Table of Contents Understanding The Kenya Metadata Server & Terminology Service (KeMDSTS). Introduction Metadata Management. Working Group Approach Current Status End State. References.

A central feature of many enterprise-quality electronic medical record (EMR) systems is a dictionary-driven database model. Creating and maintaining dictionaries with desirable properties has been a long-standing challenge for both developers and implementers of Electronic Medical Record (EMR) systems. The medical informatics literature has not comprehensively dealt with approaches to help alleviate the burden of creating and maintaining concept dictionaries in resource-limited settings. The increasing adoption of Electronic Health Records (EHR) by developing countries comes with the need to develop common terminology standards to assure semantic interoperability.

In Kenya, where the Ministry of Health has rolled out an EHR at 646 sites, several challenges have emerged including variable dictionaries across implementations, inability to easily share data across systems, lack of expertise in dictionary management, lack of central coordination and custody of a terminology service, inadequately defined policies and processes, insufficient infrastructure, among others. A Working Group was constituted to address these challenges. The country settled on a common Kenya Metadata Server & Terminology Service (KeMDSTS). The working group deliberated on the multiple approaches to create the KeMDSTS. The approaches included:

• Developing a new dictionary from scratch without influence from existing dictionaries.
• Taking all existing dictionaries and combining their terms to create a new common dictionary.
• Using an existing dictionary as the foundation, mapping other dictionaries to it, and evolving it moving forward.

The working group settled on the third approach to develop the KeMDSTS. This approach is similar to what the Indiana Network for Patient Care (INPC) used when it was coming up with its common dictionary for the Health Information Exchange in the state of Indiana, USA.. INPC based its dictionary on the one used by the Regenstrief Medical Record System.

The working group approach is to start with concepts, then move to forms in terms of metadata.

• Multiple OpenMRS implementations using different dictionaries.
• Not all dictionaries are mapped to standard terminologies.
• Other non-OpenMRS implementations that need to define terminologies the same way.

The envisioned end state is a national terminology and metadata service that is well-recognized and officially endorsed as the gold terminology service and metadata repository which allows:

• Ability to view and search the national terminology service.
• Ability to update the terminology service by adding new concepts and retiring those that are no longer relevant.
• Mechanism to support implementations to leverage the metadata service.

• Kenyet al (2015).Developing a National-Level Concept Dictionary for EHR Implementations in Kenya. doi:10.3233/978-1-61499-564-7-780
• Were et al (2007).Concept Dictionary Creation and Maintenance Under Resource Constraints:Lessons from the AMPATH Medical Record System. Regenstrief Institute, Inc & Indiana University School of Medicine: Indianapolis.