 Good morning, everyone. It is really an honor to to be in front of you all today to talk about the project with a group of people that we've learned so much from. As Jim said, I am a pediatrician by training, but don't worry. I'm also very much a geek and it probably doesn't surprise you when I say that I believe that information is care. Healthcare by its very nature is a very information-centric business. And I happen to work in an environment that started thinking about information technology as it's applied to health care since the late 60s. And the environment that I work in is almost kind of like a living laboratory where the hospital system has a lot of innovation around medical record systems. And so when some of those same clinicians started an academic partnership with the university in Kenya called Moi University, they were so accustomed to having these these cognitive support tools, these record systems. And so, you know, when they went to an environment like Kenya, they actually started to really appreciate why it was so difficult to take care of patients. And imagine being an HIV patient in Kenya and being one of 70 to 80 patients that are seen in a half day. Literally, the first time I went to Kenya, they were seeing 70 to 80 patients in a half day clinic. And imagine being a patient that sees a different clinician every time and imagine that the kinds of information tools that are present oftentimes are just simple pieces of paper and simple charts. One of the patients that I actually ultimately had the chance to meet was a guy named Musa. And the day that this picture was taken, Musa was carried by his brother for an hour to something called a Matatu, which is Kenyan for a bus. He then drove two and a half hours on this bus to go to a clinic. When he was seen, he actually wasn't able to talk and he had no pulse. They diagnosed him with HIV a couple of days later and they started him on antiretroviral medications. Believe it or not, this is also Musa after four months of antiretroviral treatment. And there's kind of a funny story that when he was eventually discharged from the hospital, he literally walked the entire way back home and no one could keep up with the guy. The fundamental thing that people like Musa have taught the global health community is that diseases like HIV and TB are not really treatment problems. We have effective medications for them. They're really system challenges. They're around information management and infrastructure. And you're seeing a lot of that happen as it relates to Ebola as well. I almost didn't have a chance to meet Musa. I actually was asked by one of my mentors to go and support information management in this growing enterprise that they were doing as part of this academic partnership. And I'm embarrassed to say that I initially said, no, I'm busy with other things, but they eventually cajoled me into going. They said, well, just go for a week as a consultant and just give us some of your advice about how we can fix the system. When I arrived there, it was kind of one of those moments where I'm like, what in the hell am I doing with my life? I should be actually focused on trying to do these kinds of activities in environments that are desperately in need of them. And when I arrived, I met a lot of the team, the Kenyan team, who was managing information at the time. And they were very sharp, very bright. And I felt like, well, a lot of the things that I had learned doing medical informatics training in my institution, I'd love to be able to give that, share that information with them. And maybe we could start working on that together. And so while I was there that week, me and my colleague, we actually started designing what we at the time called the Ampath Medical Record System. And we created this awesome logo and everything for the project. We were real excited. We got back, and I'll never forget my mentor, another one of my mentors, a guy named Glenn McDonald. We talked to him about the system that we were going to develop. And he said that we were both complete idiots. That the work of building medical record systems is the work of dozens, if not hundreds of people. And so here we are trying to, from Indiana, remotely try to help these Kenyans build a medical record system. And I remember being so frustrated by what he had to say, but realized in reality that there was something behind what he was saying. And maybe we should take a step back instead of trying to build it ourselves, work with some others, or try to find another way to do it. And so when you go out to these environments, what you end up seeing is kind of the sea of access databases and very simple systems. At the time, there wasn't really anything that would fit the needs of the Kenyan environment. We actually, a couple of months later, ended up interacting with a guy in the bottom left-hand corner, the handsome guy named Hamish Frazier, who actually runs a philanthropy out of Boston called Partners in Health. He runs the medical informatics operation. And he was in the same boat that we were. He needed a system that would scale in the same way that Ampath did. And so we agreed to start working together. Right around that same time, we also met this guy named Daniel Caiwa. And he was responsible for trying to deploy a system, a medical record system in Uganda. And this guy is like a coding wonderkind. I mean, the guy could code circles around most of us in the room. And the reason it was important for us to meet him is he really helped us understand that these kinds of systems could in fact be locally developed. And we should put away our biases around what kind of expertise is on the ground. It's oftentimes just simply activating people that already have lots of talent. And so we realized when we started working with this group in Boston, that in fact the way in which care was provided was very different than the way that we were providing it in Kenya. And so we realized that the thing that we had to collaborate on was the foundation. And so we started thinking about building the low-level infrastructure for medical record systems, sharing that work, and then extending it for our needs for the given implementation. And so we started building things like a database model. And we started building on top of that a user interface layer that we could start building a record system on. We ended up meeting a guy probably I'd say a year into our after we met Hamish, a guy named Chris C. Brex, and he said, you know, I think people might want to use this work that you're doing. And so let me establish an implementer's community for you so that you all can focus on the code development and the design. And so we went to South Africa, and this is a picture of the first implementers meeting, and we were surprised to see a whole bunch of people actually came to hear about OpenMRS. We really expected maybe like 10 or 20 people. And what we realized was that there was actually quite