{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:01:02Z","timestamp":1791910862513,"version":"4.3.4"},"reference-count":52,"publisher":"JMIR Publications Inc.","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The predominant implementation paradigm of electronic health record (EHR) systems in low- and middle-income countries (LMICs) relies on standalone system installations at facilities. This implementation approach exacerbates the digital divide, with facilities in areas with inadequate electrical and network infrastructure often left behind. Mobile health (mHealth) technologies have been implemented to extend the reach of digital health, but these systems largely add to the problem of siloed patient data, with few seamlessly interoperating with the EHR systems that are now scaled nationally in many LMICs. Robust mHealth applications that effectively extend EHR systems are needed to improve access, improve quality of care, and ameliorate the digital divide.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We report on the development and scaled implementation of mUzima, an mHealth extension of the most broadly deployed EHR system in LMICs (OpenMRS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The \u201cGuidelines for reporting of health interventions using mobile phones: mobile (mHealth) evidence reporting assessment (mERA)\u201d checklist was employed to report on the mUzima application. The World Health Organization (WHO) Principles for Digital Development framework was used as a secondary reference framework. Details of mUzima\u2019s architecture, core features, functionalities, and its implementation status are provided to highlight elements that can be adapted in other systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>mUzima is an open-source, highly configurable Android application with robust features including offline management, deduplication, relationship management, security, cohort management, and error resolution, among many others. mUzima allows providers with lower-end Android smartphones (version 4.4 and above) who work remotely to access historical patient data, collect new data, view media, leverage decision support, conduct store-and-forward teleconsultation, and geolocate clients. The application is supported by an active community of developers and users, with feature priorities vetted by the community. mUzima has been implemented nationally in Kenya, is widely used in Rwanda, and is gaining scale in Uganda and Mozambique. It is disease-agnostic, with current use cases in HIV, cancer, chronic disease, and COVID-19 management, among other conditions. mUzima meets all WHO\u2019s Principles of Digital Development, and its scaled implementation success has led to its recognition as a digital global public good and its listing in the WHO Digital Health Atlas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Greater emphasis should be placed on mHealth applications that robustly extend reach of EHR systems within resource-limited settings, as opposed to siloed mHealth applications. This is particularly important given that health information exchange infrastructure is yet to mature in many LMICs. The mUzima application demonstrates how this can be done at scale, as evidenced by its adoption across multiple countries and for numerous care domains.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/26381","type":"journal-article","created":{"date-parts":[[2021,12,14]],"date-time":"2021-12-14T11:15:00Z","timestamp":1639480500000},"page":"e26381","source":"Crossref","is-referenced-by-count":24,"title":["mUzima Mobile Electronic Health Record (EHR) System: Development and Implementation at Scale"],"prefix":"10.2196","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3010-011X","authenticated-orcid":false,"given":"Martin Chieng","family":"Were","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6353-0904","authenticated-orcid":false,"given":"Simon","family":"Savai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7178-7109","authenticated-orcid":false,"given":"Benard","family":"Mokaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4614-351X","authenticated-orcid":false,"given":"Samuel","family":"Mbugua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6102-6648","authenticated-orcid":false,"given":"Nyoman","family":"Ribeka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9661-9550","authenticated-orcid":false,"given":"Preetam","family":"Cholli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2803-3061","authenticated-orcid":false,"given":"Ada","family":"Yeung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2021,12,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.14236\/jhi.v16i2.685"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.2196\/medinform.8131"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.2471\/blt.11.099820"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.2196\/medinform.8403"},{"key":"ref5","unstructured":"Implementation of the UgandaEMR: Results of a Security AssessmentMEASURE Evaluation20202021-11-19https:\/\/www.measureevaluation.org\/resources\/publications\/tr-20-413.html"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2014.09.006"},{"key":"ref7","unstructured":"eSa\u00fade: Building a Local OpenMRS Community to Support a National EMR Implementation in MozambiqueOpenMRS201608312021-11-19https:\/\/openmrs.org\/2016\/08\/31\/mozambique-case-study\/"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1016\/s2352-3018(15)00024-7"},{"key":"ref9","unstructured":"Fast Track: