Raxa - Open source EMR software for rural healthcare systems

Peter GroenMany people in this world do not have ready access to healthcare providers and have little or no control over their personal health information.  The few who do have access are starting to see the potential benefits of using information technology (IT) like electronic medical record (EMR) system to improve their own health. These systems offer an opportunity to reduce healthcare costs while simultaneously improving quality of care. This is particularly true of Raxa, an 'open source' EMR project based in India.

Raxa has been initially targeted to support operations at The People’s Health Support Group, or Jan Swasthya Sahyog (JSS), a non-profit group of healthcare professionals operating a small hospital and village health centers located in rural Chhattisgarh in India. JSS was founded by a group of doctors from the All India Institute of Medical Sciences in New Delhi and has since become a successful model for low-cost, high quality care, providing a full spectrum of services for an extremely underserved community. Raxa is designed to support the incredible work of the doctors at JSS.

The Raxa project team consists of a diverse group of experts that have come together to work towards a single goal: to improve access to healthcare for underserved patients within India, such as those who come to JSS.  Over 150 individuals, universities, and software companies from around the world have volunteered to contribute to the project in one way or another.  If successful, Raxa software could then be shared and used by others in similar situations anywhere in the world.

The open source Raxa system is about more than just electronic medical records (EMR), it is a health information management system designed to provide decision support to health workers, and improve patients’ access to their own personal health information.  Some of the key objectives and functionality for Raxa include:

• Creating a secure, web-based application
• Use the OpenMRS system as the foundation for the system
• The ability to be easily enhanced and updated remotely
• Designed with a low-literacy population in mind
• Include voice recognition and speech processing capabilities
• Replace paper records, including x-rays, which fade, degrade and get lost over time. 
• Storing digital health information in a local, encrypted server
• Back up the system to a secure location using cloud computing technology
• Providing clinical decision support and analytics to physicians who are often pressed for time.
• Use SMS alerts for medications, outpatient and surgical appointments, as well as follow up notifications and two-way communication.

Raxa has been designed as free and open source software, with Apache v2.0 licensing. The team hopes that health systems ranging from individual providers, to clinics, and large rural hospitals around the world will find value in using Raxa.

The Raxa JSS EMR is currently being designed with specifically with JSS hospital and clinic workflow in mind, but with the hopes of later adapting it to other healthcare provider organizations and settings. The initial implementation is taking place in Chhattisgarh where the Raxa project team will work closely with the hospital to cater the system to their needs. The Initial Development Phase for version 1.0 began in May 2011 and is expected to continue through September 2012.

In September 2012, the project team will begin implementing five core modules of the software at JSS. During this time, they will be training the hospital staff on how to use the software, and troubleshooting and debugging any unexpected problems. This initial phase of the pilot project will be critical for obtaining feedback from both doctors and patients, giving the team the opportunity to more finely tune the software. An assessment of the pilot project may lead to refinements of the implementation plan to implement additional modules through April 2013.

According to Raxa, work on their EMR system would not be possible without the support from the following institutions: OpenMRS, which is the open source disease tracking platform we are evolving into a point-of-care system; Carnegie Mellon University, which has multiple initiatives with the project across its widely diverse computer science department.

Expressions of interest in Raxa have been received from more than a dozen healthcare organizations with operations in Cambodia, Kenya, Nepal, Israel, Armenia and other countries.

For more information about Raxa, go to https://raxaemr.atlassian.net/wiki/display/RAXAJSS/Raxa+JSS+EMR

Also, for more information on 'open source' and eHealth in India, go to http://www.openhealthnews.com/tagged/india