Notice F2: Shelf readiness with a focus on building local capacity and new teams.

Shelf Readiness of OpenMRS through Capacity Building for Quality Assurance

Two-sentence Overview: 

OpenMRS and University of Washington aim to advance shelf-readiness by utilizing the OpenMRS fellowship program to develop a capacity building pipeline of highly-skilled, advanced quality assurance engineers  for the OpenMRS Quality Assurance program of rigorous, comprehensive, proactive, and systematic quality assurance. By bringing together experienced community members in the QA team and local in-country engineers, this investment will be used to 1) build a structured and measurable QA fellowship pipeline for community sustainability and local country-based capacity, and 2) strengthen OpenMRS product and interoperability quality assurance and compliance.

Executive Summary: 

Founded in 2004, OpenMRS is a high quality, open source, integrated electronic medical records platform (EMR) aimed at resource-constrained settings where structured patient record keeping systems can support improved care delivery and help achieve health equity. As OpenMRS continues its growth in over 6,500 health facilities, it increasingly is recognized as a de-facto EMR standard, supported by the OpenMRS community. 

At OpenMRS, we contend that a critical factor of shelf-readiness is a user being able to trust the product.  This trust is earned through rigorous, comprehensive, and systematic quality assurance testing and protocols; thus, quality assurance is an integral part of building shelf-ready, standalone, and interoperable OpenMRS technical products. Another aspect of shelf-readiness is having a pipeline of capacity for supporting that quality assurance in a product, both at the community level and in country-level implementations of the product.  With funding from Digital Square Notice C and E0, the OpenMRS Quality Assurance (QA) Team emerged to improve community quality assurance processes and tools. As a result, OpenMRS was the first global good that adopted the OpenHIE testing framework into a community QA process and tooling, and has since modeled/mentored the OpenELIS team to do the same in their pursuit of improved QA.

With additional funding, the OpenMRS QA team can increase shelf-readiness of the OpenMRS products by maturing the critical OpenMRS QA program into a sustainable part of the OpenMRS community and local OpenMRS teams.  This will be accomplished by developing a pipeline of country-based community members into the QA program through capacity building of highly-skilled advanced quality assurance engineers in our OpenMRS fellowship program.  The expansion of the fellowship program to a structured support for developing in-country quality assurance engineers will transition the maturity level of the QA program from established to integrated, creating a pipeline of in-country QA engineers that work both within the global community on OpenMRS and on local OpenMRS implementations. This pipeline will ultimately increase OpenMRS shelf-readiness and trust in our product by Ministries of Health and users of the system.

Consortium team: 

In 2018, the University of Washington Clinical Informatics Research Group (UW CIRG) and OpenMRS partnered to establish and lead the OpenMRS QA Team work and the OpenMRS FHIR Squad projects. Our consortium team reflects our commitment to supporting the OpenMRS QA Team and FHIR Squad by continuing this partnership.

UW CIRG (University of Washington Clinical Informatics Research Group) is one of the premier global health informatics organizations, specifically working to advance digital health global goods and the communities supporting them.  CIRG has contributed substantially to multiple digital health communities, and led numerous large-scale informatics grants and programs around the world in partnership with global health funders and Ministries of Health. CIRG faculty member Jan Flowers serves as Chair of the Board of Directors of OpenMRS, a member of the Board of Directors for OpenELIS, and is the co-founder and project co-lead of the OpenHIE Laboratory Information Systems Community of Practice.  In addition, CIRG staff member Jennifer Antilla has served as the Director of Community for OpenMRS for 3 years, successfully supporting the development of a new governance model that included the decentralization of decision making into small committees focused on specific aspects of the product, strategy, or operations of the community.  Ms. Flowers and Ms. Antilla have over a decade of experience working on OpenMRS and other global goods and HIS architectures in real-world LMIC implementations.  They have each led multiple national-level OpenMRS architecture, implementation, interoperability, and quality assurance and compliance projects, including in Kenya (KenyaEMR), Haiti (iSantePlus), Mozambique (eSaude), and Vietnam (eClinica).  Ms. Flowers has been the lead interoperability architect for Haiti, Kenya, Cote d’Ivoire, Mozambique, and Vietnam health programs.  Ms. Flowers and Ms. Antilla are the founders of the OpenMRS Quality Assurance team as an ongoing critical operational group and process within the community.

