means, the doctors were entering it in paper form and then the data entry operator was entering it as post data entry activity.

With all these issues, still we have been able to complete RG Kar implementation and started the pilot project. We have more than 150 patients data recorded within a months. But the biggest blow was the primary sponsor of this project got transferred to another Government Hospital in 2013 - North Bengal Medical College (NBMC) in Siliguri which is quite far from Kolkata. We continued for few more months, but without his presence the impetus disappeared and finally stopped - They specifically pointed out two things - 1. RG Kar doctots were uncovering new concepts which are common for cancer and 2. Data entry is not easy and resource intensive 

Our project sponsor, when he moved to NBMC, tried to do the same in NBMC, but insisted that we need a system which should have cancer specific concepts already built in along with some cancer specific intelligence (UI, some Clinical Decision Support etc.) - basically opensource is fine, but it needs to be built for cancer. So,early 2014, we chose CAISIS and provided a demo to the higher authority -infact, it got installed also. But again with the whimsical nature of the government postings, he is again got transferred back to RG Kar Medical College (with a promotion obviously :-)) 

I just spoken with him and he is interested to revive the RG Kar Oncology project (the old OpenMRS implementation or may be a new CAISIS implementation) - But, at this point we have decided that we will only proceed if we have complete backing not only from the department, but from the Head of the Institution (The Principal and Medical Superitendent) as well as from the State Health Department (as this is a Govt Hospital). Based on my experience , I know that, it will be very difficult to get this support. Specifically, the current state govt is running a very tight budget due to huge deficit and I am sure that they may provide logistical and administrative support but no financial support. let me know what do you guys think?

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[Hannan, Terry J (DHHS)]

As I read this posting several times I could not but think that this documentation has soem very important lessons for the OpenMRS project(s) that possibly should be stored / formalised within the development documentation.

-dictionary formulation and enhancement

-adaptability/interoperability

-personnel involvement-locally/developers and implementer groups

-sponsorship

-etc.

I am not sure what others think.

Terry Hannan

Sent from my iPad

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[Andrew Miller]

I am not surprised by the description. IT projects need a champion and a leader, and commitment. The building phase is difficult even when understanding levels are high.

I found problems with the Concept Dictionary that I saw as the classification method was cumbersome to read, looked a nightmare to maintain and was multiple. I couldn't see how connections between concepts were maintained as there was no knowledge structure. I am concerned how we will ever develop these systems if we don't have a model from which we build the system. To this end I have been looking at Fact-Based Modelling which can be used to specify SQL tables from the model.

The notions of Forms as the leading paradigm sells modern medicine short and is a cop out by IT people. We just don't live by the form mentality or by the business process, though both have some role to play. We live more by a spider web mentality of logical interconnections between reasons, events and thoughts. Unfortunately, you have to be a doctor to see these!

In my travels next year I will try to build in a visit to Kolkata to see what happens if it gets going again. 

A

--

Prof. Andrew Miller
B.Med, B.Sc, Grad.Dip.Ed, M.Inf.Comm.Tech(Res), FRANZCR, FACHI, PHF

• Radiation Oncologist
  Illawarra Cancer Care Centre, Wollongong, NSW 2500 Australia
• Clinical Professor of Medicine
  Graduate School of Medicine, University of Wollongong
• Adjunct Professor of Informatics
  School of Informatics, University of Wollongong 
• Director
  Centre for Oncology Informatics, University of Wollongong
• Journal Manager
  Journal for Radiation Oncology Informatics

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