ending the AIDS epidemic by 2030UNAIDS20142021-11-19https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/JC2686_WAD2014report_en.pdf"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2015-000010"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2016.09.013"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-016-1943-4"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1136\/jamia.2009.002303"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2017.10.019"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocz071"},{"key":"ref16","first-page":"79","volume":"211","author":"Lop\u00e9z, DM","year":"2015","journal-title":"Stud Health Technol Inform"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1111\/ijn.12609"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.2196\/13263"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1186\/s12992-018-0424-z"},{"key":"ref20","unstructured":"Health Information Systems Interoperability Maturity ToolkitMEASURE Evaluation2021-11-19https:\/\/www.measureevaluation.org\/resources\/tools\/health-information-systems-interoperability-toolkit"},{"key":"ref21","unstructured":"mUzima2021-11-19https:\/\/www.muzima.org\/"},{"key":"ref22","unstructured":"Digital Public Goods DefinitionDigital Public Goods Alliance2020-10-01https:\/\/digitalpublicgoods.net\/registry\/"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i1174"},{"key":"ref24","unstructured":"Principles for Digital Development2021-11-19https:\/\/digitalprinciples.org\/"},{"key":"ref25","unstructured":"OpenMRS2021-11-19https:\/\/openmrs.org\/"},{"key":"ref26","first-page":"529","author":"Mamlin, BW","year":"2006","journal-title":"AMIA Annu Symp Proc"},{"key":"ref27","unstructured":"OpenMRS AtlasOpenMRS2021-11-19https:\/\/atlas.openmrs.org\/"},{"key":"ref28","unstructured":"Mobile Operating System Market Share AfricaStatcounter2021-11-19https:\/\/gs.statcounter.com\/os-market-share\/mobile\/africa"},{"key":"ref29","unstructured":"Mozilla Public License Version 2.0Mozilla Foundation2021-11-19https:\/\/www.mozilla.org\/en-US\/MPL\/2.0\/"},{"key":"ref30","unstructured":"Apache Lucene2020-10-01https:\/\/lucene.apache.org"},{"key":"ref31","unstructured":"google \/ guiceGitHub2020-10-01https:\/\/github.com\/google\/guice"},{"key":"ref32","unstructured":"Indexer (programming)Wikipedia2021-11-19https:\/\/en.wikipedia.org\/wiki\/Indexer_(programming)"},{"key":"ref33","unstructured":"RESTful Services - HTTPSagar Mane20172020-10-01https:\/\/medium.com\/@sagar.mane006\/restful-services-http-a6a83ca8fb7f"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocv189"},{"key":"ref35","unstructured":"WHO Guideline: recommendations on digital interventions for health system strengtheningWorld Health Organization20192021-11-19https:\/\/www.who.int\/reproductivehealth\/publications\/digital-interventions-health-system-strengthening\/en\/"},{"key":"ref36","unstructured":"FeaturesmUzima2020-10-01https:\/\/www.muzima.org\/features\/"},{"key":"ref37","unstructured":"muzimamUzima Wiki2020-10-01https:\/\/wiki.muzima.org\/"},{"key":"ref38","unstructured":"mUzima ForumsmUzima2020-10-01https:\/\/forums.muzima.org"},{"key":"ref39","unstructured":"JIRA SoftwareAtlassian2021-11-19https:\/\/www.atlassian.com\/software\/jira"},{"key":"ref40","unstructured":"mUzima 2.7.0 Release planmUzima Wiki202012082021-11-19https:\/\/wiki.muzima.org\/display\/muzima\/mUzima+2.7.0+Release+plan"},{"key":"ref41","unstructured":"mUzimaGoogle Play Store2020-10-01https:\/\/play.google.com\/store\/apps\/details?id=com.muzima&hl=en&gl=US"},{"issue":"Pt 1","key":"ref42","first-page":"525","volume":"160","author":"Were, M","year":"2010","journal-title":"Stud Health Technol Inform"},{"key":"ref43","unstructured":"Introducing mUzima for COVID-19youtube202007122020-10-01https:\/\/www.youtube.com\/watch?v=yDQRijQjIXA&t=2s"},{"key":"ref44","unstructured":"mUzimaDigital Health Atlas2021-11-19https:\/\/digitalhealthatlas.org\/en\/-\/projects\/1437\/published"},{"key":"ref45","unstructured":"FarmerBWhat The U.S. Could Learn From Vanderbilt\u2019s Electronic Health Records Experiment In KenyaWPLN News201801292021-11-19https:\/\/wpln.org\/post\/what-the-u-s-could-learn-from-vanderbilts-electronic-health-records-experiment-in-kenya\/"},{"key":"ref46","unstructured":"BlayaJMamlinBThe MVP-CIEL Concept DictionaryOpenMRS Wiki20201052021-11-19https:\/\/wiki.openmrs.org\/display\/docs\/The+MVP-CIEL+concept+dictionary"},{"key":"ref47","unstructured":"mUzimaGitHub2020-10-01https:\/\/github.com\/muzima"},{"key":"ref48","unstructured":"Firebase CrashlyticsFirebase2020-10-01https:\/\/firebase.google.com\/docs\/crashlytics"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.1002\/hpm.2754"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.1002\/hpm.2634"},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.21037\/mhealth.2019.10.01"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2014.12.005"}],"container-title":["Journal of Medical Internet Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jmir.org\/2021\/12\/e26381","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:36:54Z","timestamp":1782841014000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jmir.org\/2021\/12\/e26381"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,14]]},"references-count":52,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.2196\/26381","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.26381","asserted-by":"object"}]},"ISSN":["1438-8871"],"issn-type":[{"value":"1438-8871","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,14]]}}}