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 |
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| Intel Dual Core |
| 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 |
| 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 |
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| – |
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| IT providers related to the IT infrastructure |
| 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 |
| 2 technicians in country for deployment tasks with Servers administration and Network proficiency. |
| 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 | – |
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| EMR interface easy to remember for users? | Yes |
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| Yes | – |
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| 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? |
| No | No |
| – |
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| Standards used for transferring information | OpenEHR, LOINC | – | – |
| – | HL7 |
| EMR maintenance | ||||||
| Who provides operational maintenance | On-site resources | On-site resources | IT department technicians |
| – | On-site resources |
| Who is in charge of fixing EMR software bugs and developing new functionalities? | External company | On-site resources |
|
| – | 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 |
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| – | 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 |
|
| – | External company |
| Number and roles of staff involved in training tasks |
| One DREAM local IT Senior Staff. |
| 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.