Siaya District Hospital in Kenya Goes Live With OpenEMR

Peter GroenThe Siaya District Hospital in Kenya has just implemented the 'open source' electronic medical record (EMR) system called OpenEMR with the help of Medigrail, a small privately held California-based health information technology (IT) company. According to a recent update posted on the OpenEMR wiki, an implementation team composed of Medigrail and Siaya District Hospital staff worked closely together on this project for over six months to ensure its success. Initial installation of the computer servers, network technology, and the OpenEMR software system began back in late 2011. The system finally went live in early April 2012.

Siaya District Hospital, a government run institution, currently has about 240 beds. Last year, this rural healthcare facility handled approximately 120,000 patient encounters and the numbers are expected to double in the coming years. The use of computer technology will play a crucial role in the future expansion of this healthcare facilty and its capabilities.

For those interested in some of the technical details, the following paragraphs describe the IT architecture of the installed system.

Computer server hardware & software initially installed consisted of:

  • An Intel Atom Supermicro server with 4 GB RAM and a 32 GB SSD drive which is the firewall and a Linux boot server - running pfSense (
  • An Intel Atom Supermicro server with 4 GB RAM and a 2 TB drive which is the file server, IM server and future inter-department phone switch running on Ubuntu Linux and mounting user directories via sshfs.
  • Intel Xeon Sun server with 6 GB RAM and two drives which is the application server during the day and backup server at night.
  • The hospital's application software is the free & open source OpenEMR system,

Computer Network - The systems administration team laid over 9,000 feet of network cabling in conduit and terminated all the endpoints. They installed 3 HP Procurve 9078a 24-port Gigabit switches and connected them via Fiber Optic cable runs. The network will be expanded to 5 switches and each will be protected by voltage regulators and uninterruptable power supply (UPS) systems.

Workstations primarily consist of laptops with a minimum of 512 MB RAM, no hard drive and no battery. This is intentional given challenges related to shipping large desktop workstations, as well as data privacy issues. There are currently 40 Panasonic toughbook laptops installed, with more to come.

Workstation software for the laptop systems boot off the network into a very small 55 MB footprint Linux distribution called SliTaz. It contains Abiword, Gunmeric spreadsheet, Firefox browser, a PDF viewer, and a file server mount utility called sshfs. Other open source software may be added over time.

Providing a stable electrical power source is a major challenge at the facility and one which they continue to struggle with, especially given the requirement for  230 VAC continuous loads. They also installed Inverting Opti-ups UPS and APC UPS systems.

System backups - The application is backed up on an aggressive schedule using automysqlbackup. The file server is backed up using the open source Bacula backup syste. The firewall is backed up via a shell script.

Training was key to the success of the project. Because the user community had little training in the use of computer technology, an extensive 'Train the Trainers' effort was initiated. The trainers then engaged the local hospital staff, helping to set realistic user expectations, and teaching them the basics on how to begin using the system.

Ongoing monitoring of the system by MediGrail and Siaya technical staff is done via Twitter. The servers report their status to a private Twitter account on an hourly basis.

For more information about the OpenEMR implementation project at the Siaya District Hospital in Kenya, consider contacting Dr. Omoto Jackton via telephone at +254-721-761484. You can also contact Yudhvir Singh Sidhu on his cell phone at 408-677-7660 or via email. Also, remember to periodically visit the OpenEMR wiki.

Additional information on many other open source activities in Kenya can be found at


Peter Groen, Senior Editor, Open Health News (OHN)


Siaya District Hospital saw

Siaya District Hospital saw it's 21,000th patient last week - 3 Sept 2012. That's not to say we have not encountered our share of problems along the way.

This is a testament to the providers who have embraced the automated systems, to the systems administrators who have been working hard since going live over 4 months ago, to the applications team which has patiently educated the trainers, to the trainers who have gone back and trained the staff, and finally to the Administration who have provided the people and finances to make this project a success.

The facility now enjoys an electronic medical records application, a standard email service and a new chat service thanks to their technology partner, MediGrail LLC.

I think,this is a great

I think,this is a great action of Siaya District Hospital in Kenya to go live with OpenEMR. This can help people in many ways.

Calling for LAPTOPS -

Calling for LAPTOPS - MediGrail is putting out a fervent and immediate call for LAPTOP DONATIONS! 26 Jun 2012 - A team of high school students is leaving for a trip from the West coast to Kisumu, Kenya in mid-July 2012. We have a window of opportunity that should not be missed.

The laptops are to be put to immediate use at Siaya District Hospital, a 220-bed government facility in rural Kenya, to access medical records. The complete hospital medical records system has been setup by MediGrail LLC, a Bay Area startup on a non-profit basis. The founders of MediGrail have spent over $50K of their personal funds on this project and continue to donate their time DAILY.

The laptops deliver incredible value to the staff and increase facility productivity. MediGrail loads them with these open-source applications: * Word processor and spreadsheet which can read the latest Microsoft file formats * Network file server access, printing capability, chat utility and PDF viewer

To date, the system has seen about 15K patients since the system went live in April 2012. Staff is able to submit reports to the central government and check their pay stubs on-line – saving them much time. They are able to quickly retrieve patient records without the patient making an extra trip to the records department. They are able to look at patient history beyond the currently limited new year date. They are able to print payment receipts easily. This has lowered the costs and increased the quality of care.

And more can be done... the project is already a success, it can become a huge success with your TIMELY donation. We need 15-inch laptops in working order with batteries and a minimum of 1 GB of RAM. Hard drives are optional. Please ship immediately to Yudhvir Singh Sidhu, 16605 Trail Drive, Morgan Hill, CA 95037


PLEASE HELP MEDIGRAIL,LLC CONTINUE ITS WORK WITH OPEN SOURCE APPLICATIONS ... MediGrail, LLC is a small grass roots-California based health information technology (HIT) start-up. We are developing free applications that help patients take charge of their health and well-being. We also provide free services and implementation of free open source electronic medical record systems, to improve access to health care in rural areas both within and outside of the United States. This company's primary focus is to improve education and access to quality and safe healthcare across the socioeconomic strata.

To continue doing our work, we need your votes by June 30th to be eligible for a Chase Grant. The company plans to broaden these programs to more areas and add services and functionalities to the existing opensource platforms.

Please vote and request your friends and family to vote for MediGrail by following these simple steps:

  1. Go to
  2. Click "Log in and Support" under "Log in with facebook to support your community."
  3. Login with Facebook
  4. Enter information below and enter Search a. Business name: MediGrail b. State: California c. City: Morgan Hill
  5. Click on Vote for MediGrail

Thanks for voting and spreading the word for us !!

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