Open Source Handheld-Based EMR for Paramedics Working in Rural Areas

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Open Source Handheld-Based EMR for Paramedics Working in Rural Areas

This is a review of an article by Anantraman, Mikkelsen, Khilnani, Kumar, Pentland, and Ohno-Machado (2002), “Open source handheld-based EMR for paramedics working in rural areas”. [1]


We describe a handheld-based Electronic Medical Records (EHRs) for use in certain rural settings. The system is based on the Linux operating system and allows access to large mobile databases. The open source system is designed for paramedical health workers serving remote areas in rural India. A PDA loaded with the handheld-based EMR provides workers who have little access to medical doctors with different kinds of decision support and alerts. It addresses two important problems in developing countries: prenatal care and child health. This paper describes the technical challenges and innovation needed in the design, development, adaptation and implementation of the handheld EMR in a real setting in India


Research Question

The purpose of this study is to evaluate the impact of personal digital assistance (PDA) devices linked to an electronic medical records (EMR) on healthcare in remote rural areas.


A handheld-based EMR was implemented for paramedical health worker in remote areas of India. The study evaluates the challenges, as well as, the need for innovate PDA design, adaptation, and development.


PDA linked to open-source system based in a Linux operating systems were given to 4 paramedical health workers covering a population of 28,000. All PDA were loaded with handheld-based EMR data including decision support and alerts. The decision support engine CLIPS was used to provide users with a rule-based engine. The greatest need in the rural Indian community for EMR access applies to prenatal and pediatric care.


The handheld-based EMR was rate as satisfactory for usability, accuracy, and time needed for data entry. The workers were also satisfied with the replacement of paper-based records by the EMR system. Worker were even able to become entirely dependent on the electronic database. The decision support engine was reported to be very helpful by users. Challenges presented by this technology, can be dealt with by including users in the design process.


The PDA provided paramedical health workers with stable logistic support, eliminating the need for paper-based records. This study demonstrates that technology can be used at the point of care in remote rural communities to reducing clinical workflow and provide decision support. The adoption of these EMR based PDA’s will create a virtual database complete with alerts and rule-based guidelines; thereby, improving the availability and quality of care for pregnant women and children. Remote rural communities don’t have enough resources to adopt a system that requires signification cost for implementation and maintained. Because the system is open-source, the system is cost effective. Despite the system’s data security vulnerability, there are plans to expand the evaluation of handheld-based EMR’s to 10 paramedical health workers serving a population of 76,000.


Open-source EMRs offer access to beneficial technologies in developing countries and remote communities. Without a low-cost EMR option, these regions would be excluded from the evolution of healthcare. This study is a great example of how innovations, like handheld-based EMR’s, can be made available in remote areas that have limited resources.

Related Links

  1. Leveraging of Open EMR Architecture for Clinical Trial Accrual
  2. Open_source_EMR_software:_Profiling,_insights,_and_hands-on_analysis
  3. Evaluation and selection of open-source EMR software packages based on integrated AHP and TOPSIS


  1. Anantraman, V., Mikkelsen, T., Khilnani, R., Kumar, V., Pentland, V., & Ohno-Machado, L. (2002). Open source handheld-based EMR for paramedics working in rural areas. AMIA Annual Symposium Proceedings, 12-16.