New Open Source (Free) EHR Offering Developed by A Doctor

In a recent comment, a physician told me they were developing their own open source EHR called New Open Source Health (or NOSH) ChartingSystem. As a huge fan of open source and also since I consider myself a Physician advocate, I had to learn more about what this doctor was doing. The following is an interview with Michael Chen, MD who is developing this new open source EHR.

Tell us a little about yourself and your open source EHR software.

Briefly, I’m a board-certified family physician and I spent 9 years as
a solo practitioner in a low-overhead, micropractice model where it is
just me without any additional ancillary staff. I was not able to
make this possible without the maximum use of technology to help me.
That is why having a robust EHR system was vital for my practice from
the beginning.

I began development of my own open source EHR software in 2009 in
response to the changes in the EHR landscape following the 2009 HITECH
Act and the pending changes to Medicare reimbursement that would
directly affect my practice.

My open source EHR software is called the New Open Source Health (or
NOSH) ChartingSystem. It is a web-based EHR where the user interfaces
the program through any web-browser that is connected to the network
where the NOSH ChartingSystem is installed. It is a based off a MySQL
database and programmed using PHP, HTML5, and Javascript. Many of the
components are based off of other open-source code (the PHP framework,
Javascript framework and plug-ins) It is meant to be run on an Apache
web server.

Why did you choose to develop your own open source EHR software instead of going with the other open source EHR out there?

I initially started work on contributing to the OpenEMR open-source
EHR that has been in development since the late 1990’s. However, over
time, I became disillusioned with the underlying project and the fact
that no matter how I wanted to improve the user interface (which was
my ultimate criticism of the project, even though the rest of the
project was exemplary), it required that I entirely “redo” the whole
system – you can’t fix a user interface as a piecemeal project. I
began to understand that the user interface (like the adage that form
follows function) really starts from the fundamental core of how the
system is developed. OpenEMR, like the other EHRs that I have used,
is designed with the hospital administrator and biller in mind and the
physician interface was a mere afterthought.

My other job before I embarked on my EHR project, besides being a solo
physician, was a medical director of a child abuse assessment center.
Part of my job is to review chart notes from other physicians in the
community and I can tell you that the ones that used EHRs were very
difficult to read at a glance. Even though the information appeared
complete, it was difficult to sort out all the “useless” information
that was contained in the record and to get to the core of clinically
relevant information. That really speaks to where the focus of EHRs
are designed. It really was not for the physician in mind.

After my frustration, I decided to expend my energy more wisely in
starting a new project from scratch as it was already envisioned in my
own practice and in my experience as a physician how a electronic
health record should be.

How far along are you in the development of your EHR software?

It is fully developed for real-world use right now. The Ubuntu
installer and source code has been available to be downloaded and
installed since October 15, 2012. Of course, with all projects, there
are new features, updates, and specific modifications that are a part
of the project life cycle.

Do you think that an open source EHR software can keep up with the well funded EHR vendors out there? Will your EHR software be able to keep up with the changing EHR landscape?

I think there is one specific challenge that will determine if an open
source project can keep up with the well funded EHRs. That challenge,
of course, is the financial means to maintain a project. There is a
second challenge that I’ll go over in more detail regarding your
question about certification.

