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MENTAL HEALTH OEMR AND OpenEMR GRANT BLOCKS'
1. What is our specific grant request (the amount and for what project)?
OEMR respectfully requests a grant of $15,000 from the American Psychiatric Association.
2. Who is our organization? What are its mission and brief history? Whom should the funder contact, and what is that person's phone number, mailing address, fax, and e-mail?
OEMR is a non-profit 501(c)(3) organization formed to ensure that all people regardless of race, socioeconomic status, or geographic location have access to high-quality medical care through the donation of free, open source medical software (OpenEMR). Through the combined efforts of ten small IT service companies and a small cadre of intensely dedicated volunteers, the leaders of the OpenEMR Project organized a joint effort to develop the software modules necessary to achieve the US Office of the National Coordinator (ONC) Meaningful Use (MU) Certification. This $2,500,000 project was accomplished through in-kind donations from the IT companies, volunteers, and software IT vendors over the last two years. OpenEMR 4.1 was fully certified for Ambulatory Care Meaningful Use by ICSA Labs, the United States Office of the National Coordinator Authorized Testing and Certification Body (ONC-ATCB), for years 2011-2012. With this certification, all OpenEMR users can begin certifying Meaningful Use of Certified EHR software with the US Centers for Medicare and Medicaid Services and qualify for the $44,000 incentive bonus money. OpenEMR will also allow practices to avoid the penalties, effective in January 2012, for not using electronic prescribing.
The OpenEMR project came into existence in 1998 and since 2005, has been hosted at http://sourceforge.net/projects/openemr. This project has been supported by Open Source Medical Software (http://www.openmedsoftware.org/wiki)from 2005 through the present and OEMR which was organized by leaders of the OpenEMR Project in 2010. OEMR and OpenEMR information can be obtained from Samuel T. Bowen, MD, Executive Director, 2365 Springs Rd. NE, Hickory, NC 28601. Dr. Bowen's office telephone number is 1-828-325-0950. The OEMR web page is http://www.oemr.org with the board of directors listed at http://www.oemr.org/Current_Board_Members. The board members prefer being contacted by email at [email protected].
3. What is the community need that our organization, and specifically our project, addresses? What statistics and stories can we use to substantiate that need?
OpenEMR is a highly functional, easy to use electronic health record (EHR) software. To date it has been tuned for a family practice style. This EHR software has been translated into 7 different languages and distributed in 174 different countries. OEMR has distributed 140,000 free copies of the initial OpenEMR software at a fair market value of $4,900,000,000. The software is being used by low income practices operating in areas of poor economic performance. Typical OpenEMR users are small medical practices with five physicians or less. Many have high uninsured, private pay, Medicare and Medicaid payer mixes and simply cannot afford the prices charged for available commercial EHR software. The low end of the commercial software vendors charge $10,000 per practitioner. For the noted medical practices, purchasing commercial EHR software would cost between $30,000-$50,000 with additional ongoing user licensing fees of up to 5% per month adding another $17,000-$29,000 per year to the total cost. Providing the EHR software at no charge substantially lowers the financial barrier to adopting electronic health recording.
An estimated 97,000,000 Americans received some extent of mental health services in 2009. One in four Americans has some form of diagnosable mental health disorder. This concept is difficult to believe until the broad scope of elements encompassed are considered: depressions, addictions, compulsions, PTSD, etc. These conditions are too easy to find. Homeless shelters and foster care facilities evidence this situation as well as the fact that there exists a "de facto" mental health system, not the contiguous, planned one often advertised. Mental health care is frequently cobbled together from local resources and funding, private donations and scattered grants.
There are many types of practices excluded from the recent federal inducements to adopt electronic health recording. As an example, mental health clinics serve an especially economically disadvantaged population. There are large numbers of small mental health facilities, many operated by nurse practitioners and licensed counselors, that have difficultly obtaining federal assistance. The development of a custom module tuned to the needs of mental health centers and psychiatrists would fill a vulnerable niche in our society allowing these physicians and practitioners to better help this disadvantaged population and, in the case of the physicians, to apply for the federal tax incentives for adopting electronic health recording.
