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

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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.

October 25, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Analysis of MUMPS in Healthcare & EMR

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Just the other day I was at a local Vegas Tech event and happened to run into a government contractor that worked in IT. As we got talking I told him about my work with EMR and EHR. Once he heard those terms he started to recount his experience evaluating a contract position where he was to work at connecting the VA system with another government entity. He then said, did you know that the VA software runs on something called MUMPS?

Of course I’ve heard all about MUMPS and so I told him how a huge portion of healthcare IT is run on the back of MUMPS (My understanding is that Epic uses MUMPS as well). Obviously, MUMPS has its benefits since it’s gotten us this far. I even remember some past threads where people have argued some of the advantages of MUMPS over newer database technology. However, I still stand in the camp that wonders how we’re going to get off MUMPS so we can enjoy the benefits of some newer, more innovative technology.

Something called the Axial Project basically asked this same question back in March 2011 when they posted about how to Architect Vista for 2011 (which is possible since Vista is open source). They provided a really insightful look into why MUMPS has done well in healthcare and what current technologies could replace it. Here’s that section:

So if I were starting a Healthcare IT company would I invest in building on Mumps/M? No. There might be some business in supporting legacy applications, but very little innovation. I am not attacking Mumps/M from a technical perspective, I am trying to be pragmatic as a business person. So we need find an alternative. So you probably think I am going to say MS SQL Server or Oracle thinking I want that 100/hr price tag. Thanks, but no thanks. So I am not in it for the money, I must go the other way. PostgreSQL or MySQL. Intriguing, but still a no go. I have learned over the past 18 months that Healthcare data has very little integrity. One of the reasons I believe Mumps/M has excelled. Storing objects vs Storing relationships in normalized structures is not valuable to this market. Too many views of the data are required depending on your role you play in the system. I would try to use a NoSQL database like MongoDB, Cassandra, or CouchDB. My preference would be MongoDB because there are drivers for Ruby, Java, .NET, and Python. Also, these systems are truly data entry/reporting tools at their core. I need strong query support which MongoDB has through it’s BSON data structures without a ton of map/reduce requirements. So let’s go back to finding some resources that can help.

The part that struck me was when it said, “I have learned over the past 18 months that Healthcare data has very little integrity.” That makes a lot of sense and explains why a NoSQL solution could work well.

Turns out, Axial Exchange has brought on the previous COO of RedHat, Joanne Rohde, to work on the project. Check out Axial Exchange’s presentation at Mogenthaler’s DC to VC 2011:

Looks like Axial has shifted from redesigning Vista, but they’re working on some interesting stuff.

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

October 18, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

OpenEMR Passes HITECH EHR Certification

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LinuxMedNews just posted the announcement that OpenEMR is now a certified EHR. Here’s the quote from their announcement:

It’s official! OpenEMR has passed all ONC certification tests as a fully qualified emr that can be used to attest for incentive moneys. The official posting: http://onc-chpl.force.com/ehrcert/EHRProductDetail?id=a0X30000003mNwTEAU&retURL= appeared on the website 2011/08/19. Congratulations to all involved! OpenEMR 4.1 should be ready for download in a few weeks.

This is a really big announcement for the open source ambulatory EHR community. A number of other open source EHR are certified, but they’re mostly for the hospital EHR space. So, it’s a great thing for OpenEMR to provide an open source EHR to the ambulatory space.

Plus, I have to admit that it’s pretty great that an open source community can pull together the funds to actually be certified. The programming and development time is one thing, but getting the $20-30k to be certified is a big deal that I’m sure took a lot of effort. I actually wish I knew more about the process they used to achieve the EHR certification.

Now, OpenEMR users better start digging into resources like Meaningful Use Mondays. EHR Certification is the first step, but showing meaningful use of that certified EHR is the next one.

Big thanks to an avid follower of OpenEMR – Jojo the HITMAN who informed me of the news.

August 20, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Terrible Forbes Article – “Open Source Debut in Healthcare”

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I still have a hard time calling myself a writer or even press (although it’s convenient for getting into conferences). Plus, I think I reach, influence and interact with as many or more people than the traditional healthcare journalist. However, there’s something liberating about being called a blogger instead of a journalist because the standard and approach is different.

At least I thought that was the case until I read this article on Forbes.com which declares Allscripts new API as “Open Source’s Debut in Healthcare.” Ok, to be fair, it was written written on a Forbes healthcare blog and not their magazine, but as a blogger I’m embarrassed that a Forbes blogger would write such a terrible article.

Let me set the record straight. Allscripts launched an interesting API (which they call an “Application Sote & Exchange”). It’s a sort of app store for healthcare IT. This is interesting news and worthy of a story. What it’s not is open source entering healthcare.