Regarding the financial component, this project for me started out as
a pro-bono thing for me, with the aim that I could practice medicine
the way I want. I didn’t initially envision that I would release it
for others, but after I spoke to a few other physician colleagues and
saw my project, they were in awe with the simplicity and
user-friendliness of the system and wished they could use an EHR like
mine…of course, they were working in larger organizations that
already have an EHR implemented already. However, as I re-looked at
the landscape of physicians who were satisfied with their EHR system
since the meaningful use incentives began (after I came out of my
developer’s “hole” for a couple of years), I realized that there was a
“great divide” among physicians and the health IT community. If you
look at the Sermo forums and even talking to physicians one-on-one,
many are not happy with the EHR systems they are using. Most feel
that the EHR’s they used affected their workflow negatively and they
have to recoup their cost and efficiency in other ways, all in trying
to not affect patient care, which is very stressful. Most doctors
are angry that this is somehow being “forced” on them and they have no
choice but to comply. This leaves many of my colleagues
disillusioned, not just in the EHR realm, but for the whole profession
as well. Many keep asking (most without any answers, unfortunately),
“why can’t Steve Jobs build an EHR for them”? The key part of that
question, to me, is “for them”. That has been the missing piece that
no amount of incentives can rectify. The process of incentiviation
for lackluster products to doctors is going to lead to a dissolution
of the profession (especially those in primary care) and throwing out
the talent that is out there who really want to make a difference in
healthcare…unfortunately, it is already happening.

One thing that a vibrant, community-supported open source project can
do (that is a significant advantage compared to other EHR products) is
that the open source EHR can be continuously improved upon and adapted
to the needs of physicians, not just now, but in the future. There
are many examples of open source projects that have really done well
over the life-span of the project (Linux and its distributions, but
also Firefox, Android, Drupal and Puppet). I hope and envision NOSH
ChartingSystem to head in the same trajectory with the community
support coming from medical providers and developers alike.

The best open source software projects involve a community of developers and users. How far along are you in building the Nosh EHR community?

Since I just released my project in October, 2012; building my
community is at its infancy stage right now. I hope that having
medical professionals actually try out my project, know that it is
“real” and that they too can be a part of a movement and a project
that will work for them, will continue to build that community.

I’m also planning on working with individuals who are in the forefront
of health care reform to see where this project can go and how it can
work towards those goals. I feel that the EHR, if implemented with
the medical provider in mind, can transform health care in subtle, but
also profound ways, with physicians in the driver’s seat instead of in
the back seat.

Does the trend of hospitals acquiring physician practices concern you since there will be fewer doctors who can use your products? Or do you plan to scale your open source EHR for acute care?

Yes, the trend that there are few and fewer smaller or physician owned
practices does limit my project potential, but on the flip-side, I see
this as a possible way that my EHR can impact health care reform in a
bigger way, if the community support grows significantly and
physicians have voice again.

My focus right now is to make sure EHRs are accessible to the doctors
least able to afford them, even with incentives programs out there.
Those would be the smaller and solo-practice doctors, likely in the
primary care sector and also those in the rural setting, or any
physician or clinic that does not have the means to afford one. That
was why I ended up making my own EHR…because I couldn’t afford the
one I used to have since certification was “needed” for meaningful use
incentives, and even thought I met all the meaningful use criteria
with my older system and my own “modifications”, I would not have been
able to get reimbursement because my system was not “certified”.

I am betting that if a physician sees a truly user-friendly EHR, it
doesn’t need to take incentives for them to jump on board. Because I
feel that most physicians are already ready to jump on board…there
just isn’t something for them to jump on board to that they feel good
about.

One key point, and one that physicians who have implemented an EHR or
thinking about implementing an EHR have noticed, is that the EHR is
not just a product…it’s creating a level of service to make sure a
transition to the EHR is as minimally disruptive as possible to their
practice. It’s not realistic to assume that any switch will not
impact, but I think most physicians have been given a false hope that
with one EHR product is claimed to be overly superior to another that
it would not cause those impacts. I think that too many physicians,
hospital systems, and statewide health systems have been “burned” by
the process and so I’m focusing on offering this EHR project (which
does not cost anything to use and that one can modify it to their
heart’s content without penalty) alongside with consultation services
(which would be my source of revenue) to best incorporate my system to
their practice. EHR implementation is definitely not a
one-size-fits-all approach, so I think the value of these consultation
and personalization services in addition to the physician being a part
of a community, will make happier physician clients overall.

How do you balance the need for an EHR to complete sophisticated tasks, but still keep the interface simple?

