This user guide provides directions for access and use of KenyaEMR+ system deployed in health facilities in Kenya. It details clinical workflows by a provider using KenyaEMR+ to facilitate efficient service delivery. KenyaEMR+ covers various service points including: registration, triage, Out-Patient Department (OPD), In-Patient Department (IPD), Specialist Clinics and other support services like billing. The guide also details how a user may retrieve various reports from the system for efficient clinical decision making.

This user guide targets all users of KenyaEMR+ system including but not limited to the following;

1. Sub- County and county Human Resources for Health (HRH) (including Health Records Information Officers (HRIOs), Medical Superintendents, Doctors, Nurses, Clinical Officers, Pharmacists, Radiologists, Lab technicians)

2. County staff ICT officers, records officers, cashiers, accountants

3. NGOs working in the health industry.

4. Ministry of Health.

The HealthIT is a USAID funded digital health mechanism whose overall purpose is to strengthen national policies, strategies, standards and reporting related to Kenya’s Health Information System (KHIS), so as to ultimately support county and national level health service provision. The main aim is to enhance achievements towards evidence-based decision making at both the national and county levels, through the adoption of HIS policies, standards and guidelines. Ultimately this contributes to the achievement of systems interoperability and best practice.

The HealthIT’s implementation strategy is to work with; Kenya Ministry of Health (MOH),County Governments, County Proximate Universities (CPU), Service Delivery Implementing Partners (SDIP) and Digital Health and Strategic Information Partners to deploy, expand, enhance and implement electronic health records with Kenya EMR as the core clinical service module to provide a facility- wide electronic system.

KenyaEMR+is a tailored distribution of OpenMRS that follows the principles of digital development:

1. It is designed with the patient at the center of development

2. Understanding that in the current Kenyan healthcare Ecosystem there are several EHR systems, KenyaEMR+ has implemented data exchange and interoperability standards to allow for interoperability.

3. The system is modular, allowing for scalability

4. KenyaEMR+is based on OpenMRS which an open-source software

5. With OpenMRS being open source, it allows for continuous improvement

KenyaEMR+ platform is a patient centric electronic health record tool that is flexible, interoperable and scalable. It supports facility-wide functions of: clinical management, data management, clinical decision support reporting, lab information system, and inventory, billing and system management.

The KenyaEMR+ has 21 modules which facilitate service delivery in a health facility. The functionality of each module is described briefly in the table below. Respective icons for each of the modules as appears on KenyaEMR+ are also displayed.

Access to the system is based on user access rights. One must have a username and password to access the system. Users of the system have different privileges based on their roles in the system.

This user guide is organized in four sections below;

Chapter 1: Introduction and Background,

Chapter 2: Getting Started on KenyaEMR+

Chapter  3: KenyaEMR+ modules and their features 

Chapter 4: KenyaEMR+ reporting.

KenyaEMR+ Login screen appears as below. Pay attention to the four key features below;

1. Login address/URL - this is the link you will follow or paste on a web browser to open KenyaEMR+ system

2. Name of the facility - the name of your health facility will display here

3. Login section - you will enter your login credentials here

4. Reset password - you will click here to reset/recover your password if you have forgotten

To log into the KenyaEMR+ system, follow the steps below;

1. Follow the link http://41.89.94.100:8080/openmrs/kenyaemr/userHome.page (HealthIT test environment) or http://localhost:8080/openmrs on a local installation on your browser.

        2. Enter your username

        3. Enter your password

        4. Click on ‘Login’ icon

Once you click the ‘Login’ button the Home page screen will appear.

1. If you do not have login credentials, talk to the KenyaEMR+ champion or facility in-charge in your facility.

2. If you have forgotten your password, click on ‘Forgot password?’ on the Login screen and follow prompts to reset it.

This page consists of all the modules available within the system. Each module can be accessed by clicking on its respective icon. Users will be able to only view and access the modules which they have been granted rights to access. The home page screen appears as below only showing modules a user has been granted access to.

When you click on the registration icon, a window will appear as per the screenshot below. There are four tabs on the registration module which enables a user to;

1. Find or create a patient - enables a user to find a patient already registered in the system or register a new patient

2. View scheduled patients - enables a user to view scheduled patients (patients with appointments) 

3. View Active visits - allows a user to view patients currently receiving services in various clinics within a facility

4. View seen patients - allows a user view patients who have visited a facility in a given day whether still receiving a service or have left the facility

The four tabs on registration module are as shown on the screenshot below;

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The first step of a patient's journey in a facility begins at registration.  First, find if the patient exists in the system, otherwise, create them as new patient.

