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. 2012 Jul 4;2(4):e000690. doi: 10.1136/bmjopen-2011-000690

Table 5.

Technical implementer responses

EMR system OpenMRS DREAM–Sant Egidio GHIS iSanté WorldVista OSCAR
Type of server at back end
 Brand Dell Power Edge 1950 HP, Dell Dell HP, Dell Any Dell
 Type of processors

  • Intel Xeon

  • 5400 series 3.33 GHz

  • Intel Xeon

  • Intel Dual Core

 Intel Dual Core

  • Intel Dual Core

  • Others

 X86, VAX/Alpha I7
 Number of processors 4 1 1 1 1 1
 Total hard drive capacity 4 GB 250 MB 100 GB 1 GB 200 MB 500 MB
 Hard drive capacity in use 500 MB 80 MB 15 GB 500 MB 200 MB
 Hard drive configuration RAID 1 – RAID 1 No raid – No raid
 Server operating system Linux, Windows Windows Windows Windows/Linux Linux, Windows, Unix, VMS Linux, Mac OSX and Windows
 Web server Apache Not applicable Apache Apache/IIS Apache, IIS Apache Tomcat
 Database running EMR system MySQL MS SQL Server MS SQL Server

  • MySQL

  • MS SQL Server

 Any that have compatible APIs MySQL
 Other software required Java JDK 1.6 +, PHP 5.3+ MS Access MS VB.Net LDAP, Perl, Cygwin (Windows only), Java, JasperReports Sun Java
 Cost of servers US$4000–$5000 US$2000 US$1500 US$10 000 US$2000 US$1000
Type of workstations running the EMR back end
 Brand PC, NetBook, Tablet HP, Dell Dell HP, Dell Any Dell, Any
 Type of processor 1.5 GHz any processors Intel Pentium 4, Intel Core 2 Duo, Intel Celeron, AMD Intel Celeron Intel Dual Core, Others X86 Pentiums mostly about 5 years old
 Hard drive capacity 2 GB 80 GB 80 GB 500 MB 200 MB 100 MB
 Operating system running workstations for the EMR front end Linux, Windows, OSX Windows Windows Windows Linux, Windows, OSX Linux, Windows, OSX
 Cost of a typical workstation US$1000 US$1000 US$700 US$1000 US$400 US$600
Networking
 Type of network Ethernet, GPRS, 3G Ethernet Ethernet Ethernet Ethernet Ethernet
 Type and number of switches – Layer 2 and Layer 3 Fast Ethernet Switchs Routers, number varies according to site requirements. 1 linksys router Ethernet Dlink
 Network bandwidth Ethernet, Fast Ethernet Fast Ethernet Ethernet, Fast Ethernet Ethernet, Fast Ethernet – Fast Ethernet
Backup system
 Backup up functionality

  • Yes

  • Management User, role and group

  • Administration module

  • Edition advanced data record.

  • Administration service web.

  • Yes

  • Standard MS SQL backup system, plus a daily copy of the database to another computer, and to the head office.

  • Yes

  • scheduled backup to portable devices used to update master database

  • Yes,

  • Standard OS File system backup + standard database backup + custom application data replication to remote server

 –

  • Yes,

  • Cron job that runs an encrypted compressed backup of the database and documents daily
 IT providers related to the IT infrastructure

  • Lazos: Responsible of the operation and platform

  • Frontera University: Center excellence Software Engineering, responsible of the proyect and development.

 DREAM local IT Staff In-house IT department of ministry of health responsible for installation maintenance and repair of all hardware and software CIRG (Clinical Informatics Research Group) developed and supports the application. I-TECH Haiti IT staff and CDC staff supports the application in Haiti – Oscar Service
System deployment
 Number and roles of people involved in deployment tasks

  • 1 Manager Development and coordinator team

  • 1 Analyst Quality and Testing

  • 2 Software Engineers

  • 1 Systems Administrator

 2 technicians in country for deployment tasks with Servers administration and Network proficiency.