a bit of pent-up demand for this. These implementers meeting started growing and growing, and became quite a significant thing. We then started also hearing from aid organizations that were also interested in the way in which we were doing things, because they saw the model of how we were doing the implementations were empowering the local people to do the work in a way that's perhaps a little bit more sustainable. So I have a little bit of confession to make. When I first learned about open source, honestly it came across to me as kind of like a form of religion. I didn't quite understand it. It didn't seem very practical and applied to me. And as we went through this process of building OpenMRS, we realized that really open source is about the people and about the community process, and it really was a big eye-opener for us. And so we started doing lots of research. We went and read lots of books and tried to understand as much as we could about open source. This is what I consider my Bible. I read this book a couple times over a great book by Carl Fogel. And then we established a mission statement, because that's what sophisticated open source projects do. So we actually got our community together, and we started talking about what we wanted to be. And the two key parts of our mission statement is that we're focused on improving healthcare delivery in constrained environments. But we do that by not having a bunch of engineers that we've hired to write software. We coordinate a community of people that are implementing the software, and it's the hope that by them using the software they'll contribute to its growth. And we've had a lot of success with that model. And so I also went and spent a couple hundred dollars out of my pocket to make this fancy logo for OpenMRS. It's pretty snazzy, huh? Got it online. So I think one of the things that we've learned by watching communities like yours are that values are important. And keeping true to those values was kind of key to our growth. And I wanted to share a little bit of those with you. The first, which is probably not a surprise to you given the nature of the work that we do, is that we believe that the underserved are first and that others follow. You know, when you share stories about people like Wilson in the picture here, it inspires you to want to participate in activities like this. And it's really important to keep people like Wilson in the back of your mind as a community grows. Because a lot of people come to OpenMRS and they say, well, can it do this or can it do that? And the reality is by staying focused on people like Wilson, it allows us to be effective at things versus becoming very divergent in the things that OpenMRS becomes. We also are big believers in foundations, and especially ones that are standards-based and flexible. We've put a lot of energy into building a foundation that people can build record systems and other kinds of tools from. And we believe that part of the reason why our community has grown is that we haven't tried to necessarily fix the model of how healthcare is delivered, but we give people the flexibility to design it as it meets their needs. And so just from a technical perspective, OpenMRS is a Java-based application, and so the core API is written in Java. We have a database interface through Hibernate. MySQL is the database that comes out of the box, but people have used other database softwares as well. It's a web application, and so Tomcat serves as our application server, and we have a reference application that has a style guide and widgets that we are actively developing currently. We also have a pretty robust web services infrastructure that wraps the API as well, and for those of you that are in healthcare, a lot of legacy healthcare systems are using messages like HL7 and CCDs as way to transmit information between systems, and so we try to comply with those whenever we can. All of our code is licensed under MPL, and all of our content is licensed under Creative Commons, and it is amazing what people are doing with this stuff. So people are creating all kinds of ways to interact with OpenMRS, so in Malawi they created a touchscreen interface. In clinics in the U.S., they've created a paper-based OCR interface on top of the record system, and all of this code is generated inside an OpenMRS module. People have done mashups. This is a project in Pakistan, a national implementation of OpenMRS to support multi-drug resistant TB surveillance and care, and so basically you can click down through one of the patient icons, and it shows you a summarization of the person's record. People are obviously creating mobile apps, all kinds of mobile apps that interface the API as well, and groups like the World Health Organization take the platform as a way to try to encourage good standards of care, so they have a distribution of OpenMRS that's specific to multi-drug resistant TB standards of care, and they release that as something that is a WHO proctored activity. And people can do even things that don't relate necessarily to medical record systems, so there was an implementation that they simply used to generate ID cards for people in clinics. Community-based development, ownership, and apprenticeship is really important to us, because aid from our perspective is really helping people help themselves, and so it's really important to us that the ownership of these systems happens locally, and the customization happens locally, and the ownership of the systems and the ecosystems that form around these record systems happen by indigenous people that work within these countries. And so we put a lot of effort into having internship programs and activities that allow for that kind of commingling and educational activity to happen. Garima is a student who started off through a Google internship, but she ultimately, once she finished that, stayed involved. She got initially involved in documentation, she's now a part of a team that welcomes new members into the community, and she's just, you know, a wonderful presence. And we have lots of other people as well who initially don't present themselves as anything other than acronym, but they start making all of these contributions and completing tickets in our code tracking system, and then you find out that these are people that don't necessarily even have a healthcare background, they're just participating because they want to do something philanthropic with their time. The guy in the middle is a guy from Uganda, his name is Joseph Kouisi, he's actually gotten to a place where he's the release manager for one of the upcoming releases of our software. So we're really big believers in helping kind of build that ecosystem of users. And that even goes as far as helping establish careers. Sarangha was someone who also did an internship with OpenMRS, he ended up liking the work so much, not having any healthcare experience, and he's actually pursuing a PhD in health