OpenMRS, Inc. OpenMRS is an open source EMR and community that functions as a consortium, with many organizations working in LMICs supporting the work of individual OpenMRS contributors. As such, the community seeks to engage and motivate both volunteers and supporting organizations to actively contribute to all aspects of the software development and implementation process.  OpenMRS is the home for the OpenMRS Quality Assurance team, with the expectation that this emerging team, led by the UW currently, will continue the transition to a core operational component of the OpenMRS community long-term and will be funded under the OpenMRS core operational budget after that transition in the next few years once the QA process and adoption has been fully established.  The OpenMRS Quality Assurance team has led the first global good community pilot of the OpenHIE test management platform.  In addition, the QA Team has established a need for and disseminated lessons learned in how to manage the required culture change in a global good community to build and incorporate a comprehensive proactive quality assurance program as part of a core aspect in software development.  This ultimately leads to increased trust and value in the products, and their approach has been adopted by or influenced the approach of additional global goods communities towards systematic, repeatable quality assurance.

Project Description: 

Problem statement

OpenMRS is utilized globally as the de facto EMR for LMIC, implemented in more than 6520 known facilities across 64 countries, serving ~14.6 million patients.  Although OpenMRS is a mature software, QA processes have been largely left to developers to manage; resulting in limited and non-systematic testing that didn’t involve the acceptance by implementers, which leaves low levels of trust in the safe and effective use of the product.  With the establishment of the QA Team from Notice C, and expansion of the portfolio and strengthening of the QA processes in Notice E,  there has been nearly community-wide adoption of these QA processes in the software release lifecycle, but the number of trained QA engineers remains extremely limited - both at the community level and particularly at the local country-based implementation level.  In addition, there is a recognized gap in engagement of country-based teams, not only in quality assurance and software validation processes, but also engaging in the collaborative, community processes.  Due to the reliance upon such a small number of community members who have this QA engineering capacity, the current maturity of the QA project in OpenMRS is established, with some leaning towards a maturity level of integrated. In order for OpenMRS to be considered shelf-ready from a long term perspective and at the local implementation level, there is an urgent need to develop a robust, structured, and measurable pathway and pipeline for developing highly-skilled, advanced QA engineers in the community and the field.  The team proposes two work packages that will 1) build the pathway for country-based engineers to engage and gain the skillset to participate in the QA team using the existing OpenMRS fellowship program, and 2) focus practical exercises and activities of the fellowship program around expanding the QA automated testing portfolio, applying the QA processes to product releases, and developing and piloting the OpenMRS testable FHIR Implementation Guide for QA conformance testing to defined standards.


Deliverables and Schedule


Month/Quarter Due

Work Package 1: Build a capacity pipeline of highly-skilled, advanced QA engineers in the community and at the local level of OpenMRS implementations

Objective: Develop and conduct structured QA Engineer capacity building program

Activity 1.1.1: 

  • Published program pipeline structure and learning materials (assessments, learning pathway, learning materials)

  • Iterative review of learning materials and updates made based on experience of fellowships


Q1 M2


Q2 M6, Q3 M9, Q4 M12

Activity 1.2.1: 

  • Country-implementation fellows selection announcement, 

  • Notes of on-boarding sessions

Q1 M2

Activity 1.2.2: Documented QA mentor and fellowship learning goals and plans

Q2 M4

Activity 1.2.3:

  • Fellowship blog posts

  • Fellowship assessments, goals and milestones

  • Fellowship artifacts and achievements

Q4 M12

Work Package 2: Developing shelf-ready testable FHIR Implementation Guide and expanded QA automated test cases to support priority OpenMRS releases.

Objective: Automate interoperability testing of OpenMRS releases using a testable FHIR IG approach for the FHIR module integration.

Activity 2.1.1: 

  • Notes from roadmap update community sessions

  • Updates QA prioritization roadmap

Q1 M3

Activity 2.1.2: Expanded published QA Portfolio (test cases, test code, results)

Q4 M12

Activity 2.1.3: Strategy for QA Portfolio use in real-world implementation

Q4 M12

Activity 2.1.4: Report out of results and recommendations from pilot testing QA portfolio strategy in implementation

Q4 M12

Activity 2.1.5: Strategy document for long-term capacity in participating country-based implementation teams

Q4 M12

Activity 2.2.1: 

  • OpenMRS FHIR Squad Call Notes

  • OpenHIE DevOps Call Notes

  • Development of Testable OpenMRS FHIR Implementation Guide

Q4 M12

Activity 2.2.2: 

  • Report out of results of pilot of FHIR IG testing, Recommendations

  • OpenMRS FHIR Squad Call Notes

  • OpenHIE DevOps and Architecture Call Notes

Q4 M12


Risk Mitigation

There is some risk when working with country-based individuals for their dedicated attention to work on learning new technologies and approaches.  This risk is mitigated by aligning the initial program focus and materials with the implementation goals of the selected country-based fellows.  

Global Good Maturity Model Assessment

Digital Health Atlas

Application Status: 
Approved - partially funded


Thank you for the application. For the full technical application, in addition to general recommendations per the email, please expand on:

-Plans for contributing back to the OpenHIE testing framework.

-Plans for collaborating to ensure the FHIR IG is aligned with other OHIE IG standardization work, HL7 practices, etc.