OEMR Grant Blocks

This is a series of Informational Blocks that allow our grant writing to be easier and more organized.

1. What is our specific grant request (the amount and for what project)?

OEMR respectfully requests a grant of $15,000 from the American Association of Family Practice.

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. The OpenEMR program has been translated into 8 different languages and distributed in 174 different countries. Through the combined efforts of ten small IT service companies and a small cadre of intensely dedicated volunteers, OpenEMR 4.1 was fully certified for Ambulatory Care Meaningful Use by ICSA Labs, a United States Office of the National Coordinator Authorized Testing and Certification Body (ONC-ATCB), for years 2011-2012. OEMR and the OpenEMR project has facilitated the distribution of 140,000 copies of OpenEMR.

The OpenEMR project came into existence in 1998 and had been hosted at http://sourceforge.net/projects/openemr since 2005. This project has been supported by http://www.openmedsoftware.org/wiki/Main_Page%7C Open Source Medical Software from 2005 through the present and OEMR which was organized by leaders of the OpenEMR project in 2010.

OEMR 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. Our web page is http://www.oemr.org and our board of directors are 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 software (EHR). To date it has been tuned for a family practice style. The EHR has been translated into 7 different languages and distributed in 174 different countries. To date OpenEMR has distributed 140,000 copies at a fair market value of $4,900,000,000. The software is 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 electronic health record software at no charge substantially lowers the barrier to adopt electronic health records.

The leaders of OpenEMR organized a joint effort of ten small IT companies and a group of volunteers to develop the software modules necessary to achieve the US ONC Meaningful Use Certification. OpenEMR is now Certified for Ambulatory Care for 2011-2012. This $2,500,000 project was accomplished through in-kind donations from the ten small IT companies, volunteers, and software IT vendors over the last two years. With this certification, all Open EMR 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. Open EMR will allow practices to avoid the penalties, effective in January 2012, for not using electronic prescribing.

There are many types of practices excluded from the recent federal inducements to adopt electronic health records. As an example, mental health clinics serve an especially economically disadvantaged population. There are large numbers of small mental health facilities that have difficultly getting any federal assistance. Many of these are operated by nurse practitioners and licensed counselors. The development of a custom module tuned to the needs of mental health centers and psychiatrists would fill a very 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.

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 you consider the broad scope of elements encompassed: depressions, addictions, compulsions, PTSD, etc. It is too easy to find. Homeless shelters and foster care facilities evidence this situation as well as that there exists a "de-facto" health system, not the contiguous or planned one often advertised.

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 US 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 EMR system, including the typical significant operating costs, is easy to realize when mental health workers' incomes statistics 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; Offices of other health practitioners =$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 who have well-established practices, as well as counselors employed in group practices, usually have the highest earnings.

4. How does our proposed project address the need? What methods will we use? How many people will we serve or involve?

The development of a specialized module for mental health counselors will improve the quality of the medical records and billing methods making it easier for these clinics to provide consider using the term 'more precise, individualized' rather than 'quality' care in a timely fashion and to bill appropriately for the services rendered.

Developing the software is estimated to take 250 hours. We have a number of software vendors very familiar with the OpenEMR Meaningful Use project and who will provide high quality software in a relatively economical fashion. We have already made an estimate of the development effort necessary and, after receiving grant approval, will present the project to these small vendors for their respective bids.

5. What are our measurable project goals or outcomes?

OEMR has contacted 6-12 This sounds 'fishy' to me. The span of contacts is too broad to be believeable.mental health clinics that could benefit from this project and which are already considering using OpenEMR as a pilot project. We are aware of one psychiatrist who would be very interested in the new module. In addition to the known clients, we would like to promote the finished software to different mental health agencies.

6. What is our timeline and work plan? Have we included everything from planning to evaluation?

December 1, 2011 Start software development. January 1 2011 Disseminate software to interested pilot projects for feedback on the software from real world users February 1, 2011 Promote the software to associations of mental health clinics, other mental health entities, and the American Psychiatric Association members.

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 from the following companies. The software development estimate is 250 hours, approximately 6 weeks. Contacting the companies as well as the mental health associations and organizations will be done by mail and email.

Companies

[1] Clinic Doctor (cassilup), a commercial reseller, has a live, built-in patient portal. They agreed to contribute a version of that portal that would run entirely inside OpenEMR and meet the MU MU definition, please criteria.

[2] Ensoftek (DrCloudEMR) contributed staff to work with Medical Information Ingegration (mi-squared) on clinical decision rules, automated measure calculations and patient reminders as well as clinical quality measure reporting and immunization register reporting.

[3] Garden State Health Systems contributed expertise and programmers to develop the CCR and CCD CCR CCD definitions? core modules that allow OpenEMR to meet many of the certification criteria around patient medical records sharing, both with the patients and with referrals. Thanks specifically to John Williams and Micheal Firriolo.

[4] Medical Information Integration (mi-squared) contributed overall project management from the beginning. Additionally, staff from mi-squared, including Aron Racho and Ken Chapple contributed significant parts of the clinical rules, clinical quality measures, automated measure calculations, patient reminders, document encryption and integrity modules. Jeremy Wallace wrote interfaces and improvements to the “procedures” tools to work with Lab Exchanges to meet the “incorporate lab results” requirement. Jason Brooks put many hours into maintaining and improving OEMR web, wiki and repository servers and Sara McCormick maintains the User Guides.