The following statistics for the mental health sector are from recent government studies including the Surgeon General of the United States, CFRA.org, and the National Institute of Mental Health. According to the Surgeon General's 2009 report, there were the following types of mental health counselors in the US: Educational, vocational, and school counselors = 275,800; Rehabilitation counselors = 129,500; Mental health counselors = 113,300; Substance abuse and behavioral disorder counselors = 86,100; Marriage and family therapists = 27,300; Counselors et al = 33,400. As of 2009, there were 9,372 independent, non-profit mental or behavioral health institutions and agencies (non-faith-based empirical) with five or more Masters Level licensed or certified counselors.
Why it is hard for Masters Level counselors to afford a commercial EHR system, including the typical significant operating costs, is easy to realize when mental health workers' incomes are considered. Median annual wages of mental health counselors in May 2008 were $36,810. The middle 50% earned between $28,930 and $48,580. The lowest 10% earned less than $23,580; the highest 10% earned more than $63,100. Median annual wages in the industries employing the largest numbers of mental health counselors were as follows: Local government = $45,510; Other health practitioners offices = $40,880; Outpatient care centers = $37,590; Individual and family services = $36,130; and, Residential mental retardation, mental health and substance abuse facilities = $29,950.
Educational, vocational, and school counselors fared somewhat better in May 2008 with median annual wages of $51,050 while rehabilitation counselors received the lowest compensation with median annual wages of $30,930. Substance abuse and behavioral disorder counselors, marriage and family therapists annual incomes were intermediate. Self-employed counselors with well-established practices as well as counselors employed in group practices usually have the highest earnings.
OEMR is unique in that its sole purpose is the development, maintenance, promotion and distribution of the OpenEMR software at no charge to medical practices and organizations. An OEMR mission is to serve disadvantaged populations by improving the quality of healthcare; the mental health community provides a perfect opportunity.
4. How does our proposed project address the need? What methods will we use? How many people will we serve or involve?
A typical mental health counselor generates 40-60 times more written documentation when compared to a medical doctor. This includes many varieties of official reports including reports to local Departments of Social Services, police departments, various courts, and other social agencies. A specialized EHR module for mental health counselors will improve the quality of the medical records and billing methods making it easier for these clinics to provide quality care in a timely fashion and to bill appropriately for the services rendered. This OpenEMR module is estimated to improve the efficiency of the counselors by as much 200%.
There were 9,372 independent non-profit mental health and behavioral health institutions and agencies with five or more Masters Level licensed or certified counselors as of 2009. This number did not include the tens of thousands of for-profit clinics and smaller practices of less than five practitioners. Jointly, these mental health facilities served an estimated 97,000,000 Americans. The impact of this program will be extensive.
5. What are our measurable project goals or outcomes?
The leaders of OEMR have been contacted by approximately 18 mental health clinics nationally which are already considering using OpenEMR as a pilot project. Two psychiatrists have notified OEMR of their respective interest in OpenEMR and in a mental health practice module. In addition to the known clients, OEMR would nationally promote the finished software to a variety of mental health programs.
6. What is our timeline and work plan? Have we included everything from planning to evaluation?
December 1, 2011 Start software development January 1, 2012 Disseminate software to interested pilot projects for feedback from real world users February 1, 2012 Promote the software to associations of mental health clinics, other mental health entities, and the American Psychiatric Association
7. Who are the key volunteers and staff on this project, and what are their qualifications? How much of their time will be spent on this particular project?
The software development project will be put out for bids to companies already experienced with the OpenEMR Meaningful Use Project. (List follows.) The software development estimate is 250 hours, approximately 6 weeks. Contacting the companies for bids as well as promoting the OpenEMR Mental Health module to mental health associations and organizations will be handled by mail and email.
Companies with OpenEMR experience through the development of modules for the ONC Health Information Technology Ambulatory EHR Certification:
[1] Clinic Doctor, a commercial reseller, has a live, built-in patient portal. This company agreed to contribute a version of that portal which would run entirely inside OpenEMR and meet the Meaningful Use criteria.
