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Togán Labs – not just embedded anymore!

“You know that’s not what we do, right?”

“Yeah, but I think we could do it. And besides, I said I’d give it a go and she asked me, what, a dozen or so times?”

It may not be the most auspicious-sounding beginning to a job. But it worked out rather well in the end, if I say so myself. And in the meantime your friendly local Togán Labs intern (hello!) got a few bonus crash courses for free.

It all started with a message from a friend. She works for an organisation supporting women and families around pregnancy and family life, and they were about to update their record-keeping system from physical paper records to… well, to what?

She initially asked me for help making Word/Excel forms, but it quickly became clear to me that what they really needed was something a little… more. A little more flexible, a little more powerful. If they were going to go to all the trouble of moving their record keeping from paper to computer-based, then I couldn’t see a sensible reason why they’d want to end up having to go through a massive rigmarole every time they wanted to actually use the data they were collecting. And as a charity, they’re under pressure to wring every bit of use they can out of every euro they get.

Also, she brought me tea and cake. Just try and say no to someone who’s just brought you tea and cake.

Which is how I ended up back in the Togán Labs office, convincing Beth Flanagan, our CEO/CTO, that what Anew needed was a new records database (all the reports they could do! Think of the statistics! Imagine the hours of data entry time saved! We can rescue them from the horror of having to physically search through paper files every day! And how much more secure could we make their records?!), and that we should be the ones to do it.

Beth- and trust me, you’ll hear me say this a lot in future- rolled her eyes and sighed. “Fine. Let’s do it.”

But first I had to learn a lesson. The hard way.

She sent me off to make it.

I’m not going to go into too much detail about the next few days. Suffice it to
say I learned my lesson and, tail between my legs, went back to Beth with a stack of paper and an “okay, I guess this was more complicated than I’d expected?”

(Protip: most things are.)

She may have been a little smug. It’s possible. In fairness to me- I was just a few months into my time in Togán Labs and pretty much every day was a new adventure in figuring out how much I didn’t know. (In other words: things were pretty damn fun)

In fairness to me as well: a smug Beth is a frequent and fabulous thing.

This was where the first task- make sure Aoife knows what she doesn’t know- ended and the second task, of creating a records system for Anew, began.

Let’s start with what we needed to do.

Anew do a lot of different kinds of work with their clients. They run, among other things, counselling for people experiencing crisis pregnancies, family support, prenatal and parenting courses, homelessness support, and local outreach. It’s essential that they can keep track of all of these different activities, as well as keeping patient notes from their counselling appointments. Client confidentiality and security of information are extremely important. At the same time, they need to use the information they take in- to be able to easily run reports and dig out numbers on what they’re doing and where they need to do more (or not!).

Additionally, as they provide all their services free of charge it was important to us to be able to provide our services without breaking their bank, so that as much of their funding as possible can go back to their clients.

This left us with two options: we could build something from scratch. Or we could take something already in existence and adapt it to our needs. While small, clean systems appeal to me an awful lot, once we found OpenMRS it became clear to us straight away that it was something we could use.

Why OpenMRS?

Let’s start with a simpler question: what is OpenMRS?

OpenMRS is short for Open Medical Records System. It’s an open-source electronic medical records system that was first developed in the mid-2000s to help support HIV care in Kenya and Rwanda. From the beginning, it was based on a philosophy of openness and collaboration. Because of this, its uses expanded rapidly, and it’s now used in dozens of countries in the developing world. Since it’s used in so many different settings and is constantly being developed by a large community of developers and medical professionals, there are dozens of added modules available to adapt it to drastically different needs.

This looked perfect for us. We needed something flexible- OpenMRS is made to be flexible. We needed something secure- it’s secure. And we wanted to do all of that at an affordable budget- done.

What did you do with it, then?

While OpenMRS is a fantastic platform, there was one small problem: it was developed
for clinics and doctors, and our clients job was counselling and community support. This, however, was where OpenMRS’s flexibility came into its own. Because we were modifying existing software instead of writing our own from scratch, we didn’t have to reinvent the wheel (although we may have resized a few and given it a new coat of paint!). We were able to strip out most of its components and repurpose what was left- modifying some parts and adding others. And since so much of the work had already been done, we could do our part in a tiny fraction of the time it’d take to build it up from the beginning.

As for Anew? What they get is a system that’s designed to be as foolproof as it is flexible. When it comes to data-entry, we’ve got a simple interface for counsellors and administration staff to easily enter information. There’s drop-down menus that make both data-entry and running reports simple. And plenty space for writing notes and bringing up client files if needed. Regular reports? Automated. And for managers, creating new reports is a piece of cake.

What’s this mean for them? For one thing, we’ve cut out days of labour in painstaking- and, let’s admit it, boring- data entry from every month. Because data only has to be entered once instead of twice, human error is cut in half overnight. That’s two significant instant improvements to the centres’ day-to-day operations.

And as for the long-run?

With the ability to easily generate reports and compare their data, they’ll be able to develop evidence-based strategies for the future with no need for guesswork. And they’ll be able to help more people.

Which is what it’s all about, right?

And what about the future?

Here’s the thing: we now have another set of skills in our toolbox. A lot of the work we did in creating Anew’s record system involved educating ourselves in how to work with OpenMRS and understand how it’s structured. While we’ll be working with Anew over the coming months to adapt their system even more closely to their needs, we also now know how to do this even more quickly and easily from scratch.

And we know that Anew isn’t the only organisation in Ireland slowly burying themselves in a mountain of papers and time-consuming manual transcription. We know that the thought of making the change to a computerised system is a daunting one- and that we’ve worked out a way to make it as easy and cost-effective as we can, without compromising on usefulness and flexibility.

If you’d like to hear more about what we can do for you, from embedded services to medical records systems and beyond, please do get in touch with us at sales@toganlabs.com.

About the author

Beth Flanagan

CTO, hacker-in-chief and co-founder of Togán Labs.

She is a contributor to the OpenEmbedded and Fossology communities and was the release manager for the Yocto Project.

By Beth Flanagan
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