The Development and Growth Of the OpenEMR Project Samuel T. Bowen, MD Executive Director OEMR And
Tony McCormick Project Manager, Treasurer OEMR
Agenda
Sam Bowen
Tony McCormick
History
Meaningful Use
Software structure
Modular Certification
Growth
Future Plans
International Use -
Languages
Developers
Supporters
Comprehensive
What your Return on Investment (ROI)?
A doctor in Private Practice A user of Open Source Software
Founder of Open Source Medical Software Executive Director of OEMR a 501(c)(3) Tax Exempt Project
What is OpenEMR?
Open Electronic Medical Record OpenEMR is a Web Based Client-Server program that uses the Apache, MySQL, PHP stack. -
PHP, javascript, jquery, Ajax
If run can run the Apache, MySQL, PHP stack you can run OpenEMR. This includes: - -
Windows, Linux, OS X, FreeBSD OpenBSD, Solaris
Early History
Created by Synitech of Boston Massachusetts in late 1990s as an adjunct to their billing services. OpenEMR 1.3 was released 2001. PennFirm of San Diego took over project management around August 2002. The sourcecode was transferred to SourceForge and to the current project management March 8-9, 2005 Open Source Medical Software March 15, 2005 and assumed project leadership
OpenEMR Project Growth
Usage in the USA
Internationalization
Downloads by Country
International Use
IPPF (International Planned Parenthood Federation) -
Excellent Documentation
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Pentaho business analysis
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Minimalist installations
India (17), Nepal (9), Indonesia (3), Central Africa, Armenia, Barbados IPPF operates in 150 countries on 5 continents
International Use
Languages - - - -
Dutch Spanish Portuguese Greek
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Turkish French
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Chinese
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Simplified 37%
Developers 2005 – 3 2007 - 6 2009 - 12 2011 – 23
Richard Stallings – Founder Free Software Foundation, The GPL license
Major Supporters
MI-Squared (Tony McCormick)
Visolve / Vicare (Sena Palanasami)
ZH Healthcare (Shameem Hameed)
IPPF (Daniel Messer)
Sunset Systems (Rod Roark)
Brady Miller
EMRs, Meaningful Use and What it Means to Your Practice Tony McCormick
Objectives
Why is the government pushing EMR/EHRs?
The ARRA of 2009
What is Meaningful Use?
What about the tax credits?
The Federal Push for EMRs
Institute of Medicine -
To Err is Human 11-1-1999
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Preventable Medical Errors
44,000 – 98,000 deaths
7th-8th most common cause of death
Agency for Healthcare Research and Quality (AHRQ) Bill Clinton HIT – ONC George W. Bush 2004 mandated the use of electron health records by 2014 -
Ineffective due to poor funding ($100M)
The ARRA 2009
HR-1 signed into law by Barack Obama -
02-19-2009
Funding increased to $65 Billion
Language to require “Meaningful Use”
$19 Billion in tax credits to adopting qualified practitioners and hospitals $17 Billion in education ONC and CMS placed in charge of defining “Meaningful Use”
What are the core measures?
Security and Privacy
CPOE
Drug-drug and DrugAllergy checking
E-prescribe
Demographics
Up-to-date Problem Lists
Medication List
Allergy List
Vital Signs
Record Smoking status for age > 13 Implement one Clinical Decision Rule Report ambulatory Quality Measures Electronic copy of PHI Provide clinical Summaries Exchange Clinical PHI
5 of 10 Optional Measures
Laboratory test results
Summary Care Record
Patient Lists
Immunization Registries
Patient Reminders
Electronic Access PHI
Electronic Syndromic Surveillance
Medication Reconciliation
Patient Specific Education Resources
Automatic CQM calculation * One Public Health Measure is Required
Security and Privacy (Core)
Encryption -
Encrypted file systems
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Encrypted transmissions of data Secure Logins
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Managing and revoking permissions
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Timed sessions
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Log changes to the record Record disclosures Cryptograhic proof that the record has not been altered
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CPOE (Core)
Computerized Physician Order Entry -
E-Prescribing (Drug-Drug interaction Checking)
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Lab Orders Referrals
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Radiology Orders
CPOE allows easy transmission of orders by electronic means through Health Information exchanges and receipt of discrete data into the EMR
E-Prescribing (Core)
Interaction checking -
Drug-Drug
- -
Drug-food Drug-Disease
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Drug-Herbal
Creating Prescriptions -
New prescriptions
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Changing modifying prescriptions Prescription History
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Lab Test Results
Interfacing with multiple Laboratories Scanning time reduced by half by direct introduction of discrete data directly into the EMR Allows graphical plotting of discrete lab data
Showing Lab test results in the EMR is an optional requirement but incorporating discrete results in information exchange is required. (Hey! It's the Government, You want Logic?)
