Letter to the NC Dept. of Minority Healthcare
Dear Ms. Pullen-Smith:
It is my understanding from Forrest Toms that you have had an opportunity familiarize yourself with my project. As Forrest has already explained, I am the president of a not-for-profit company, Open Source Medical Software (OSMS) chartered in the State of North Carolina on March 15, 2005. OSMS provides the structure and guidance to a growing number of all developers who donate their time and software improvements to the project. At my last audit of donated time we were receiving approximately $550,000 dollars a year in donated time and software. We have no paid employees and have done this with no income. We have received $3,500 dollars in donations from a private corporation and individuals.
OSMS develops a free open source electronic medical record and billing application, OpenEMR. OpenEMR has already been successfully used in several pilot projects and an estimated 400 medical practices in the United States. Counting the installations is very difficult because of the nature of anonymous downloading of the software. This number may be as high as 4,000. OpenEMR has a fair market value of $35,000 per copy. We are currently donating about $54 million dollars of free software a month to low income, small, and initially established practices per month.
OpenEMR is a full electronic health record with integrated practice management, electronic filing and e-prescribing. The software is ideally suited to serve the needs of low income practices, rural health clinics, inner city clinics, and public helth departments. Currently the large foundations in North Carolina such as Kate B. Reynolds and BCBSNC Foundation are receiving growing numbers of requests for funding to provide provide electronic medical records. As stated this would cost these foundations an average of $35,000 per donation. OpenEMR is ideally suited to fill this need at a much lower cost per installation. The software itself is free which would reduce the required funding to hardware, installation, training and ongoing maintenance.
I have been in contact with El Futuro, a mental health facility serving the needs of the low income Latino population in Carrboro, North Carolina and also the Cleveland County Health Department. Both of these facilities are interested in OpenEMR because it is free and completely open source. The program is highly extensible and the open source nature of the software allows the end user to extend to program in whatever way meets their needs the best. Both organizations are some what put off by our being an "unknown quantity". They are also worried about the national certification (CCHIT) that is very difficult and expensive to obtain.
I spoke with Dr. David Hunt of the Department of Health and Human Services in the Health Information Technology (HIT) section on January 16th, 2009. It was very clear from Mr. Hunt that the HIT would not provide any support or funding without the CCHIT certification. Current estimates on the cost of CCHIT certification by typical commercial electronic health record vendors is that this process starts with a $35,000 application fee and that additional software modifications run Approximately $160,000 for a total of around $200,000.
In the Senate form of the bill on page 718 the bill proposes:
11 SEC. 4206. STUDY ON AVAILABILITY OF OPEN SOURCE
12 HEALTH INFORMATION TECHNOLOGY SYS
15 (1) STUDY.—The Secretary of Health and
16 Human Services shall, in consultation with the
17 Under Secretary for Health of the Veterans Health
18 Administration, the Director of the Indian Health
19 Service, the Secretary of Defense, the Director of
20 the Agency for Healthcare Research and Quality,
21 the Administrator of the Health Resources and Serv
22ices Administration, and the Chairman of the Fed
23eral Communications Commission, conduct a study
1 (A) the current availability of open source
2 health information technology systems to Fed
3 eral safety net providers (including small, rural
5 (B) the total cost of ownership of such sys
6 tems in comparison to the cost of proprietary
7 commercial products available;
8 (C) the ability of such systems to respond
9 to the needs of, and be applied to, various pop
10 ulations (including children and disabled indi
11 viduals); and
12 (D) the capacity of such systems to facili
13 tate interoperability.
14 (2) CONSIDERATIONS.—In conducting the study
15 under paragraph (1), the Secretary of Health and
16 Human Services shall take into account the cir
17 cumstances of smaller health care providers, health
18 care providers located in rural or other medically un
19 derserved areas, and safety net providers that deliver
20 a significant level of health care to uninsured indi
21 viduals, Medicaid beneficiaries, SCHIP beneficiaries,
22 and other vulnerable individuals.
The federal government wants to see an open source solution for rural health care and other critical medical infrastructure. OpenEMR clearly fills this niche perfectly. OpenEMR is a high quality free open source package that is exactly what Congress and President Obama are calling for. To be considered at all we will be required to have CCHIT certification.
What I am seeking is support from the NC Rural Health Office, Kate B. Reynolds, and BCBSNC Foundation to receive funding for this certification. In addition, I would like to provide the OpenEMR software to all the clients being served by these organizations. I believe this will dramatically lower the cost of delivering this software to all concerned and provide an open source software solution as requested by President Obama and provided for by the current stimulus package.
Per Forrest Toms' recommendation I would like to meet with you and borrow from your experience to give me some guidance on how to accomplish this important goal.
Sam Bowen, MD
Open Source Medical Software