It really goes back to the adage of form follows function. You don’t
have to sacrifice function for form. In fact, most of the functions
that NOSH ChartingSystem has is very much what most other EHRs have,
its just presented in a very different way and in a way that (I think)
makes sense to most physicians. Even though I designed this system
for physicians, I know that there are certain non-clinical information
that is important. For instance, if you’re a clinic administrator or
a solo physician like me, there is information in NOSH ChartingSystem
that shows monthly statistics for how many patients have been seen and
how much each insurance company is reimbursing for each visit type or
what has not been paid yet so you can keep track of those accounts
receivables. You can also quickly query a list of all active patients
who are male and have diabetes so you can keep track of your practice
quality.

It’s not just even what type of information is being presented or how
it is entered, the whole system was meant to evoke the feeling of
calmness. As a physician, the last thing I need is a system that
looks like you’re operating a military-grade dashboard with
multi-colored panels with tons of information, and I have decide at
that moment what is important or not without fearing that I’m going to
do something catastrophic with the system. I don’t want to be playing
the “Where’s Waldo” game when I’m working one-on-one with a patient.
As a physician, I’m there to listen, examine, and diagnose…not
figure out minute-by-minute how to enter this finding or locate a
medication allergy or issue for this patient. It just has to be,
almost literally, at my fingertips.

What is the best feature you’ve created in your EHR that others don’t have?

I think I mentioned it before, but it bears mentioning again, a user
interface that is familiar to physicians. One that does not need a
book, tutorial, or class to learn how to use. That is the best
feature of my EHR. For busy doctors, the last thing they need is to
learn something new that takes a lot of time to learn. My philosophy
is that the EHR should be an everyday tool, like a pen, so that
physicians can do the work of physicians. If a patient that you treat
does not know that you are using an EHR while you’re in the middle of
an encounter, that is an example and a testament of a great EHR. If I
can do my part to let physicians be physicians again, I can say that I
successfully accomplished my goals with my EHR project.

What features are still on your EHR roadmap that you haven’t been able to create yet?

My next priority is to port my project to a mobile application; it’s
not a daunting task given the structure and framework that this system
already has, but it just takes a little more time. I think there are
always different customizations one physician would like over another,
which one could consider them as features, but I like to present them
as options rather than adding unnecessary overhead to the core project
over time.

Do you plan on getting your EHR certified? Can a doctor show meaningful use and get the EHR incentive money with your open source EHR?

That is very good question. At this point, I’m hesitant for getting
my EHR certified for the following reasons. I feel that the current
EHR certification process, at its core, is not compatible to the
open-source philosophy. Certification, in it of itself, is a good
idea for any software or service, but the devil is in the details. If
an open-source developer cannot afford certification (like myself),
there’s something to be said about exclusion and giving the upper hand
to already established entities that have a foothold in the EHR
marketplace. For instance, the cost of certfication only applies to
the specific version that is being tested. Updates need to be re
certified, at the same cost of initial certification. Over time, that
can be very costly to a small developer. Certification ought to
promote and encourage innovation (which the current process does not).
I see this issue as a potentially huge challenge for my project as
meaningful use incentives are tied to certified EHR products. I think
there are many examples where a practice or physician is able to meet
meaningful use in a defined and measurable way, but because they
didn’t use a “certified” product, they will get penalized (like me
when I was in practice). What is the point? All the process did was
to disincentivize me into using EHRs as it would cost me nothing if I
used a paper and pen and I stopped seeing Medicare/Medicaid patients.
Is that really want the government wants? Is that good public health
policy?

I believe most physicians are unaware that certification means that
the costs get passed down the physicians and practices. I knew that
it happened to me in 2009 before I started my own project. But most
physicians don’t own their own practice so the issue isn’t even in
stream of consciousness. But as they become more disillusioned with
the MU incentives program as time goes on, it’ll be clear to them that
the real winners here are the established EHR system providers and the
certification bodies and not to the doctors and the patients. This is
where I am actually outraged, from a physician standpoint.

So, I’m not sure I’m going to go the certification route (both
financially and philosophically).

