Exploring the potential of Open Source solutions to deliver Clean, Clear Information for Health Service Improvement Electronic Health Records (EHR) systems are computer systems used by hospitals and clinics to record medical information about patients. They include information about patients' symptoms, medical diagnoses, treatment, operations, blood tests, x-ray results and how they are progressing.      Although EHR systems have been used in hospitals in high-income countries for many years now, in low-resource countries such as Kenya, they are just beginning to be used at scale. This proposal is the result of the the  research team in Kenya being asked by the Kenyan Ministry of Health (MoH) and the World Health Organisation (WHO, Kenya office) to explore how EHR systems could be used, not just to help doctors and hospital workers in managing their patients, but to also re-use the information that is collected for improving health services more widely. The information needed to improve care locally and across the health system needs to be clean and clear if it is to be used effectively to make the right decisions in the same way that drinking water needs to be clean and clear to be safe to drink.      The aim of this proposal is to allow us to develop the partnerships (both academic and institutional) and knowledge necessary to create a new large programme of research around the development and use of clean, clear information contained in EHR systems for improving health.      To achieve this aim, the first part of this proposal will find out which EHR systems are currently in use in Kenya, why they have been implemented, whether they are meeting expectations of users, whether they contain the kind of information that would be useful to improve care and whether they adhere to best practice international standards for safe and effective use.      We will then investigate how a particular open-source EHR system called OpenMRS is being used in Machakos County in Kenya. This system is used in lots of HIV clinics across Africa (and the rest of the world) but is not usually used in more general forms of care or in hospitals. A recent project supported by the Kenyan MoH and WHO is attempting to implement OpenMRS widely in Machakos County but early experience suggests challenges and we aim to find out what lessons can be learned to support the further introduction of EHR systems in Kenya and how best to gain advantage from the open source (voluntary) community that can help develop and improve these not-for-profit systems.      Finally, we will look at what kind of information from EHR systems could be useful enough to incentivise hospital and county administrators to invest in implementing and sustaining EHR systems that include the ability to collect medical information as well as the kind of financial information that is commonly the first priority for these kinds of system.      Once we know what kind of EHR systems are in use and the type of data they are collecting, how EHR systems are currently being implemented, and what kind of data is of use to policy-makers, administrators and health workers, we can identify the specific objectives of our planned larger programme of research. This new programme will aim to ensure that EHRs in developing countries such as Kenya are implemented efficiently and effectively with minimal disruption to healthcare workers but that will also enable the re-use of clean, clear information throughout the health care system to foster improvements in health. The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world.