Maybe there is some sliver of open source software that’s part of the Allscripts API/App store (or maybe not), but that’s backed by a heavy set of proprietary Allscripts software. It’s not like Allscripts has open sourced their MyWay or Allscripts Professional EHR. Then, you could really talk about Allscripts entering the open source EMR world. This is NOT!

Besides the fact of saying that is open source when it’s not, is the blogger’s headline that this is the first open source in health care. That’s just absolutely silly. Here’s just a few of the Open Source EMR on the EMR and HIPAA wiki page that have been around for quite a while and led I believe by OpenEMR and the various flavors of Open Source Vista EMR.

Honestly, Zina Moukheiber should be embarrassed by what she wrote. Even a blogger should be held to a higher standard than what she wrote. Of course, the sad part is that her mistakes likely drove a ton of traffic to the post. It’s her top post with 51 people tweeting the post and 15 people sharing it on Facebook. Too bad she lost all credibility in the process so the short term spike won’t turn into long term readers.

December 13, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

CCHIT Town Halls and CCHIT Comments on New Jersey Bill

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For those that participated in the CCHIT town hall meetings at HIMSS, it seemed like the writing was on the wall that CCHIT needed to offer some more town hall meetings. There was certainly a lot more to discuss. CCHIT just announced 2 more web “conferences” where the public will have a chance to comment on CCHIT.

The first conference, “New Paths to Certification: Dialog with the Open Source Community,” will take place on June 16 at 1 p.m. EDT and focus on technology. It will address outlying concerns on certification of solutions that are licensed under open source models. Leavitt and Dennis Willson, the commission’s technology director, will be the moderators.

The second conference, “New Paths to Certification,” will take place on June 17 at 11 a.m. EDT and be more geared toward a generalized audience, with dicussion focused on new CCHIT programs.

I think it’s good that they’re having another open source EHR session. I’m just not sure why they would have it before the general session. That means that the open source discussion is going to not be as focused since many people will want to discuss the general issues with CCHIT certification during the open source session.

I’ve made my views on open source and CCHIT certification pretty clear. So, it will be interesting to hear what CCHIT could change to avoid some of the problems I’ve suggested. There’s just not the right motivations for open source EMR to certify. I’ll publish more details on these meetings as they become available.

In a different CCHIT issue, CCHIT has made a comment on the New Jersey bill I’ve written about previously. Here’s the part of their comment that really matters:

First, I do not believe this is an appropriate use of health IT certification. Our goal, stated in almost every presentation I’ve given, and to which I’ve adhered in my leadership of the Commission, has always been to unlock positive incentives for health IT adoption. Bridges to Excellence provides a role model for integrating health IT into outcome-based, pay for performance incentives. Successfully executed, ARRA might too. But the New Jersey bill is nowhere near that. Making software purchases illegal, like dangerous substances? Let’s “just say no” to that idea.

Second, neither I personally, nor CCHIT as an organization, have lobbied, advocated, sponsored, or had anything to do with that bill. We were unaware of it until it started showing up on listserves Friday. The bill has never been mentioned in any of our Trustee, Commission, or staff meetings.

Kudos to Mark Leavitt and CCHIT for making these comments. Underscores my previous feelings that Mike Leavitt and CCHIT really sincere in his desire to help. It’s just that they’re going about it the wrong way.

June 10, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

NJ Bill to Make Non CCHIT EHR Use Illegal

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Graham over at EMRUpdate found a really crazy bill being proposed in New Jersey that would make the use of non CCHIT certified EHR illegal.

Here’s the sections of the bill that seems to capture the crux of what’s being proposed:

“· On or after January 1, 2011, no person or entity is permitted to sell, offer for sale, give, furnish, or otherwise distribute to any person or entity in this State a health information technology product that has not been certified by CCHIT. A person or entity that violates this provision is liable to a civil penalty of not less than $1,000 for the first violation, not less than $2,500 for the second violation, and $5,000 for the third and each subsequent violation, to be collected pursuant to the “Penalty Enforcement Law of 1999,” P.L.1999, c.274 (C.2A:58-10 et seq.).

· The bill defines “health information technology product” to mean a system, program, application, or other product that is based upon technology which is used to electronically collect, store, retrieve, and transfer clinical, administrative, and financial health information.”

” 5. (New section) a. The Director of the Division of Consumer Affairs in the Department of Law and Public Safety, in consultation with the Office for e-HIT in the Department of Banking and Insurance and the Commissioner of Health and Senior Services, shall require that, on or after a date to be determined by the Office for e-HIT and in accordance with requirements established by that office pursuant to and in furtherance of the purposes of subparagraph (a) of paragraph (1) of subsection b. of section 8 of P.L.2007, c.330 (C.17:1D-1), each health care professional who is licensed or otherwise authorized, pursuant to Title 45 or Title 52 of the Revised Statutes, to practice a health care profession that is regulated by a professional and occupational licensing board within the division or by the director, shall purchase, rent, lease, or otherwise acquire for use in that person’s professional practice only those health information technology products that have been certified by the Certification Commission for Healthcare Information Technology.”