To find an existing patient, click on ‘find or create patient’ on the ‘Registration’ window and a window below will pop up as per screenshot below. You can search a patient by name or system patient ID in the steps below

1. Click on find or create patient on the Registration window.

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    2. Type in the patient ID or Name in the search box

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   3. The patient's details will appear on the right side of your screen, select the exact patient by clicking on their name

   4. On the Patient window that will pop up,  click check-in for visit as per screenshot below

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This window also allows a user to;

1. Update obstetric information of a patient

2. Add relationships information for the patient

3. Enroll them to HIV, TB, IPT, MCH & Key population services.

5. Select the preferred visit type, then finally submit.

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6. Move to Queue Patient Module on the ‘Home’ screen to queue the patient

To register a new patient follow the steps below;

1. Click on ‘find or create patient’ on the ‘Registration Module’ as per screenshot below;

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A new window will appear as per screenshot below.

2. Click on ‘Create New patient’ Tab to register a new patient

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A new window will pop providing you with 2 options as per screenshot below

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These two options provided to register a new patient will enable a user to; 

Option 1: Register New Patient Tab- this tab is used to register a new patient who does not exist in the system

Option 2: Register Existing User to Patient Tab- this tab is used to register a new patient who exists as a user BUT not as a patient in the system. A good example is an employee in a health facility who is registered as a user to offer services to patients but is now seeking health services

Option 1: Register New patient 

To register a new patient follow the steps below;

1. Click on ‘register new patient’ icon (Option 1), registration window below will pop up. Input patient information by clicking and typing on spaces provided alongside each information required.  All fields marked with an asterisk (*) are mandatory fields. 

2. Click create patient at the bottom right of the page to create the patient

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3. A new window as per screenshot below will pop up. Click on ‘Check in for visit’ Tab

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4. Select the preferred visit type, then finally submit.

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5. Move to Queue Patient Module on the ‘Home’ screen to queue the patient to respective queue

Option 2: Register existing user to patient 

To register an existing user to patient, follow the steps below;

1. Click ‘Register existing user to patient’ icon (Option 2), the filter window below will pop and will enable you to search and pick an existing user. 

2. Type in the staff name on the filter space provided and when their name appears, move your mouse pointer and select the user (staff) you want to register.  

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3. When you select an existing user on the screen above to register as a new patient, then the registration window below will pop up with new user details which are already in the system populated in respective fields. Add any missing details of the patient

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4. Click on Save Changes to register existing user to patient

5. A new window as per screenshot below will pop up. Click on ‘Check in for visit’ Tab

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6. Then select the preferred visit type, then finally click on submit button.

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7. Move to Queue Patient Module on the ‘Home’ screen to queue the patient to respective queue

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You can view scheduled patients according to the dates they are scheduled for visits by clicking on respective dates on the calendar. When you click on a date, the names of scheduled patients will display as per screenshot below;

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Go to Appendix 3: Queue Patient Module Workflow to view Queue Patient module workflow

The figure below illustrates the workflow in the queue patient module.

On clicking the Queue patient icon, a user is able to search a patient by typing the first three characters of the patient name on the “ID or name” text box that is on the left-pane of the screen, This will display a list of possible patients that you are searching for, then click on the patient from the list below.

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After selecting the patient, you will be able to queue the patient according to;

1. Patients category

2. Paying category

3. Visit type

4. Room to visit

5. Visit information

By selecting the patient details accordingly, then click on the Green Finish button as per screenshot below;

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After selecting the details, click on the green ‘finish’ button on the above screen then a receipt will be displayed as appears below. 

Click on the purple ‘print’ button to print the receipt which is issued to the patient.

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This page appears when the triage page and from the “Select Queue” drop down menu, select the triage section.

Filter the name of the patient from the queue

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A user in the triage section enters the patients’ vital information below:

1. Temperature* - mandatory field 

2. Blood pressure

3. Body Mass Index

4. Circumference: MUAC, Chest and Abdomen

5. Room to visit *  - mandatory field  

Note: All the fields marked * are mandatory

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After entering the patients’ vitals, click the finish button in green at the bottom left of your screen.

 Note that the ‘Finish’ button will be activated only after filling in all fields marked with an asterisk (*).  

The patient will be queued in the OPD queue (respective queue selected under ‘room to visit’) as shown in screenshot below;

The diagram below shows the Out-Patient Department Module Workflow