Mosa is a 19-year-old woman living in a small village in Rwanda.  Mosa is pregnant, and like many in her village, she is HIV positive.  She is registered at a local clinic providing Ministry of Health sponsored antenatal care (ANC). The clinic uses a local instance of an electronic medical record (EMR), referencing her national ID and syncing with her country-wide shared electronic health record (SHR) maintained in the Ministry’s database.  The clinic’s EMR notes that she requires a hospital delivery using PMTCT (prevention of mother-to-child transmission) protocols. This information is updated to the national shared health record (SHR).

When Mosa was entered into the local EMR, the Create patient demographic record workflow is used to send the patient's demographic information to the Client Registry.

The Save patient-level clinical data workflow is used to create a shared health record for Mosa.

Weeks into her pregnancy Mosa experiences minor bleeding or spotting.  During a routine home visit, Mosa’s community health care worker (CHW), Grace, logs this information.  Grace uses a basic mHealth application on her mobile phone to update Mosa’s SHR. Grace advises Mosa to go to the local clinic for a checkup.  At the clinic Mosa is found to be anemic and referred to hospital for follow-up. The referral is flagged as urgent, and is updated to Mosa’s shared SHR.

Send health worker alert workflow

1. Baby (Rebecca) is born and gets registered through a vital registration system 

Mr Kamau is a 25 year old male patient who lives in a rural community and receives care at a local clinic that is using the OpenMRS system to record information.  His demographic data has been entered into this OpenMRS and he has a unique ID at the clinic. As as result, Mr. Kamau is a registered patient in the local clinic. He has a known diagnosis of new HIV case (three years ago), new HIV disease (two years ago), and HIV on Treatment (two years ago) These diagnoses/triggers have already been reported through the CBR module to the Surveillance Officer.

Send Case Report to SHR

Mr Masane is a 35 year old male patient with presents to the clinic with unintentional weight loss over the last few weeks. He notes that he ‘doesn’t feel like eating’.  He denies any cough, fever, or rigors. He tested for HIV two years ago and was negative at that time. He has had malaria in the past, but has no symptoms of that at the current time.

Send Case Report to SHR

A pregnant mum gives birth to her baby boy during an at-home delivery in her village.

A young woman suspects that her husband has been unfaithful and, as a precaution, attends at a voluntary counselling and testing (VCT) clinic in a nearby village to be tested for HIV. 

The nurse at the VCT clinic uses the local electronic medical records system (EMR-1) to confirm the woman’s identity based on her health ID#. The EMR-1 system, in the background, retrieves the woman’s demographic record from the national health information exchange (HIE).

The nurse counsels the woman and obtains her consent to do a rapid HIV test. The test result is positive for HIV – as is the repeat test.

The nurse advises the young woman regarding what should be the course of her HIV care and records the information regarding her test results in the EMR-1 system. The information in the local EMR-1 is updated to the national HIE.

the young woman discovers that she has become pregnant. A community health worker (CHW) in the young woman’s village notes her condition and discusses with her that she should attend at the district antenatal care (ANC) clinic in a nearby village. Because of her sense of stigma, the young woman has told no one of her HIV+ test result; she does not share this information with the CHW.

The CHW uses her mobile phone to access an mHealth application developed by the Ministry of Health (MOH) to manage the national maternal care registry. The CHW sends an SMS message to an MOH short-code indicating the young woman’s ID# and the finding that she is pregnant.

The reply SMS message from the mHealth application indicates to the CHW that the young woman should urgently attend at the ANC clinic. The CHW re-emphasizes the instructions to the young woman to go the ANC clinic and helps her make arrangements for the short trip.

The young woman attends at the ANC clinic. Upon her registration there, the ANC nurse uses the clinic’s electronic medical records system (EMR-2) to establish the woman’s health record in the system. In the background, EMR-2 accesses the national HIE to confirm the woman’s demographic information and to retrieve a summary of her health information.

 During the woman’s antenatal care visit, the nurse reviews with her the important ways that care during her pregnancy will impact the health of her baby. The ANC doctor then counsels her regarding the prevention of mother-to- child transmission (PMTCT) protocols that will help the woman’s baby be born without HIV and orders for her a course of antiretroviral (ARV) medications.

The young woman begins her course of antiretroviral medicines and starts making plans for having her delivery in a facility that can deliver her baby according to the PMTCT guidelines.