Cloud-Based Open Source Primary Care Electronic Patient Record System for Sri Lankan Citizens

Sri Lankans made over 100 million visits to public and private outpatient departments (OPD) during 2015, which is estimated to double in 2027. However, these visits have no records, either paper or electronic. Medical records are essential to provide continuity of care, and computer-based medical records were identified as essential technology in 1990 by the Institute of Medicine. The main initiative of the Ministry of Health addresses either OPD health information system or inward system, but it is limited to a few selected hospitals. There are no electronic health records (EHR) that can track patients as they crisscross between different primary care providers in public and private sectors, which is the normal behaviour of the majority of our patients. This paper gives a snapshot of the current healthcare system in Sri Lanka, notes the existing projects related to primary care health information systems, briefly reviews the current status of the global primary care EHR and describes our solution of a generic, cloud-based, open source EHR for use across public and private sectors focusing on a patient-centred electronic `personal health record'. We opted to modify a time-tested software solution OpenEMR - https://www.open-emr.org/ OpenEMR is a free and open source, ONC certified, electronic health records and medical practice management application featuring fully integrated electronic health records, practice management, scheduling, electronic billing, internationalization, and multi-lingual support. Sri Lanka OpenEMR (SLOEMR) is now used at the University Family Medicine Centre, Faculty of Medicine, University of Kelaniya at Ragama. Paper medical records of more than a decade were converted to the electronic format. We are in the planning process of piloting the SLOEMR in the Ragama Medical Officer of Health Area with a population of 70,000, with a single electronic record for each person across all private and public sector healthcare providers.