Factors Determining a Successful OpenMRS Implementation

Press Release | Regenstrief Institute | January 1, 2010


A number of different global organizations use OpenMRS1, a free open source medical record system developed at Regenstrief Institute although this list is incomplete. The factors that drive a successful implementation of OpenMRS have not been explicitly studied. The goal of this project is to investigate and learn from the organizations that successfully use OpenMRS and determine the factors that foster adoption, use and sustainability.


Implementing electronic medical records in a resource-constrained area can be challenging. There are differences in culture, workflow, healthcare provider workforce, infrastructure, government regulations, as well as reporting needs both locally and nationally.2 The cost in implementing the system is not trivial in that even though the software is free, it requires the time of a knowledgeable information technology support staff to configure and customize it for the organization's needs as well as time to support training, integration into workflow and optimization. We plan to look at the implementation patterns from current OpenMRS sites to determine the factors of a successful implementation.


In order to begin to describe implementation and usage, we will identify and survey key informants at each of the organizations currently using OpenMRS via an electronic survey. Then we will follow up using a semi-structured interview with key informants found by soliciting their information from the implementers network via the list server.3 The design and analysis will be driven using the sociotechnical systems framework. The interview will include characteristics of the institution, extent of implementation and usage of OpenMRS, the infrastructure used to run OpenMRS, the information technology support for the institution, the workflow of collecting information from clinicians into the EMR, how the clinicians view the information and if the information flows to other systems in the organization.We will assess these factors predictive of successful implementation. We also plan to incorporate several open-ended questions using the critical incident technique to determine instances to show where OpenMRS has effectively been incorporated into clinical workflow and/or driven practice improvement. Criteria for success are not well defined or quantified but we will find central themes and measure them within and across different organizations. Central themes will be identified and incorporated into a new user's manual for the implementation of OpenMRS. Ultimately, we would like to test these themes in a new installation of OpenMRS.


Based on the information gathered from the surveys and interviews and their analyses, we plan to inform the OpenMRS community regarding effective strategies in implementation and sustainability of an open source electronic health record system (EHRs). Little research has been done identifying factors leading to the successful implementation and use of open source electronic health records particularly in the global setting.


1Mamlin BW, Biondich PG, Wolfe BA, et al. Cooking up an Open Source EMR for Developing Countries:OpenMRS - A Recipe for Successful Collaboration. AMIA Annu. Symp.Proc.(2006).

2 Van Damme W, Kober K, Kegels G. Scaling up antiretroviral treatment in Southern African Countries with Human Resource shortage: How will health systems adapt? Soc Sci Med. 2008 May;66(10):2108-2121.

3Seebregts CJ, Mamlin BW, Biondich PG, et al. The OpenMRS Implementers Network. Int J Med Inform. 2009 Nov;78(11): 711-20.Epub 2009 Jan 2.