Practice Management
The Practice Management Applicability of OpenEMR, A Nationally Certified Electronic Health Record Software Program
1. What is the specific grant request (the amount and for what project)?
OEMR respectfully requests a grant of $15,000 from the North Carolina ____________________________________ to fund the development and distribution of OpenEMR Practice Management Software.
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 record software called OpenEMR. Through the combined efforts of ten small information technology (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 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 Electronic Health Record (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.openmesdsoftware.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?
The US government has supported widespread adoption of electronic medical records since the 1999 findings that preventable medical errors are the 7th and 8th most common causes of death in the US. The passage of the American Recovery and Reinvestment Act of 2009 offered incentives to medical doctors to use electronic medical recording provided that the physicians did so in what the government defined as "Meaningful Use" (MU). The term was defined as satisfying 20 out of 25 requirements as defined by the ONC. Since the law was passed, the use of MU electronic health recording has increased dramatically and physician use has improved. At the beginning of 2009, physician use of EHR was approximated as: Basic Systems = 10%; Comprehensive Systems = 7%; Systems that would meet current MU standards = 0. As of 2012, the physician use of EHR is approximated as 56.9% but 33.8% of that total are considered basic and do not meet MU criteria. Surveys indicate that 41.1% of US physicians are planning to install and use compliant systems by the end of 2012 which means that almost 60% of US physicians will be non-compliant and have no plans to become complaint by the end of 2012. Specifically, the number of North Carolina physicians using or planning to use MU certified EHR falls below the national statistics with only 30.9% currently using a basic system and 34.2% planning to apply for MU benefits. The major roadblock for physicians in small practices is primarily financial - significant costs for the initial purchase and monthly user fees for a certified EHR program. OpenEMR modules can be adapted, by the OEMR software experts, for any medical practice or health care professional organization's specific needs.
OpenEMR is a highly functional, easy to use EHR software created and 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 for the small to average sized medical practice.
4. How does our proposed project address the need? What methods will we use? How many people will we serve or involve?
The fact that the OpenEMR software is provided for free significantly lowers the cost of moving from paper to electronic recording. The companies that specialize in this free software will continue to participate in the adaptation of the module, working together to create software modules that will meet the needs of individual physicians as well as the needs of broad categories of medical treatment.
Implementation of an EHR system can be difficult and, without competent guidance, mismanaged. An estimated 18% of adopting practices have abandoned the effort during or shortly after implementation. OEMR is unique in that the small vendor companies which help create the modules make their incomes from service and support of the re-branded software. It is very important to their financial success that their clients do well with their software implementations and continued use of the EHR module. If their clients do not succeed, the vendor company loses customers.
Software development of the Practice Management module is estimated at 250 hours. The small software vendor companies very familiar with the OpenEMR MU Project have shown that they can and will provide high quality software in an economical fashion. After receiving grant approval, the OpenEMR Practice Management Module Project will be presented to these vendors for their respective bids.
5. What are our measurable project goals or outcomes?
Using EHR software allows physicians to record medical records electronically and to more easily share those records, laboratories, and x-ray findings with other physicians involved in the care of the respective patient. Increasing the coordination of care improves the quality of the care and helps avoid potentially harmful errors. The new MU certified EHR also allows electronic prescription of medications. Gone are the pitiful handwriting of well-intentioned physicians and the pharmacist who was left to interpret the hieroglyphic handwriting styles of many physicians. The MU certified programs also provide immediate drug-drug and drug-allergy interaction information and alerts, further improving a patient's safety.
6. What is our timeline and work plan? Have we included everything from planning to evaluation?
March 1, 2012 Start software development June 1, 2012 Disseminate software to interested pilot projects for feedback from real world users September 1, 2012 Promote the software to NC ____________________________________, State Medical Societies, and other primary care entities
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 Practice Management module to physicians, associations, and other medical organizations will be handled by mail and email.
OpenEMR Project Participating Companies:
[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 MU criteria. [www.clinicdr.com]
[2] Ensoftek is a Portland, Oregon company that maintains approximately 100 developers. Ensoftek 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 concerning patient medical record sharing, both with the patient 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 CCR, CCD, and in clinical quality reporting. [4]
[6] Sunset Systems is a Fairfield, California based company. Rod Roark, the principle, has been the longest, currently active, contributor to the project. Mr. Roark developed the framework of the laboratory results and made major contributions in terms of code review and integration of new software as the ONC Certification project progressed. [1]
[7] ViCare+ is a company based in Coimbatore, India. An open source software development companies, 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]
[8] 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 Contributing 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 OpenEMR ONC MU certification to fruition by organizing a MU 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 software 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 ONC MU 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. He and Tony McCormick organized the large OpenEMR MU Project that resulted in the national certification of the OpenEMR software. Dr. Bowen 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 MU 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 an OpenEMR Practice Management 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 who have and 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 nationally. These range in size from relatively small vendors to several 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.
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 VistaA operational would cost an estimate 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.
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.
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, 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 to create an OpenEMR Practice Management module and then providing it to physicians and other medical organizations 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?
________________ practices and ______________ association members will be recruited for input during the design process. These same practices 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 kept with the software users. Quarterly reports will be made to __________________________________ about the numbers of clinics and practices using this software, including user comments and experiences.
12. Who and how many will benefit?
There are over 500,000 US physicians in varied practices who have not committed to use MU Certified EHR software by the end of 2012. Financial issues are a major barrier. These physicians, as well as the several hundred medical practices which are already using OpenEMR, would benefit directly from an OpenEMR Practice Management Module. As the OEMR project grows with the creation of OpenEMR modules specific to varied medical specialties, larger grant requests will be submitted to the US government and the respective medical associations to increase national awareness. The OpenEMR project may, one day, be a routine part of every person's medical experience.
13. Why are we approaching this funder at this time?
________________________ is a leading organization in ___________________ care. The federally mandated medical recording changes offer _____________________ and its members an immediate leadership opportunity.
14. How can we best thank the funder for their generosity and consideration?
Thank you for your representation of ____________________, a mainstay in the medical world, and your leadership in the area of health. The _________________________ will be recognized and thanked as a co-sponsor in all OEMR documents referring to the OpenEMR Practice Management Module project.
15. What attachments will we be including?
Organizational Resume, Project Summary Sheet, Board List.
Respectfully,
Samuel T. Bowen, MD Executive Director, OEM
References
1. Centers for Medicare and Medicaid Services Official Website for the Medicare and Medicaid EHR Incentive Programs. Available from: https://www.cms.gov/ehrincentiveprograms/.
2. Blumenthal D, Tavenner M. "The 'meaningful use' regulations for electronic health records", New England Journal of Medicine, 363(6):501-504. 2010.
3. Bruen BK, Ku L, Burke MF, Buntin MB. "More than four in five office-based physicians could qualifty for federal electronic health record incentives". Health Aff (Millwood), 30(3):472-480. 2011.
4. Robert Wood Johnson Foundation, "Health information technology in the United States: Where we stand, 2008". 2008.
5. Hsiao, CJ, Hing E, Socey TC, Cai B "Electronic medical record/electronic health record systems of office based physicians: United States, 2009 and preliminary 2010 state estimates", Health E Stats, National Center for Health Statistics. 2010. Available from http://www.cdc.gov/nchs/data/hestat/emr_ehr_09/emr_ehr_09.pdf.
6. http;//www.cdc.gov/nchs/ahcd/ahcd_survey_instruments.htm#namcs. Downloaded January 2012.