Like I’ve said before, I think a good EHR product should stand on its
own merits without incentives. Physicians are savvy enough to know
what works and most have already caught on to smartphone technology.
Why? Because it’s intuitive to use. Like other human beings,
physicians don’t like to be patronized and told to adapt to a system
that doesn’t make sense to them. Physicians are really looking for
something that works for them. There are just not many options out
there, but I’m offering mine to see where it goes.

What do you see as the future of EHR in healthcare?

Recently, I came across these “10 Commandments of Healthcare
Information Technology” by Dr. Octo Barnett, who penned these way back
in 1970. You can see them on my project website. I found it
fascinating that these concepts are very much what I envision
healthcare information technology to be even now. I found it
disturbing, though, that a lot of what has been happening in
healthcare IT, unfortunately, goes against these concepts. I feel
that for EHRs to succeed in healthcare, we really have to go back to
these concepts. Only then, will EHRs be accepted and used by
physicians. After all, the physicians are the ones that enter the
information in these systems. The value of EHRs and the information
provided is only as good as how the information is entered. We’ve
totally missed the boat on this, from a health IT standpoint in my
opinion…leaving the physicians behind so to speak, but I don’t think
it is too late to change course and start over again. Generations of
younger physicians are craving for a good functioning EHR (I was
astounded that my first job over 20 years ago as a cash attendant at a
cafe involved these touch screen systems that were really easy to use
and then to find that my stint as a medical student, I had to resort
to using paper charts and pens…it’s really telling how far behind we
are on EHR implementation…and that was 15 years ago!). I think it’s
about time that there is something real for physicians to use.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

27 Comments

  • Here we have yet another doctor who thinks he can do better than the 200 other EMRs and EHRs….

    I think this doctor is doing a disservice to his peers, because now they have to evaluate yet another EMR. Or at the very least he is wasting his time.

    We all agree the MU certification is not good because it doesn’t focus on usability. But if NOSH won’t be certified, what’s the point if doctors can’t avoid the upcoming cuts.

    If you think this will force vendors to make an intuitive EHR, keep dreaming. They don’t care.

    By the way I tried the demo. NOSH turns me into a 1960s secretary, right out of Mad Men.

  • I’m all for innovation.

    I don’t really care that there are hundreds of EHRs out there, choice and options are generally a good thing.

    What if phone innovation stopped with Blackberry?

    I think NOSH is shooting itself in the foot by not getting certified. Most certifications are BS and a crutch, but it is reality if a doc wants that reimbursement check.

    Rather than reinvent the wheel, why wouldn’t you tweak/customize Vista. It is certified.

    Finally, the EHR world has glommed together PM & EHR recently. Yet, there are still EHRs out there without the PM side of the equation. I didn’t notice if NOSH has PM built into it or not.

  • Thank you for the comments about my project. NOSH ChartingSystem does have practice management built in (billing, claims generation, tracking accounts receivables).

    Regarding certification, I know that this is very hot topic and it was an issue that I needed to come to terms with when I decided to release my project to the public.

    My background as a solo family physician who provided care in a non-traditional way (low overhead, no ancillary staff, direct patient encounters) allowed me to experience the impact of policies of the current US health care system, including health IT. I knew that the impact of the 2009 HITECH act had profound implications for smaller practices like mine regarding cost of owning a certified EHR for the long-term. With the lack of available and viable options in 2009 (Vista at the time was not ready for outpatient usage, and I have to admit, I was not knowledgeable about programming the MUMPS database or the open source equivalent, GT.M) and for the same reasons that I kept getting frustrated with current EHR systems, where the user interface was difficult to modify due to the constraints of the underlying framework, I decided that I needed to make my own just so that my practice could survive the upcoming changes. I decided that I was willing to forgo the risk of payment cut (Medicare reimbursements for primary care were already ridiculously low, so the threat just caused me to opt-out of Medicare entirely…that’s another hot topic) so that I could continue to provide the type of care for my patients without working on an outdated EHR system that I could no longer afford.