[http://www.mrsb-ltd.com%7C MRSB, LTD full name needed provided a lawyer, Greg Neumann, to coordinate the OEMR 501(c)(3) work. This allowed OEMR to contract with the certification body (ICSA Laboratories) without which we would not be registered or certified as an open source project. The rest of the world requires a legal entity to work with. This sentence lost me.

[5] Phyaura contributed code to help integrate RxNorm and SNOMED coding requirements which are used in CCR/CCD and in clinical quality reporting.

Vicare+ / Visolve – Selvi's - I'd suggest adding first or last name team at Vicare+ and Visolve has been the mainstay of the project through their work as the sole formal Quality Assurance group. This group are experts at interpreting the full name neededNIST testing criteria and working out what needed to be adjusted, fixed or redone to make it possible for certification. 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 OEMR to begin testing.

[6] Z&H Healthcare Solutions has contributed the completion of the CCR/CCD modules and development of the NewCrop e-RX interface to meet the CPOE requirements. They also contributed a very complete patient portal option that can been used in this test??? if required and which meets all requirements as an optional solution for those clinics that do not want to manage their own portal access.

Key Volunteers:

Stephen Boyd-Smith is one of the four github integrators and was the one who suggested using github for our software repository. He is a skillful and knowledgeable developer.

Michael Brody, DPM acted as our ONC Meaningful Use consultant and paid for the syndromic surveillance registry reporting. It would have been very difficult to understand the government requirements without his help and direct advocacy with ONC and CCHIT I'd suggest complete namesoriginally. His contributions allowed us to get started even before the rules were finalized.

Tony McCormick's personal contributions have been tremendous. He is one of the four github integrators and personally steered the ONC Meaningful Use Certification to fruition. Tony set up the Meaningful Use work group and met every Monday night for two years from 11-14-2009 through 08-08-2011. Tony is a skillful developer who has been in medical software development since 1988 and has had a long professional experience in project management which he put to great use in this Project. His company Medical Information Integration is highly qualified in custom development, support and training.

Rod Roark has been the longest, currently active, contributor to the project. His contributions to the project have been protean. Check out his web page at Sunset Systems - personally this is a little too 'friendly' for a grant application, in my opinion. Rod has an outstanding reputation as a developer and gives great service to his clients. Rod has put in a lot of work in terms of code review and integration of new software, instrumental in OpenEMR achieving the recent ONC Meaningful Use Certification. Rod 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. Dr. Bowen, 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 - Sena and his company Visolve performed a huge amount of work for the project. Visolve did the initial gap analysis of the Meaningful Use project that allowed us to start breaking the work up into manageable pieces. Visolve 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. The project budget is attached. The largest portion of this budget is for the software development.

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?

There are approximately 500 commercial companies operating selling a bewildering array of EHR software. These range in size from relatively small vendors to several that are Fortune 500 companies such as GE, Allscripts, Cerner, and McKesson. All of these vendors are focusing on large population centers on the East and the West coasts and offering very expensive EHR software.

Many of the small OpenEMR vendor companies have rebranded OpenEMR. They sell their IT services to private clients using the rebranded, “private label” software. These software development companies do not distribute the software directly, only their respective services. Did I get that correct?

The number of companies in the US that offer free certified software is very small. PracticeFusion is an slick opinion comment not appropriate in a grant application in my opinion interface that profits from advertisements incorporated within the 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 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 VistaA operational would cost a practice estimated fees of $750,000 - $1,000,000 per practice? or per practitioner?. VistA works very well for medium to large hospital systems but is not well suited 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 the organizations that benefit from the software. Since our mission is to serve disadvantaged populations by improving the quality off their healthcare, we look specifically for this type of community. This is the main reason our program has such growing acceptance in India, Pakistan, Indonesia, Nigeria and other impoverished nations.

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 and long-standing commitment with a high level of expertise and organization to this type of project. We are, literally, the only group capable of remodeling the OpenEMR software for mental health counselors and then providing it at no charge or encumbrance to our clients. The successful completion of the Meaningful Use project with its $2,500,000 software effort over two years is a good example of the dedication of the OEMR creators and contributors not the words I'm searching for, but close.

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?

We have actively recruited psychiatric practices and mental health clinics 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 our development process provide the opportunity for rapid adaptions adaptations? and improvements for real world users who need this software.

We will stay in close contact with the users of the software and report back on a quarterly basis to the American Psychiatric Association about the numbers of clinics and practices using this software and include user comments and experiences.

12. Who and how many will benefit?

There were 9,372 independent non-profit Mental Behavioral Did you mean to use both words? 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. We believe the impact of this program will be quite large.

13. Why are we approaching this funder at this time?

The American Psychiatric Association is a leading organization in the mental health care or Nation thought needs to be completed. The APA provides leadership and sets mental health care standards in the USA.

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 in the USA and your leadership in the area of mental health. How about adding: The APA will be listed and thanked as a co-funder in all OEMR documents referring to this particular project.

15. What attachments will we be including?

Organizational Resume, Project Summary Sheet, Board List.

Respectfully,

Samuel T. Bowen, MD Executive Director, OEMRNew Page of Info