Although MDS is a very useful program, the fact that is was written using a proprietary database (Caché) is a big drawback to its widespread use in the emerging economies of South Asia. In order to resolve this issue, Lunar Technologies was contracted by the RDHS Kegalle in 2010 to convert the MDS software into an open-source patient record database based on the free software LAMP (Linux, Apache, MySQL, PHP) and to pilot it in five hospitals in Kegalle District. Funding for the project was provided by the World Bank, channeled through the Information and Communication Technology Agency (ICTA), a Sri Lankan Governmental agency responsible for extending e-governance throughout the country. The project included general computer and medical record training in all 5 pilot hospitals.

Installation of the network and the computer hardware took place in each pilot hospital while the training was being carried out. For the staff training, 10 workstations were put into one large room in each hospital, usually an auditorium, and connected to a small server. As in the Eastern Province, the first 2 hours of training for each group covered general computer knowledge, use of the mouse and an introduction to touch typing with 10 fingers. This was followed by 2-3 hours practice on the HHIMS software. At the end of the half-day of training, hospital staff could usually go to their workplace and start working on their own computer which was now installed there.

In accordance with the wishes of our client, the main thrust of the programming effort was to improve speed and user-friendliness of the OPD medical record. As a result, the main benefit of HHIMS over MDS was seen in busy out-patient departments where clinical records, prescriptions, laboratory requests and treatments could now be produced by the doctor without using paper. There was less acceptance of the system in the wards, where it had not proved possible to program as user-friendly a system as the hand-written “Bed-Head Ticket” used for admitted patients. The unstructured and largely narrative form of these manual tickets make them easy to write to, but difficult to extract a structured and systematic medical record from. We tackled this problem in our 7th project in collaboration with the staff of the Pain Clinic in the NHC.