[2] Ensoftek is a Portland, Oregon company that maintains about 100 developers and is a contractor for the Microsoft Corporation and the U.S. government. This company contributed development work on the clinical decision rules, automated measure calculations, patient reminders, clinical quality measure reporting and immunization register reporting. [1]
[3] Garden State Health Systems (GSHS) is a small New Jersey IT company that makes Health Information Exchange its primary business. GSHS contributed expertise and programmers to develop the Continuity of Care Record (CCR) and Continuity of Care Document (CCD) core modules that allow OpenEMR to meet many of the certification criteria around patient medical records sharing, both with the patients and with referrals. [2]
[4] Medical Information Integration (MI2) is a small Portland, Oregon based company with 4 developers. The Chief Information Officer, Tony McCormick, contributed overall project management for the ONC Certification. Additionally, staff from MI2 contributed significant sections of the clinical rules, clinical quality measures, automated measure calculations, patient reminders, document encryption and integrity modules. MI2 contributed work to the Laboratory Exchange Network and has contributed the OpenEMR User Guides. [3]
[5] Phyaura is a Tampa, Florida based company which does custom development work on OpenEMR and which contributed code to help integrate RxNorm and SNOMED coding requirements used in the CCR, CCD, and in clinical quality reporting. [4]
[6] ViCare+ is based in Coimbatore, India. An open source software development company, this team has been the mainstay of the OpenEMR certification project. Vicare+ performed the original gap analysis at the start of the certification project and worked as the formal quality assurance group. This group is expert at interpreting the National Institute of Standards and Technology (NIST) Health IT testing criteria and worked out what needed to be adjusted, fixed or redone to make certification possible. Their team developed all of the required security modules (password policies, audit logging, client certificates, emergency access, recording disclosures, HIPAA de-identification, and consent management) which allowed OpenEMR to attain certification. [5]
[7] Z&H Healthcare Solutions has contributed work on the CCR and CCD modules, developed the integrated electronic prescribing module, and helped complete the Computerized Physician Order Entry (CPOE) requirements. They also developed a patient portal option that can be used as a drop-in replacement for the integrated patient portal. [6]
OpenEMR Project Key Volunteers and Experts:
Stephen Boyd-Smith is one of the four github integrators and was the one who suggested using github for the OpenEMR software repository. Mr. Boyd-Smith is a skillful and knowledgeable developer.
Michael Brody, DPM acted as the OpenEMR ONC Meaningful Use consultant and paid for the syndromic surveillance registry reporting. It would have been very difficult to understand the government requirements without Dr. Brody's help and direct advocacy with the ONC and the Certification Commission for Health Information Technology (CCHIT) originally. His contributions allowed the OpenEMR project to begin even before the governing rules were finalized.
Art Eaton lives in Tampa Bay, Florida. Mr. Eaton is the IT administrator of a mental health counseling group that employs 42 counselors. This group uses OpenEMR and will perform the alpha testing for the anticipated mental health modules. He also works with a large psychiatric clinic currently switching from a commercial management system to OpenEMR.
Tony McCormick is one of the four github integrators. He personally steered the ONC Meaningful Use Certification to fruition by organizing a Meaningful Use work group which met every Monday night for two years from 11-14-2009 through 08-08-2011. A skillful developer who has worked in medical software development field since 1988, Mr. McCormick has had a long professional experience in project management which he put to great use in the OpenEMR Project. His company Medical Information Integration (MI2) is highly qualified in custom development, support and training.
Rod Roark has been the longest, currently active, contributor to the project both personally and through his company Sunset Systems. His outstanding reputation as a developer and the work he donated to the OpenEMR software's terms of code review and integration of new software were instrumental in OpenEMR achieving the ONC Meaningful Use Certification. Mr. Roark serves as one of the administrators at the SourceForge/openemr web page and helps maintain the OpenEMR git repository.
Samuel T. Bowen, MD has been volunteering on the OpenEMR project since 2003. He organized the first not-for-profit Open Source Medical Software that has helped sponsor the OpenEMR project since 2005. Dr. Bowen and Tony McCormick organized the large Meaningful Use Project that resulted in the national certification of the OpenEMR software. He also organized the OEMR non-profit with the assistance of MRSB, LLC, a healthcare consulting firm in Houston, Texas. Dr. Bowen was named the OEMR Executive Director in February 2011.
