JMIR Publications

ABSTRACT

Background:

The predominant implementation paradigm of electronic health record systems (EHRs) in low- and middle-income countries (LMICs) relies on standalone system installations at facilities. This implementation approach exacerbates the digital divide, with facilities in areas with inadequate electrical and network infrastructure often left behind. mHealth technologies have been implemented to extend the reach of digital health, but these systems largely add to the problem of siloed patient data, with few seamlessly interoperating with the EHRs that are now scaled nationally in many LMICs. Robust mHealth applications that effectively extend EHRs are needed to improve access, quality of care, and ameliorate the digital divide.

Objective:

We report on the development and scaled implementation of mUzima, an mHealth extension of the most broadly deployed EHRs in LMICs (OpenMRS).

Methods:

The Guidelines for reporting of health interventions using mobile phones: mobile (mHealth) evidence reporting assessment (mERA) checklist and the World Health Organization (WHO) Principles for Digital Development framework were employed to evaluate the mUzima application. Details of mUzima’s architecture, core features, functionalities, and its implementation status are provided to highlight elements that can be adapted in other systems.

Results:

mUzima is an open-source, highly configurable Android application with robust features including: offline management, de-duplication, relationship management, security, cohort management, and error resolution, among many others. mUzima allows providers with lower-end Android smartphones (version 4.4 and above) who work remotely to access historical patient data, to collect new data, view media, leverage decision support, conduct store-and-forward teleconsultation, and geo-locate clients. The application is supported by an active community of developers and users, with feature priorities vetted by the community. mUzima has been implemented nationally in Kenya, is widely used in Rwanda, and is gaining scale in Uganda and Mozambique. It is disease-agnostic, with current use-cases in HIV, cancer, chronic disease, and COVID-19 management, among other conditions. mUzima meets all WHO’s Principles of Digital Development, and its scaled implementation success has led to its recognition as a Digital Global Public Good and its listing in the WHO Digital Health Atlas.

Conclusions:

Greater emphasis should be placed on mHealth applications that robustly extend reach of EHRs within resource-limited settings, as opposed to siloed mHealth applications. This is particularly important given that health information exchange infrastructure is yet to mature in many LMICs. mUzima application demonstrates how this can be done at scale, as evidenced by its adoption across multiple countries and for numerous care domains.