PAGE OPEN FOR INPUTS

Introduction

As we embark on a new year, we look forward to inputs from the Bahmni community, with regards to priorities and initiatives that Bahmni core team members should focus on. This document provides context on the year gone (2023), the initiatives and happenings to help put things in perspective. For 2024, we would like to continue on the major initiatives / goals from 2023, and also get guidance and inputs from the community on other initiatives that they feel are high priority for them, and should be considered.

2023

Goals for 2023

The goals & priorities for 2023, as mentioned on this wiki page (Bahmni Roadmap) were: 

1. GOAL 1: LIGHTWEIGHT VERSION OF BAHMNI FOR CLINICS: Provide a lightweight, secure, cloud ready version of Bahmni for Clinics & small Hospitals, so that facilities that are looking for a simple system for only EMR, Billing and Reporting needs can adopt Bahmni. ACHIEVED

2. GOAL 2: INDIA READY: Given the strong focus on a digital public health strategy in India, make Bahmni ABDM ready and provide out-of-the-box packages for India-ready forms, drugs, tests, SNOMED/ICD-10 mappings, clinical terminology, etc. This will help in rapid adoption of Bahmni across India. ACHIEVED

3. GOAL 3: SECURE AND SAFE: Harden Bahmni product and development security, along with guidelines for ensuring strong patient data privacy. significant progress

4. GOAL 4: INCREASE DOCTOR ADOPTION: In most Public Health settings, doctor time is a premium, with high patient loads. Bahmni aims to provide features that make it easy to accurately, safely and quickly capture clinician notes/orders/etc. by using templates, speech-to-text, OCR, shortcuts, etc. Some progress (mostly in IPD, responsive clinical screen, etc).

5. GOAL 5: CLOUD FRIENDLY: Along with on-prem, also make Bahmni Cloud-friendly, to allow for Implementors to be able to scale/support multiple installations of Bahmni on the cloud, more easily. Significant progress (cloud ready with terraform. Not yet multi-tenant)

6. GOAL 6: KEEP SOFTWARE COMPONENTS UP-TO-DATE: Upgrade out of legacy components, libraries and programming stacks. This will help keeping Bahmni secure, performant, easy to extend, and provide wider community support. significant progress

Major Initiatives Conducted in 2023 (Previous Year)

The following are the noteworthy major initiatives started/completed in 2023 (also see the Active Initiatives Page):

1. Bahmni LITE: COMPLETED Bahmni Lite Release (for clinics and small hospitals), with India specific Master Data/ Drug List, CEIL Dictionary and ABDM Certified. Read more here: https://bahmni.atlassian.net/wiki/spaces/BAH/pages/3064332289

2. Dockerized / Containerized: COMPLETED All components of Bahmni (EMR, ELIS, Odoo, DCM4chee, Mart, Metabase, Crater, etc) are fully dockerized and published as containers, which can be brought up on-prem, laptop or on cloud using docker-compose. This makes installation, configuration and upgrades significantly easier, and unlocks us from CentOS to using any Docker compliant OS including Ubuntu. Read more here:

3. IPD Features for Bahmni (in React): IN-PROGRESS Thanks to funding from CURE International (see announcement), significant development has happened in last year, and will continue in 2024, with regards to various IPD features like Drug Chart, Ward Dashboard, Nursing Dashboard, Discharge Summary, Task Lists, etc, including adoption of the new Carbon Design System (like OpenMRS v3) and Frontend development in React with Microfrontend. Read more about the features here: 

   1. Bahmni IPD Active Development

   2. Bahmni - Migrating to React with Microfrontend Architecture

4. Integrating SNOMED Terminology Server over FHIR: COMPLETED Bahmni team and SNOMED International  collaborated to bring the power of SNOMED CT ontology, including features for developing CDS, ICD-10 reporting, SNOMED reporting, Bulk Patient Data export over FHIR, etc. Read more about this initiative with videos here:

5. Launch of Bahmni Outreach for Community Health with Offline Mobile App Avni: COMPLETED Bahmni was deployed as part of a Govt of Karnataka (India) pilot project across 5 sub-centers integrated with offline mobile app Avni, e-Sanjeevani teleconsultation platform, eAushada Inventory Management system and Bahmni Metabase. An outcome of this initiative is a solution called Bahmni Outreach, that provides an offline capable mobile app, that allows community health workers (CHWs) to register patients, capture clinical forms, and push data to Bahmni (bi-directionally) when Internet connectivity is available. We are looking for more organizations to evaluate Bahmni Outreach, and help in making it truly “global”. Read more about this here:

   1. Bahmni Outreach Mobile App(Offline Ready)

   2. GoK Pilot Project

6. Odoo Upgrade to v16: IN-PROGRESS: This upgrade has been on our ToDo list for a long time, since Odoo-v10, which was shipped with Bahmni, was out-of-support. We have now completed the first level of Bahmni/Odoo-v16 integration and QA environments are available. Read more about this initiative here:

7. Clinician Facing Doctor App: PROTOTYPE : A mobile app for Clinicans to use Bahmni. See screenshots here. Code is here. This is a prototype app, and not for real-world use.