    The point of this is that there is a large, but silent, subpopulation of physicians (at least where I am in Oregon) that shared similar experiences with my own – small group, solo doctors, especially in primary care, likely rural (but also urban) that are literally on the fence about this MU program. These set of doctors (who like to remain independent and prefer not to be confined in their practice by being widgets in a production machine) are the ones that are being left out in the dust with the current MU program and health care reform as a whole. They cannot afford the current options in EHR. Even the ones that are free or ad-supported, most didn’t like the fact that their data might not belong to them, and there was little transition support if something goes wrong with the implementation. Ultimately, most did not like how the EHRs did not allow them to input information in a manner that was how they thought clinically. That was what I set out to do, first for my own practice, and now to share with others, especially for the subpopulation of physicians I just described. I understand that not everyone has the same ideas of what a good user interface should be (it’s very subjective), but I think at the very least, it would be an another option for physicians to consider.

  • Question for anyone; if one has an EHR that is not certified, I do understand that they will not get MU incentives, but will they still be hit by penalties from CMS?

  • R Troy,
    They will on their Medicare reimbursement. It should also be noted that one could get the EHR certification on their own, but that’s usually more of an option for a hospital than an ambulatory practice.

  • Current language in the 2009 HITECH act does state that if a physician does not show meaningful use with a certified EHR, reimbursement rates will be decreased starting 2015. However, the whole MU program is now on shaky ground politically – http://www.healthdatamanagement.com/news/ehr-electronic-health-records-meaningful-use-45067-1.html; and resentment aobut the program from physician is growing.

    Interestingly, CCHIT had created the EACH program http://each.cchit.org/ to allow entities to conglomerate legacy, non-certified systems, to verify meaningful use objectives to obtain reimbursement. Nevertheless, it is very costly program to enroll in (doesn’t say on the website, you have to enroll to get the idea of cost), the math still add up, especially for smaller practices.

  • When you get down to it, if CMS gets what it needs from that EHR, and if health authorities can get what they want, IMHO there should be no penalty. It seems like CMS is trying to inhibit open source projects like this given the huge cost of the nearly meaningless certification requirement. Maybe this is something else that needs to be reconsidered before Stage 2 goes into effect.

  • @ Dr. Chen — Believe me, I’m a fan of innovation, but when consulting with a doc about which EHR to go with…

    1) Why would a doc choose an EHR that they can’t get MU money on AND will get dinged on future reimbursements?

    2) Trust: as you mentioned, NOSH does include a PM side of things. The PM is arguably the more valuable to a practice. If billing gets screwed up this is a major problem.

    3) Is this out there for folks to do only on their own, or do you have plans for a “Red-Hat-Like” option where you set it up for them?

    What is your USP? Why would a doc choose NOSH over, say eClinicalworks?
    What size screen is this optimized for? The calendar requires a lot of scrolling on my 22″ widescreen

    Note: when on a chart I noticed that if I click Demographics, I can still click say, Alerts, but if I click Alerts or Prevention, I must close the windows before I can choose something else. Is this by design?

  • John,

    1. I think presented this project as a fundamental and philosophical alternative to the path created by MU. Although it sounds crazy from a business perspective, I feel that there is enough anger and resentment from the physicians about the process that they would be willing to risk the reimbursement costs, granted nothing changes with the law until 2015. However, we’ve got 2 1/2 years to go and a lot can change from now until then. I working from other angles with my project from a state legislation level to see there are ways to “exempt” open-source software from this crippling law, especially regarding the reimbursement reduction. Punitive measures usually will not effect change, if we’re trying to encourage EHR adoption. http://healthaffairs.org/blog/2012/10/11/will-pay-for-performance-backfire-insights-from-behavioral-economics/

    2. I agree with your PM statement. I could not have managed my own clinic over the past 2 years (which was my real live “testbed” so to speak) without this feature in my EHR. That is why it is built into my system – it just doesn’t look like the traditional PM layout, but then again I designed it from a physician’s point of view.

