Background: Humanitarian Needs Meet Digital Complexity

Médecins Sans Frontières (MSF) operates in some of the world's most challenging environments, providing medical care to populations affected by conflict, epidemics, disasters, or exclusion from healthcare. In these contexts, efficient and cost-effective digitalization is crucial yet exceptionally difficult to achieve.

The MSF Operational Centre Geneva (OCG) initiated the LIME (LIght Modular EMR) project to create an electronic medical record system specifically designed for humanitarian field operations. The pilot implementation site, Mosul Hospital in Iraq, serves approximately 30,000 patients annually in a post-conflict setting where healthcare infrastructure remains fragile.

Challenge: Making EMRs Reusable Across Missions

Beyond the day-to-day obstacles of paper-based records and fragmented patient information, MSF faced fundamental architectural challenges in their approach to digital health systems:

• Lack of Portability: Previous EMR implementations were tightly coupled to specific environments, making it difficult to deploy the same solution across different MSF missions with unique infrastructural constraints - and complicating the long term maintenance of the systems.
  
  
• Limited Adaptability: Systems often required extensive reconfiguration or custom development for each new deployment, increasing costs and delaying implementation.
  
  
• Poor Interoperability: Siloed systems hampered effective information exchange between different components of the healthcare ecosystem, limiting the value of collected data within and outside facilities - such as external lab tests for example. 

These challenges directly impacted MSF's ability to scale digital health solutions across their global operations. With each new mission typically requiring its own custom implementation, MSF faced unsustainable costs and inconsistent user experiences across different contexts.

Solution: Modular EMR with OpenMRS 3 and Ozone

After a comprehensive feasibility study, MSF partnered with Ozone to begin implementing OpenMRS 3 as the foundation for their LIME project. This collaboration directly addressed MSF's three critical success criteria:

• Portable Architecture: Ozone's approach leverages containerization and orchestration to create an agnostic architecture that can function across diverse infrastructure environments, from well-connected hospitals to remote field clinics.
  
  
• Modular Configuration: The implementation utilizes Ozone's content and configuration management capabilities that separate core functionality from site-specific settings, enabling easy updates without modifying the underlying system and inheritance of configurations which is key to reusability across projects.
  
  
• Interoperable Design: Ozone allowed MSF to easily add an interoperability layer like OpenFN to enable data exchange between the OpenMRS 3 and DHIS2, saving hours of manual data entry and increasing the quality of data. 

The implementation at Mosul Hospital began in 2024 and serves as a proof of concept for this modular approach. The system is designed to be replicable across other MSF missions with minimal reconfiguration, and also allow for an iterative digitalization, one department at a time. 

"The modular approach of Ozone means that the same configuration that works in Iraq can be deployed in other countries and projects with minimal changes, dramatically reducing the time and cost of bringing digital health to projects in the field." - Michael Bontyes, Technical Lead at MSF. 

Early Progress and Future Direction

Though still in its initial implementation phase, the project is already demonstrating the value of Ozone's modular approach and as the implementation progresses, MSF plans to:

• Document the reusable components and configurations for deployment in other missions.
• Create a library of clinical packages that can be combined to meet the specific needs of different contexts and across implementers in the community. 
• Develop standardized integration patterns that can connect with local health information systems.
• Establish a configuration management workflow that enables field teams to adapt the system without technical expertise.

Takeaways: Reusability Cuts Cost and Increases Reach

Even at this early stage, the MSF experience in Iraq offers valuable insights into building truly reusable digital health solutions:

• Containerization and orchestration are essential for creating portable systems that can function across diverse infrastructure environments.
• Separating configuration from core functionality enables rapid adaptation to new contexts without requiring custom development.
• The modular approach significantly reduces the total cost of ownership by enabling components to be reused across implementations.

This pioneering implementation exemplifies how Ozone's modular architecture can transform humanitarian healthcare delivery. As the pilot project in Mosul continues to evolve, it will serve as a model for future deployments across MSF's global operations, potentially saving millions in development and maintenance costs while bringing digital health benefits to more projects and patients.

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