I’m really kind of speechless. If you read this blog regularly, you know that’s pretty rare. As Graham points out, why would they want to pre-empt whatever rules ONCHIT puts in place for EHR? I also wonder how they plan on enforcing this act. Plus, what is this senator really thinking? I think that each of these bills should require a full disclosure as to the impacts both good and bad and the reasoning behind even proposing such an idea. Reminds me a lot of the senator who called for an open source EMR, but this is much crazier.

Seriously, what’s the basis for this senator wanting to have it illegal for someone to use any EHR other than a CCHIT certified EHR? I’ve asked many times for some sort of study (independent hopefully) that shows that CCHIT certified EHR have a higher implementation success rate, or improve patient care, or save doctors time or any other benefit over the non CCHIT certified EHR out there. So far no one has produced such a finding. I’d suggest we haven’t found that study since the results of said study would find the opposite.

All I can say is that I’m glad that I don’t live in New Jersey and for their sake I hope this bill fails miserably.

June 6, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Wall Street Journal Talks About Open Source EMR and Vista

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I’ve had a number of people ask me my thoughts on this Wall Street Journal article which talks about open source EHR and in particular the open source EHR developed by the VA hospitals called Vista.

I must admit that I’ve been enamored by the concept of free EMR. One of my most popular blog posts was this guest post about Free EMR by Medicare. Turns out that Vista is one of those open source (free) emr software that keeps popping up. I imagine it will continue to pop up for a long time to come.

Let me offer three points that I keep hearing over and over when I hear people talk about open source Vista.

1. (We’ll start with the good) Those that go to the VA are quite happy that no matter what VA hospital they go to, they have their information available. I’ve heard this on multiple occasions. I’m not sure if people are saying this because they’ve actually experienced it (which is likely considering the transient nature of veterans) or because they’ve had the concept drilled into their head. Either way, this is the major perception and considering it’s all one nice package I’m inclined to think it’s a huge advantage of Vista in the VA hospitals. I’d love to hear someone address how this “EHR interoperability” using Vista would work in commercial hospitals.

2. The users of Vista really don’t like using the program. It’s clunky, unwieldy and not the friend of the user. I’ve heard this multiple places and not just from doctors, but also from nurses and the IT people supporting the software.

3. The “database” that Vista uses, MUMPS, is a piece of junk and a major anchor on what could be an otherwise interesting open source project. I’m sure there’s some really interesting history behind the VA’s decision to use this MUMPS “database” system instead of one of the current SQL based database systems. Unfortunately, I’ve seen numerous people talking about the pains of MUMPS and the problem it creates for the future of open source EHR Vista.

I’ll admit that I’m not an expert on Vista, but I’m just telling you about the common themes I’ve read over and over again. Any other ones we should know about or other perspectives on Vista EHR?

May 4, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Senator Calls for Open Source EMR

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I love when senators come out and write bills requesting for the government to fund an open source EMR. Turns out the most recent request came from Senator John D. Rockefeller has proposed a new law which would establish federal grants to develop open source software and standards for electronic medical records. You can read more about it on ars technica.

I have to admit that I strongly support the concept of open source EMR and really open source software in general. I just don’t know why government thinks that government grants would really help open source software. I could be wrong, but has there ever been a significant open source software project that was grant funded by the government? It just generally seems contrary to the open source development model.

I guess I just wonder how a senator gets it in his mind to write a proposal for open source EMR grants. Did an open source project request for him to do it? Where did the senator get this idea that it was a good idea to have an open source EMR? Did he consult the existing EMR projects to see if this is something that they would find beneficial to the cause?

Maybe he in fact did do all of these things, but I wouldn’t be surprised to hear that Senator Rockefeller knows little about open source software and in particular the challenges that open source EMR software is currently facing.

April 29, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

CCHIT and Open Source HIMSS Meeting – Audio and Powerpoint Slides

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I’ve been meaning to post about the CCHIT and open source meeting at HIMSS for a while now and just haven’t ever gotten around to it. I did post my twitter thoughts on the CCHIT/Foss meeting, but I think there’s plenty more that could be said about that meeting.

For those of you that missed it, you can find the audio of the meeting on the CCHIT website and I’ll embed the powerpoint presentation from the meeting below:


My biggest complaint from the meeting was a slide that Mark Leavitt used to describe why he feels that CCHIT isn’t excluding the little guy. Basically it talks about the size and market share of the EHR vendors that have applied for CCHIT certification (you can see it as slide 12 above).