    3. Yes, this project gives you 2 options to install – do it on your own. However, what I mentioned on my project page is that I provide consulting services (like Acquia for Drupal and Red Hat for Linux) for installing the system and services to transition to system successfully.

    Thank you for the comments about some of the features you mentioned. It looks like what you mentioned are minor bugs, which would be rectified when the next version comes out approximately within the next 2 weeks.

  • R Troy,
    They had a whole discussion about EHR certification and open source when the idea of a certified EHR for EHR incentive money first came out. I’ll have to dig to find the discussion, and I’m not sure I ever saw the final result. There are a lot of issues with it. For example, it’s open source so anyone can modify it, so there are no two open source EHR that are the same, so how does that work with certification. It gets ugly.

    The interesting thing is that ONC is actually very positive on open source and they use it themselves for many projects. I think they’re stuck between a rock and a hard place.

  • I’ve had one big issue with MU for a while; that it should only affect practices with Medicare and Medicaid. Now I think I’ve a second; that open source users not only don’t get any incentives, they can still be penalized even if the system they use does everything CMS needs it to do.

  • R Troy,
    That is exactly the concern I had back in 2009 when the HITECH Act passed. Because I used an EMR (not mine) at the time that I modified for my own use so I could do all these things that MU “recommended”, but it did not matter because my setup was not “certified”. If certification was not bound by cost or ability to pay for certification (either from the EHR product or by the provider), then I would not have objected. However, this is a distinct issue of discrimination (both for practices that could not afford such a setup, and for open source projects that don’t have the kind of capital to invest in certification as it can be extremely costly for various implementations of open-source software, like John mentioned. Certification, if done appropriately and fairly, ought to be an open-source software that tests the functions of an EHR – which is what certification now is already doing (it’s just a software test, nothing more), but doesn’t cost an arm and a leg to do it every single version at a time. There was something exactly like that in the works called Laika (http://laika.sourceforge.net/) that was sponsored by CCHIT, but it seems to have died (no development since 2009) around the same time legislation was passed. In short, the current MU certification and associated legal ramifications for physicians are stifling, not spurring innovation.

  • One wonders how ONC and / or Congress chose to include an expensive certification process; did lobbyists have anything to to do with it?

  • R Troy,
    I think the EHR vendors were involved in the “lobbying.” I was actually surprised to see that the EHR certification body at the time (CCHIT) was basically clueless when it came to the EHR certification requirement. They probably should have lobbied and made sure they were the EHR certification, but happily they didn’t and we’re in a better EHR certification than we were before. Might be hard to believe, but is true.

    I once asked Marc Probst, CIO of IHC and on the Govt Committee that put together EHR certification and meaningful use, why you needed to have an EHR certification and meaningful use. I told him they seemed redundant. If you can show meaningful use, then of course the EHR has the functions necessary. His answer, “I lost that argument.”

  • I’m not, at all, defending MU, BUT you have to admit, there needs to be a way to ensure that a doc hasn’t cobbled together WORD & Excel as their “EHR”.

    Also, the fact that reimbursements are not for the cost of EHR, UP TO $XX, is ridiculous as any doc can sign up for a “free” EHR and get the full MU reimbursement. This is pure idiocy.

    I personally believe the smartest thing to do would have been to NOT give any money, but “give” everyone Vista and say: either use Vista or buy something.

    On the customization side of things: I’m sure we all know you can customize most of the “big dog” EHRs our there. What’s to say a customization tweak doesn’t require certification again??