  • IT department technicians

  • Site coordinator (system manager/administrator)

  • Trainer

 8–10 IT personnel do physical installation of hardware and installation and configuration of software across all sites in country – 1 programmer from Oscar Service for install and one trainer from Oscar Install. Both done remotely via the internet
 Overall estimated time for EMR software deployment (not including hardware/network) 8 months 1 h for 10 computers 1 month 3 days for software installation and training – Half day training session over the internet
 Estimated cost for configuration and installation of software (not including hardware/network) US$120 000 US$10 per site of 10 computers US$5000 – – US$1500.00
EMR interface usability
 EMR interface design follows standards/best practices ISO 9241 ISO 9241 No ISO 9241 – ISO 9241
 EMR interface intuitive and easy to learn for new users? Yes Yes Yes Yes –

  • Yes,

  • You can teach it over the internet. Locums are able to manage the system with minimal instruction by my nurse (15 min)
 EMR interface easy to remember for users? Yes

  • Yes

  • It has good layout, functions buttons always in the same area and basic functions just a few clicks away.

  • No

  • Requires time to get accustomed to NEW forms and reports

 Yes –

  • Yes,

  • Same routine daily
EMR performance
 Number of users of the EMR system – 20 per site 3–10 per site 5 per site – 20
 Average number of concurrent users utilising the EMR system 10 8 3–10 3 – 10
 Maximum number of concurrent users utilising the EMR system 40 No defined limit. 3–10 10 – No real limit
 Current size of database files 26 GB, 4.000.000 records 500 MB. 70 MB 1.27 GB – Backups fit on a DVD. 1.2 GB for documents and 240 MB database (Gziped)
 Average availability of EMR system Always available Always available Unavailable once a week Always available – Always available
 Average down time of EMR system when it fails <1 h <30 min <1 day <1 h – <1 min
Subjective speed of EMR
 When entering patient data 2 s 0.5 s Instant Adequate – No delay
 When accessing patient data 3–5 s 1 s Seconds Adequate for single patient access; large reports are cached and/or run overnight – Depends on the file. Opening a large patient file can take 3 up to 30 s with an internet connection
 When sending queries for reporting 120 s 3 s Depends on complexity of query Aggregate real-time reports may take up to 30 min in some cases, but most standard reports take 30 s or less – Depends on the query. Some whole database conversions to CIHI XML format can take up to 20 min
 EMR system integrated with other software?

  • CMS Typo3

  • Medica Agenda

 No No

  • Yes

  • OpenELIS (lab info system)

 –

  • Yes

  • Local hospital reporting system. External laboratory reporting system
 Standards used for transferring information OpenEHR, LOINC – –

  • No

  • Connected by Custom interface

 – HL7
EMR maintenance
 Who provides operational maintenance On-site resources On-site resources IT department technicians

  • CDC Haiti staff/

  • I-TECH Haiti IT

 – On-site resources
 Who is in charge of fixing EMR software bugs and developing new functionalities? External company On-site resources

  • IT department technicians

  • Site coordinator (system manager/administrator)

  • CIRG (Clinical Informatics Research Group—University of Washington)

 – Community
 Overall cost of EMR maintenance US$5000 per month None US$15 000 per year – – No contract with our installer and upgrade locally. This does take time which I don't bill for … about 8 h to convert, test, and then convert live data.
EMR system deployment
 Who was in charge of system deployment? External company On-site resources

  • IT department technicians

  • Site coordinator (system manager/administrator)

  • CDC Haiti staff

  • I-TECH Haiti IT

 – External company
 Time for system deployment 2–3 s Around 1 h for 10 computers. 1 week 3 days – Quite some time as they had to convert our existing proprietary EMR data to the Oscar standard. Apprx 50 h. A de novo install of Oscar is the time to install Ubuntu plus 15 min.
 How many people were involved in the deployment tasks? 3–5 Technician 1 Technician 4 Technician 1 Technician – 2 Technician
Training
 Time required for user training 1 week 15 min for each section of the programme 1 week 1 day – One half day
 Who conducted training tasks? Software community In-site resources

  • IT department trainer

  • Site coordinator (system manager/administrator)

  • CDC Haiti staff

  • I-TECH Haiti IT

 – External company
 Number and roles of staff involved in training tasks

  • 2 roles

  • 1 Coordinator

  • 1 assistant

 One DREAM local IT Senior Staff.

  • IT department trainer

  • Site coordinator (system manager/administrator)

 One I-TECH Haiti trainer – One external employee and all the clinical and secretarial staff
 Software currently has training manuals for the following: IT Technical staff Receptionists, clinicians, pharmacy staff Receptionists, physicians, nurses, counsellors, DOTS staff, pharmacy staff, site coordinator, IT technical staff Clinicians, users, IT technical staff – Receptionists, clinicians, pharmacy staff, IT technical staff

EMR, electronic medical record.