informatics, and we'll probably go back to his country and be a leader in his country around health informatics going forward. What's also really interesting is we're starting to see a lot more corporate interest lately, and Roy Singham for those of you who might not know is the founder of a big IT consultancy firm called ThoughtWorks, and as part of their social impact program, they've seconded lots of engineering and support talent on DevOps and things like that into the community, and so a big part of our community is increasingly becoming these kinds of companies who participate alongside us. And then finally, I think the community that we have the foundation of it is really these people who work in countries in leadership positions and are dreamers, but most importantly, they're doers. People like Alvin Marcello, who's a surgeon that works for the Ministry of Health within the Philippines, and he's responsible for a distribution of OpenMRS called CHITS, which is being rolled out nationally in the health system. There's also people like Richard Gacuba, who similarly to Alvin, also is responsible for a national rollout of OpenMRS in all of the clinics within Rwanda, and last I heard, it's in about 400 at this point, so that's all locally developed version you can see in the background. You can see the customization that the Rwandan people have built on top of it. Gabu Mandi is a guy who came to one of our implementer's meetings. He was responsible for a collection of clinics in Nigeria that were sponsored by the Nigeria Institute of Human Virology. The last I understand, a pretty vibrant ecosystem has formed around that early work, and there are eight to nine service vendors who are now implementing OpenMRS on behalf of clinics in the country. Not only do you have these large-scale implementations, but then you also have these really kind of forces of nature. These people like Judy Wawira, who went into probably one of the most impoverished areas I've ever been in in my life, called the Kubera Slum in Kenya, and there's a clinic inside there called the Shining Hope Clinic, and she basically went and volunteered on her own time and established the record system for that clinic. It's just amazing work, and eventually I got to go see it, and it's just unbelievable what she's been able to accomplish. And then there's also people like Tobin Greenswag, who in his medical training established a medical record implementation, and it's actually been a national-scale rollout. He's built some proprietary modules on top of that that allows him to distinguish the work that he's done, and has been very successful with that. So, you know, our OpenMRS community has evolved quite a bit since when we started back in 2004, and we actually even had someone to volunteer creating us a real logo. So if you fast forward to where we're at today, we have right around between 70 and 80 countries that have had substantive implementations of OpenMRS. So we've come a long way from the one or two sites where we started, and our community has grown by leaps and bounds. I mean, we're constantly seeing new people come in. I think the big issue that we're dealing with now is just being able to manage the volunteers, trying to find meaningful work for them to do, and bringing it back so that it's cohesive and whole when it's done. But there's plenty of room for more community growth. You all are certainly welcome to come and join us. We have lots of ways for people to get involved. I think some of the specific things that we're looking for now are people that are interested in working with the actual environments on the ground. What we find is that there's a big amount of work from translating features that are requested to work that can be done by engineers. And so people with business analysis and project management experience, we greatly value those. Of course, engineering time that's predictably reliable, i.e. I could be available on Thursday this week or in every week, that would be a really nice thing to have as well. And from an organizational perspective, we're always looking out for organizations that are interested in implementing record systems and emerging economies, and we like to partner with those organizations. And in the past couple of years, I've started to see a growth in meeting sponsorships, and we turn those sponsorships into scholarship opportunities for people who are part of the community but don't have the wherewithal to be able to pay for themselves to go. And so if you're interested in providing sponsorships, we're certainly happy to talk with you about that. I guess the final thing I would say to you all is that many of your projects have been an inspiration to our project, and I'm sure most of you haven't even heard about OpenMRS in the past. But I can tell you that we followed you all vicariously behind the scenes silently, and I'm sure for every OpenMRS, there's probably another 10 OpenMRSs out there who are following your lead. So when you feel like you're tired of writing about how to be successful in open source projects, please keep writing because it influenced me, it influenced our community, and we're very appreciative of not only your work, but the opportunity that we've had to talk to you about the work that we're doing. So thank you very much. Hold up one second. So this is exactly what I'm talking about. Like when you first got started in this, did you think that, you know, if you look back in 2004, did you ever think it would get this big? Did you ever think there would be this many people involved? I almost didn't go in the first place. I mean, so I mean, just to put things in perspective, I literally was in Kenya in this small room thinking about how we were going to start a medical record system project. I didn't think about open source. I didn't think about, you know, anything other than trying to support this environment. But the nature of how we started working together and the way in which it drew other people in helped us understand that open source was a really empowering model of being able to build local capacity and to build resilience so that people can build their own systems, which is what we're after. That's what aid actually is. Yeah. In fact, is Carl Vogel, is he in the room right now? Because I know he's speaking here this week. Carl, are you here anywhere? So Carl, who wrote the book you mentioned in your talk, he's here this week. But, you know, I want to again emphasize what you said to these folks, which is, you know, I don't think Carl, when he wrote that book, would know that you might pick it up someday, and then a community as important as something like this would form from that. But that really is such an important thing. And what we're trying to bring more people to our events so that, you know, you can share those stories and vice versa. So I just want to thank you for coming. It's a terrific story. You guys are doing killer work. Thanks. Thanks. Appreciate it.