  • So let’s see what’s wrong with MU and the incentives and disincentives;
    1. Only those with CMS interaction are helped – or hurt.
    2. Free EHR users (where the EHR is certified) can get nice payments.
    3. Expensive EHR users have sometimes had to pay more for EHRs that are certified as the EHR vendor raised prices (or so I’ve heard) to absorb most of the incentive payments.
    4. Open source is discouraged for the most part because any major changes require new, expensive certification.
    5. Certification has nothing to do with usability.
    6. There are no FREE resources out there to help one pick and implement the right EHR, especially in the world of small practices.
    7. EHRs don’t by default typically include practice management yet that is a critical part of them for billing (think CMS) and scheduling.
    8. Current MU stage encourages a patient portal, but does not really encourage practices to tell their patients that they have it or that it should really be functional.

  • R. Troy,
    You can also add under #5: Certification has nothing to do with patient safety.

    Also, there is really no meaningful path towards Interoperability (or rather, the path towards it is fraught with disaster). That’s one of of the concerns that was brought up about the lack of it in Stage 2 certification. It’s also not in the “best interest” of the EHR company to do so, as monopolization of the industry is the “logical” step for these companies.

  • Hi,

    I’m one of the volunteer developers on the OpenEMR project. Meaningful Use was actually very positive for the OpenEMR project as it provided a nice set of features for the community to work towards. The project is actually looking forward to fulfilling stage 2.

    Regarding the user interface issues of OpenEMR brought up in the original article above; in open source projects, I’ve pretty much come to the conclusion that any problem is solvable/fixable (there were many that thought accomplishing MU stage I certification with OpenEMR would be impossible); that is one of the many beauties of open source. That being said, though, I wish Michael the best in making NOSH a success.

    -brady

  • Brady,
    I do have to say that OpenEMR has definitely made the most of MU. That’s interesting to hear that MU helped to bring the community together (if I’m reading your comment correctly).

    My big question though is what could have OpenEMR built if they didn’t have so many developers focused on the MU requirements? Could there have been more focus on the UI issues that Dr. Chen would like fixed?

    Also, do you know what concessions were made in the final meaningful use and EHR certification rules to allow for open source EHR to be part of the program? I vaguely recall something about EHR certification remaining for minor updates and re-certification only being needed for major updates.

  • Hi John,

    At the time, the OpenEMR community felt that OpenEMR would not be feasible for US physicians if MU was not obtained. So, a lot of the effort/resources that arose to complete MU would of likely not even existed if MU was not there. So, to answer your question, MU didn’t detract too much from focus in other places.

    The GUI issue is interesting(on a related note, this is also related to working on mobile platforms). At this point, this seems to be the main talking point to rationalize starting another project. In fact, the OpenEMR gui has been markedly improved by several vendors whom then rename it and brand it as their own SAAS service. Likely just a matter of time before OpenEMR gets a modern day facelift.

    I don’t recall any concessions being made for open source MU certification (however, I am not an expert on the subject). I do know that OpenEMR maintains certification for minor updates (such as going from OpenEMR version 4.1.0 to 4.1.1) and will need to be re-certified for major updates (such as when we go from OpenEMR version 4.1.1 to 4.2.0 in the future); I am guessing this is the same for the proprietary counterparts.

    -brady

  • Brady,
    Thanks for the reply and insight. I think it’s a great feat that OpenEMR is certified and can handle MU. The fact that an open source EHR could muster the development effort required to do so and even the cash to pay for the certification is a good sign for that project.

    The mobile interface is a good point and could be a great impetus for redesigning the UI. Reminds me of this post I did a while back called the iPad opportunity: https://www.healthcareittoday.com/2011/11/04/the-ipad-opportunity-a-decent-emr-interface/

    I think that was the biggest concession made. In the original certification details even minor updates had to be recertified. A problem for open source and proprietary.

    Thanks for sharing more about OpenEMR. I invited them in the OpenEMR forums to share more about what was happening on my network of sites, but unfortunately no one took me up on my offer. I’m happy to support open source EHR where I can.

  • Brady,

    Thank you for your support. I just had a question regarding updates and certification. It wasn’t clear in the documentation that I received from the various certifying bodies; I was under the impression that any updates or changes was a trigger for re-certification. What is the threshold for minor versus major changes in the system? Is it structural (database) changes or certain features?

    Michael

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