Operation Smile Successfully Implements Electronic Medical Record After Dozens of Cracks at It




Gone are the days of working laboriously to locate a paper chart to answer simple patient questions. Operation Smile can now accurately capture the patient information we need. And, we now do it with a dramatic increase in accuracy, quality of patient data capture, and at significantly reduced costs. We're thrilled with the results and eternally grateful for our technology partners' generosity."

- Christopher Bryant, Senior Vice President of Technology, Operation Smile


Operation Smile is an international children's charity that has provided more than 400,000 free surgeries to children and young adults in developing countries who are born with cleft lip, cleft palate and other facial deformities. Operation Smile and its' volunteers have strived for years with limited success to implement an electronic medical record (EMR) system to facilitate patient management. In 2013, Operation Smile was introduced to Vitro Software who stepped up to donate its EMR solution. Recently, Dynamsoft also stepped in to donate its web scanning SDK for use with the Vitro EMR. This combination of solutions has helped the charity realize their goal. Now, the EMR gives volunteers an easy method to capture patient information, which is critical to providing safe and comprehensive care. And because patient data is consistently captured, crucial yet previously cumbersome research initiatives can be supported through the collection of comprehensive patient data. Today, the successful Vitro and Dynamsoft implementation enables Operation Smile to extend its reach and take care of even more children while supporting its quest to fully understand the cause of these birth defects.


Operation Smile is an international medical charity that has provided hundreds of thousands of free surgeries and millions of specialty clinical interventions for children and young adults in developing countries who are born with cleft lip, cleft palate or other facial deformities. Since 1982, Operation Smile has developed expertise in mobilizing volunteer medical teams to conduct surgical missions in resource-poor environments while adhering to the highest standards of care and safety. Operation Smile helps fill the gap in providing access to safe, well-timed surgeries. With a passionate goal of creating sustainable access to locally delivered safe surgical care, Operation Smile partners with local hospitals and health systems, governments, and ministries of health and provides extensive training to local, in-country medical personnel. The organization also donates much-needed supplies and equipment to surgical sites around the world. Operation Smile has extended its global reach to more than 60 countries through its network of credentialed surgeons, pediatricians, doctors, nurses, and student volunteers. It is based in Virginia, U.S., and provided free surgeries in 32 low and middle-income countries in 2016 alone.


Like many medical organizations, Operation Smile volunteers had long been using paper-based procedures for documenting care. The organization understood they would benefit from using an electronic medical record (EMR). They had long sought out such a solution. To help the charity, Vitro Software donated its EMR solution. Vitro Software, formerly Sláinte Healthcare, is a leading international technology company that provides software and services that drive efficiencies and quality in healthcare. The software enables healthcare providers internationally to create efficiencies while reducing costs, addressing change management challenges and providing better patient outcomes. For Operation Smile volunteers, the EMR emulates previously used paper charts. So, any learning curve is eliminated.

Operation Smile medical volunteers previously had to use multi-part forms. These forms required extensive time to use. There was also the cost of shipping forms within countries of operation and sometimes back to headquarters. The paperwork not only added to costs, it also significantly impacted overall efficiency. Being able to scan patient charts into an EMR would empower Operation Smile volunteer staff with instantaneous access to patient information. The staff views this as critical to the delivery of comprehensive cleft care. Using an EMR would help track administrative procedures for other treatments too. This includes surgery, speech therapy, dental services, child life psychology, nutritional assessments and more.


To implement the EMR a strong team was assembled to fine-tune the Vitro Software solution. This included individuals representing information technology, medical records, quality assurance, medical oversight, volunteer management, and finance. The solution would be web-based and accessible via any common Internet browser, such as Internet Explorer, Chrome, or others.

Part of fine-tuning the solution was addressing the scanning capabilities. Scanning is the heart of transforming existing paperwork to a digital document management workflow. Rather than building a scanning component from scratch, the team instead sought out a software development kit (SDK) vendor. By using a ready-made scanning component, several advantages would be realized. Cost would be reduced. Development time would also be reduced by months. And, the vendor would also support the scan module for patches and updates as needed. This is important because users don't always use the same browser vendor or browser version and because browser providers continually update their software. So, the SDK vendor would also need to provide cross-browser capabilities. The team settled on Dynamsoft's Dynamic Web TWAIN SDK. Dynamsoft also donated its SDK to the charity.

About Dynamic Web TWAIN
Dynamic Web TWAIN provides developers with tools to create immediate cross-browser and cross-platform document scanning capabilities. Users can scan documents from TWAIN and SANE-compatible scanners using a variety of browsers - Chrome, Firefox, Edge, Internet Explorer (IE), Safari, and others – across Windows, macOS, Linux, iOS and Android operating systems. Images can be saved in various file formats – JPEG, TIFF, PDF, and more – or transferred and stored across varying protocols, local or remote file systems, database and document repositories.

Dynamic Web TWAIN provides programmers with simple built-in interfaces to access local imaging devices from web pages. They need only write a handful of lines of JavaScript code to enable cross-browser document scanning, uploading, and processing. It saves on costs by eliminating months of work coding from scratch to create comprehensive scanning and image capture functions. Development teams also realize long-term time and cost savings with better application robustness and faster time to market.


Today, the Vitro EMR gives more than 13,000 Operation Smile volunteers an easy method to capture patient information, which is critical to providing safe and comprehensive care. It also allows ease of access to patient information during patient follow-ups. Critically, patient information is now instantly available in support of various research initiatives that help the organization better understand where its patients live and more effectively schedule and designate mission sites. The data will be easily stored in the cloud and with local synchronization. This way headquarters and local country personnel can conveniently access data for their respective needs.

Summary patient information is entered into the Vitro EMR in a manner that facilitates prioritization and scheduling of surgery. This information is also searchable via metadata inputs for simple call-up of details later. After finishing a mission, or at the end of each day during the mission, full patient charts will be scanned. Scanned charts will then provide the details required to conduct patient follow-up.

Operation Smile can now accurately capture the information they were previously unable to capture. It also now happens with a dramatic increase in quality and at significantly reduced costs. The patient information captured includes all the demographic and medical information desired. And, it all now happens in a single, secure and easily accessible application regardless of the country the organization is conducting surgeries in.

Operation Smile relied heavily on guidance from Vitro Software to determine an optimal approach for implementing a reliable EMR in what are admittedly some of the most IT resource-constrained environments on earth. The organization has finally realized a successful EMR implementation. It has made a real and immediate impact on their ability to efficiently collect crucial patient information.