Exchanging Electronic Information
Continuity Care Record (CCR)
Continuity Care Document (CCD)
Electronic Copy of PHI (Core)
Clinical Summary (Core)
Exchange Clinical Information (Core)
Summary of Care for Transition of Care (Optional) Electronic Access to Personal Health Information (PHI) (Optional)
Clinical Decision Support
Allows creation of plans and formal tracking of chronic health conditions (1 rule required) -
Diabetes mellitus
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Asthma/COPD
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Obesity Heart Failure
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Patient Reminders (Optional)
Clinical Quality Measures -
PQRi (Required to report)
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Automatic Measure Calculation (Optional)
Other Core Measures
Problem Lists
Medication List
Allergy List
Demographics
Vital Signs
Smoking Cessation
Additional Optional Measures
Medication Reconciliation
Immunization Registries
Electronic Syndromic Surveillance
Patient Specific Education Resources
Modular Certification
OpenEMR achieved Meaning Use Modular Certification March 14, 2011. ICSA Laboratories Requires Use with a certified E-Prescribing Application
Future Goals
OpenEMR Comprehensive Certification Requires integration of a certified e-prescribing application
Five Year Return on Investment
The Paper Practice
Paper has volume and mass -
Storage space, racks
The Chart Hunt -
Such a small office and I can't find my chart
Illegible hand writing
HIPPA -
Controlled (locked) access
Hostile Audit -
Average $200,000 fine per practice
EMR
The physical footprint is dramatically smaller
Controlled access is dramatically easier -
Controlling current users, defining user rolls
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Removing access to ex-employees Client/server it's easy to put the server in a locked room
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Documentation and meeting audit requirements is much easier. Improved documentation means enhanced revenues
Fully Integrated EMR/Practice Management
Federal Mandates have nothing to do with billing and collections Many practices have separate billing systems that they like and don't want to change. Fully integrated systems improve office efficiency. Having two separate systems usually means building a software bridge between the systems
Meaningful Use
Security and Privacy
Smoking Status
CPOE
Lab Test Results
Drug Decision Support
Patient Lists
Problem Lists
CMS Quality Reporting
Electronic Prescribing
Patient Reminders
Medication List
Clinical Decision Rules
Allergy List
Electronic Copy
Demographics
Electronic Access
Vital Signs
Clinical Summary
More Meaningful Use
Exchange Clinical Information
Patient Specific Education
Medication Reconciliation
Automatic Measure Calculation
Summary Care Record Immunization Registries
What about the tax credits?
Who is eligible? -
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Medicare
MDs, DOs, Dentists, Chiropractors, Podiatrists
Optometrists
Medicaid
More than 30% Medicaid Pediatrics with more than 20% Medicaid FQHC or RHC Physicians, Dentists, Certified Nurse Mid-wife Nurse Practitioner PA in FHQC or RHC
What about the tax credits?
Medicare $44,000 over five years -
Medicaid $63,750 -
$18k, $12k, $8K, $4k, $2k $21,250, $8,500 yearly x 5 years
Medicare program attestation period needs to start before 2015. Attestation period is reduced in 2013, and 2014 Eligible Medicaid providers may participate for the full amount as late as 2016.
What do I do?
Register with CMS -
National Plan and Provider Enumeration System user name and password
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Your NPI number Enrolled in PECOS
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Payee Tax ID (one number is selected)
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Payee NPI number (one number is selected)
Attest that you are using a certified her – 15 core functions, 5 of 10 optional functions
Wait, 3 months, 12 months
Payment
One lump sum to one NPI / Tax ID per year 75% of Maximum Allowable charges up to a maximum of $18,000