8. Code-4-Gov-Tech: Under the C4GT program, students helped create Prototypes for Patient Portal, Whatsapp Based Appointment, New Document Upload module. This is not production-ready, but a good start to build more mature offerings.

9. JIRA Tickets: CLOSED The Bahmni team and contributors closed a total of 742 tickets in the year 2023! Click this link to see the ticket list.

10. Migration to Bahmni Standard: The team also conducted trainings on migration from Bahmni legacy to Bahmni standard. See documentation and recordings here: . A hospital in Ethiopia and in JSS (India) have already successfully upgraded their instance of Bahmni, to the latest Docker based binaries (from legacy v0.92).

11. Trainings Conducted: Docker Training (Feb 2023), ABDM Training (Feb 2023), Docker upgrade training (Dec 2023). Click on the links to access the recordings.

2024

High Priority Recommendations

Items which are most likely to get selected

1. Bahmni Standard v1.0 Release: Bahmni Standard v1.0 has not yet been released, although it is available for preview. We want to club the Odoo-v16 upgrade, any critical security fixes, performance testing and multi-locale support, before doing a Bahmni Standard (for Large Hospitals) release.

2. Bahmni IPD Release: Merge and release a comprehensive IPD release (based on the work being done for CURE International), based on the work started in early 2023. In-patient Department features like Drug Chart / MAR, Ward Summary, Nursing Care Dashboard, Task List, Discharge Summary, etc are in-development and soon to be deployed across multiple hospitals in CURE, and we would like this work to be merged into Bahmni, and available on our demo servers, and to the community. Read more about this here: Bahmni IPD Active Development

3. Better UX for Clinicians: Provide a more user-friendly, mobile-first experience to Clinicians (Patient Search, Dashboard, Consultation, Orders/Investigations, View Documents, Appointments, etc) on mobile, likely built using Flutter. Also uplift the web experience to use the new React micro-frontend architecture, so that clinicians can use the app more effectively on the go.

4. Help existing Bahmni adopters to upgrade to latest version of Bahmni: A ton of new features, bug fixes, interoperability support has gone into Bahmni in the last 2-3 years. We want most of the Bahmni adopters who are still using v0.91/0.92/0.93 to immediately create plans for moving to latest version of Bahmni --- so they are decoupled from CentOS, and have a stronger / better supported / more stable version of Bahmni. Our Community Support channels are active and helping existing organisations prepare for this migration. Don’t miss out!

5. Prototype how GenAI / LLMs / OpenAI can improve Bahmni adoption and User Experience: We want to experiment with LLMs to help improve Bahmni user-experience / development / adoption / evaluation use-cases. Some experiments were conducted last year, where Thoughtworks loaded Bahmni Wiki into an LLM, to create a Bahmni chatbot for implementation / support queries. We wish to see if there are more impactful use-cases like Consultation Notes → Structured Text, OCR, etc. More ideas needed here.

6. Extend interoperability through wider FHIR / OpenHIE support: Bahmni already has significant support for FHIR and Open Standards. Read more here. But, as OpenHIE and ABDM standards evolve, we need to keep up.

7. Upgrades / Security Fixes: Update Java version, OpenELIS libraries, DCM4chee, MySQL / Postgres, etc – to ensure stability, performance and security.

Other Recommendations

Items which are also important, but due to bandwidth, might be hard to prioritize

1. Patient Portal / Mobile App for better Patient experience (e.g Book Appointments, Teleconsultation, View Clinical Notes, Orders, etc).

2. Comprehensive Security Posture and Plan for Bahmni including Single Sign-on

3. Stronger support for AWS / GCP / Public Cloud including Docker Swarm (besides the Docker container approach which is already supported across cloud providers)

4. Bahmni Outreach (out-of-box version): Ensure the Bahmni Outreach Community Healthcase (offline-ready) app is easy to use out-of-the-box while requiring minimal customization / code changes, for rapid rollouts.

5. Multi-tenancy for low-cost SaaS offerings: OpenMRS currently is single tenant (with dedicated DB per facility). While this increases security, it becomes costly for SaaS providers to host one instance of OpenMRS per clinic. With Multi-tenancy, the same OpenMRS/Bahmni instance should be able to support multiple clinics (20x), which will reduce operational overhead and bring down hardware costs.

6. Oncology Version of Bahmni

7. BikaLIMS / Senaite LIMS Integration out-of-the-box. Read more here.

8. Better Episode-of-Care Management

9. Better Patient Document Management

10. Split Screen view for Clinical Dashboards

11. Speech-to-Text for Clinicians

12. Faster Navigation / Universal Search / Speech Search and other related ideas

13. Patient De-duplication or duplication registration detection

14. Doctor Notification for Patient Lab Results, Events, etc.

15. Rich Text and Template support for Consultation Notes, Discharge Summary, etc.

16. Triage, Internal Referrals and Consultations

17. More robust user-experience for Patient Tele-consultation