Sena Palanasami and his company ViCare+ performed a huge amount of work for the project. ViCare+ did the initial gap analysis of the OpenEMR Meaningful Use project that allowed the participants to organize the project's work into manageable pieces. ViCare+ also donated the entire security and privacy portion of the project and were in charge of quality assurance of the entire project.
8. What is our projected cost and what are our sources of revenue? How will the project be sustained after the grant period, if applicable? (You can refer to an attached budget in this section.)
The cost for development of the OpenEMR Mental Health Module is estimated at $15,000. (Project budget attached.) The largest portion of this budget is for the software development, an estimated 250 hours. OEMR has worked with a number of software vendors very familiar with OpenEMR and who will provide high quality software in an economical fashion.
9. What other organizations in the community are providing similar programs or projects? How is ours different? How do we work together with the other providers?
Currently, there are approximately 500 commercial companies selling a bewildering array of EHR software products nationally. These range in size from relatively small vendors to Fortune 500 companies such as GE, Allscripts, Cerner, and McKesson. All of these vendors are focusing on large population centers on the US coasts and offer very expensive EHR software packages.
Many of the small OpenEMR vendor companies have re-branded OpenEMR. They sell their IT services to private clients using the re-branded, “private label,” software. These software development companies do not distribute the software directly, only their respective services.
The number of companies in the US that offer free certified software is very small. PracticeFusion is an interface that profits from advertisements incorporated within its software. To “turn off” the advertisements costs $8,000-$10,000 per practitioner. Similar practices occur in the lower cost certified software. The United States government helped pay for the Veterans Administration's medical EHR system - VistA. This software is available for free through the Freedom of Information Act but it is very difficult to install. To install and make VistA operational would cost a practice estimated fees of $750,000 - $1,000,000 per practice. VistA works very well for medium to large hospital systems but is not financially feasible for the average medical practice.
OEMR is unique in that its sole purpose is the development, maintenance, promotion and distribution of the OpenEMR software at no charge to medical practices and organizations. Their mission is to serve disadvantaged populations by improving the quality of available healthcare.
10. Why is ours the right organization to launch this program, buy this item, or whatever it is we are proposing?
OEMR presents a visible long-standing commitment with a high level of technical expertise and proven logistical skill to organize and support this project. OEMR is, literally, the only group capable of remodeling the OpenEMR software for mental health counselors and then providing it at no charge or encumbrance. The successful completion of the ONC Certification Project with its $2,500,000 software effort over two years is evidence of the dedication of the OEMR developers and contributors.
11. How will our program be evaluated, how often, and by whom? What will the evaluation process do for the program—will it help us adjust the program, replicate it in other cities, or plan in other ways?
Psychiatric practices and mental health clinics will be recruited for input during the design process. These same clinics will be participating in "debugging" and evaluation of the module for its effectiveness in making their lives and jobs more productive. The open source techniques used in the original OpenEMR development process provide the opportunity for rapid adaptations and improvements for real world users who need this software.
Close contact will be maintained with the software users. Quarterly reports will be presented to the American Psychiatric Association about the numbers of clinics and practices using this software, including user comments and experiences.
12. Who and how many will benefit?
There were 9,372 independent non-profit mental health and behavioral health institutions and agencies with five or more Masters-Level licensed or certified counselors as of 2009. This number did not include the tens of thousands of for-profit clinics and smaller practices of less than five practitioners. Jointly, the mental health facilities served an estimated 97,000,000 Americans. The impact of the OpenEMR Mental Health Module project will be extensive and expanding as news of easily obtained, free, and efficient EHR software is shared throughout the mental health community.
13. Why are we approaching this funder at this time?
The American Psychiatric Association is a leading organization in mental health care. The federally mandated medical recording changes provide the APA an immediate leadership opportunity.
14. How can we best thank the funder for their generosity and consideration?
Thank you for your representation of the psychiatrists and mental health counselors and your leadership in the area of mental health. The APA will be recognized and thanked as a co-sponsor in all OEMR documents referring to the OpenEMR Mental Health Module project.
15. What attachments will we be including?
Organizational Resume, Project Summary Sheet, Board List.
Respectfully,
Samuel T. Bowen, MD Executive Director, OEM