I can’t quite place why this measure feels wrong, but it does. Maybe it goes back to something one of my professors taught me when doing research analysis. He basically said, that when first looking at the numbers does it feel right. Considering what I know about the EHR and EMR market and CCHIT certification in particular, I know that something doesn’t feel right. Let me explain a few reasons and hopefully someone else smarter than me can comment on what else is wrong with this measurement.

First, the graph showing practice sizes served is misleading. I don’t know specifically how they found out which size practices a certified EHR vendor served, but I’m guessing it was self reported by the EHR vendor itself. If this is the case, most EHR vendors will say they can work in any practice size. So, that basically makes the data pretty useless. Possibly you could look at the size of the practices using the EHR system, but even then you get into trouble because how do you define “using” the system. A few EHR vendors can claim tons of purchases of their EHR software, but then you find out that very few if any of those purchases are actually implemented.

The second part of the slide shows a nice pie chart of the size of EHR vendors that are certified. The challenge I have with this chart is that it may just illustrate how small the EHR industry really is right now. The revenues of EHR companies are spread out over 300-400 EHR companies. Considering 5-15% (depending on where you look) adoption, that means that the majority of EHR companies are all small businesses with very low revenue.

I bet if we did a percentage of EHR vendors that did CCHIT certification for each of their annual revenue classifications you’d see something like this:
> $100 million – 100% CCHIT certified
$21 – 100 million – 90% CCHIT certified
$11 – 20 million – 50% CCHIT certified
$1 – 10 million – 15% CCHIT certified
< $1 million – 3% CCHIT certified

I’m just pulling these numbers out of the air, but I think you can see the principle of how CCHIT certification is being adopted by large EHR vendors and not as many small EHR vendors. CCHIT’s measure is just wrong. It should be percent in that EHR size category that are getting certified. It’s not the percentage of all CCHIT vendors that are doing it.

Reminds me of the common phrase that statistics can tell you anything you want to know. Something for all you EMR and EHR fans to chew on over the weekend.

April 24, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Medscribbler Announces Open Source Tablet EMR

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I recently became aware of a new open source tablet EMR that was going to be offered by Medscribbler. Everyone that reads this blog should know that I’m a huge fan of open source (see my previous posts about open source EMR). It’s about time that a really strong tablet based EMR software was available as open source software.

Open source EMR purists will probably be a little disgruntled that Medscribbler is built on top of other technologies which are not completely open source. However, I give them a pass for now since the open source community has so far failed to deliver very good tablet based software.

You can find more information about the free Medscribbler EMR software here or at their sourceforge page. The following is the official press release announcement:

Medscribbler is released as an Open Source electronic medical record

Scriptnetics, the leader in Tablet PC mobile healthcare applications, will announce Monday its release of the proprietary source code for Medscribbler electronic medical record, EMR, to the open source community. Installable components and the code for programmers are available at the globally recognized open source portal, Sourceforge.net.

“Releasing a Medscribbler Open Source EMR is the next logical step to drive the innovation that is needed to get to a point where the majority of physicians and other health care providers take up electronic medical records,” said Michael Milne, Chief Executive Officer of Scriptnetics. “We hope to encourage a stable, widely available and affordable entry level EMR that uses cutting edge technology with the mobility of the Tablet PC,” he continued.

To provide focus and stability to move the project forward Scriptnetics has assigned programmers to manage and contribute new programming code on a regular basis. Other programmers wanting to contribute but needing help in understanding the considerable amount of code that already exists can access live help and support. For programmers looking to maximize their skills, project suggestions are posted in a forum.

The new Open Source EMR is called Medscribbler Community and is the first vertical, enterprise level open source project to be designed specifically for handwriting recognition on the Tablet PC. Medscribbler Community is already being used by many healthcare providers both in stand alone computer situations and client server multi computer offices. This cutting edge EMR is also being used in Internet WAN mobile remote access situations.

Scriptnetics is the largest vendor of penable Tablet PC designed medical software in the world. The company’s flagship product, Medscribbler, has been distributed since 2003 and is being used by healthcare providers in the United States and Canada. Its offices are located in Wilmington, Delaware and Moncton, New Brunswick. www.scriptnetics.com and www.medscribbler.com

SourceForge’s web sites connect millions of technology professionals and enthusiasts each day. Combining user-developed content, online marketplaces and e-commerce, SourceForge is the global technology community’s information exchange network and the world’s largest open source software development and distribution environment. Its offices are located in Mountainview, California.

For more information on Medscribbler Community see: www.emrfreesoftware.com and sourceforge.net/projects/medscribbler/

Press Contacts:
Michael Ferguson
Scriptnetics
(506) 859-9271
prnews@scriptnetics.com

Full Disclosure: Medscribbler is a an advertiser on EMR and HIPAA.

April 21, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.