Anyone using OpenEmr in Las Vegas?

Day-to-Day Users
1

chokidney wrote on Tuesday, August 16, 2011:

I just opened a solo practice a few months ago. I only had little time to look at different type of EMR systems since then.
I initially looked into openemr due to the fact it is free. Then, being able to change the system the way i want it may be attractive (could be cost prohibitive?)
As it is most common reaction to other, when i mention i am thinking about openemr, other physicians never heard about it. Then, i mention it is free, then immediately, they suggest not to use free stuff.
So far last three months, when i did something to save money (eg biller and phone system, etc) i end up getting ripped off with work undone. Everybody warned me not to do that but me being bone headed, i did and i got ripped off.

I have only used ubuntu sometimes ago for personal use and liked but decided not to use due to compatibility issue with some programs like lightroom and adobe acrobat (couldn’t find good simple pdf editor)

Wheni tried openemr demo site about a year ago, i didn’t like GUi. Now, when i went back to see, it had a lot of improvement and i have good faith. But due to busy schedule i have and concern if this would really work, i am hesitant.

People suggested Amazing Chart since it is cheap and nice but i found that program is so slow to start. But it is cheap and would guide me to get that meaningful use money.
And i read from a site saying OpenEmr which was very active on development is slowed down and dying breed.

All these… A lot of rumors. So, i was wondering if there is anyone out there in Las Vegas using openemr?

Another issue is, if i hire IT company to set up this openEMR, they quoted me $400 for simply download and do unzip and installation as auto install provided from OpenEmr which exclude IT prson to set up server system ($1000-1500) and $1500-2500 to customize the EMR and $400/mo to maintain.
Suddenly that cost way more than full commercial EMR system. Many EMR just charge me $400-500/mo to get everything. Why would i get free software and end up paying more for IT company to maintain is a new question now.

Before i concluded not to use openemr, i thought i would ask opinion of people who used it or participation on development.
Big reason is, inthe future when i have more money, i want to intergrate emr system so that patient can call in and my opensource pbx phone (asterisk) pick up. The patient would input certain info like their id and some clinical information like BP, weight etc.  Then, these alues will be imported to chart and if value is abnormal, it would alert staff to review the data and call pt if needed. I believe in preventive medicine and i am tring to develope clinic that automate and help people.

Unfortunately, i have been ripped off four times since i started my practice three months ago (my billers, IT guy and phone guy) that i have no money left to spare another mistake.
I want to make right decision on emr system but this has not been easy. What do you think?
Thank you in advance for your input.

2

voipbound wrote on Tuesday, August 16, 2011:

Well, take it from another physician, IT IS WORTH EVERY SECOND THAT YOU INVEST INTO IT.  I practice here in Virginia.  Aside from the few minor GUI problem with aesthetic, I love it.  It is everything you need.  It does scheduling, billing, accounting and more if I have the time to read the manual.  You won’t be ripped off with this solution.  However, you need to spend the time to learn and set it the system by yourself.  There are IT guys, phone guys, integration guys, billing guys, etc… out there who will try to rip you off.  Other users of this system will chime in and give you their 2 cents on the pluses and minuses with this system.  But compare to the rest in the field that will charge you an arm and a leg and a long term contract for maintenance, you can’t go wrong with OpenEmr.  I for one can’t wait for the 4.1 to be stable.

3

billybus wrote on Tuesday, August 16, 2011:

OpenEMR is free as an open source but it’s not free to the users. I read somewhere that Dr. Bowen has invested $200K into it. Many other developers have put in thousand dollars worth of time. It’s funny that you would complain about IT fees when doctor fees are 10-20 times more expensive. Sure you can take the time to learn how to configure and program it. But is your time worth it?

4

sunsetsystems wrote on Tuesday, August 16, 2011:

Most OpenEMR users choose it not because it’s “free”, but because it is Free Software, free as in freedom.  For example no vendor can lock it up or abandon it and keep you from changing it or hiring someone to change it.  In that respect it’s a safer choice than the commercial offerings.

Your time investment is probably the biggest expense.  Most vendors charge less per hour than doctors make and, if competent, will do a professional job.  $400 for an install doesn’t seem so bad, but as a monthly maintenance fee sounds high, depending on what exactly they do.  Just make very sure that, at a minimum, nightly backups are done and that the recovery process is periodically tested.

Rod
www.sunsetsystems.com

5

billybus wrote on Tuesday, August 16, 2011:

Also, it’s unlikely that everyone wants to rip you off. Maybe it’s just a mismatch of expectations? Maybe you should network with other physicians in your area to understand the cost of starting a business and investing in IT, billing services?

6

marka1211 wrote on Tuesday, August 16, 2011:

It sounds like you have discovered the difference between “free” and “cheap”.  When you buy a “cheap” phone system, you are selecting between different vendors who are using the same business model.  Free and Open Source Software is fundamentally different from the proprietary model of software development.  As several decades of Linux development have shown, FOSS is not “cheap”, in the sense of being low-quality.  Quite the opposite.  The people behind OpenEMR work on it because they believe in it, not because they are trying to under-bid a competitor.

The other, HUGE advantage to OEMR, in my opinion, is the fact that you cannot get “locked-in” to a single vendor’s product.  There will always be somebody who can help you trouble-shoot/maintain/upgrade an OEMR installation, as long as there are people who can program in PHP.

Disclosure: I don’t yet have OEMR in my office, but plan to be installing it soon.  If I have to retract anything I just wrote, I will do so.

7

cverk wrote on Wednesday, August 17, 2011:

As a solo fp doc using openemr I think you should go the openemr route if you are intellectually interested in computers and willing to learn about systems and programming. This approach allows a lot of potential freedom and independence, but requires a certain amount of sweat equity.  As you learn about what helps it work for you, you should also be willing to share your observations and experience.  Otherwise, if you need hand holding and a lot of individual instruction you probably have to be willing to pay for it, and maybe should use a more commercial product.  I am about 10% of the way to understanding the programming that goes into this project after the first year of use and study, so I can tell you it has to be your intellectual hobby if you plan to do it all yourself.

8

chokidney wrote on Wednesday, August 17, 2011:

Thanks so much for all of your input. I think i agree with all the comment. I really like the fact that i can do manipulation of the product and potential to change or improve (likely will need programmer’s help to achieve that).
The most scary part of it is i do not know how much i can afford to spent in time wise. I was one year CSE major before i changed to premed and i always had been most savy on computer among my friends and family. Spent endless not trouble shooting computer things that people just didn’t understand why i am doing that. Then, i became more of savy user that anything (meaning no developing or anything). As i get older (i am stilllate 30’s) with kids, less time to do such thing.
I wanted tomset up phone system myself but been busy with clinical work that my office is without phone for 15 days now. We are using skype with call forwarding for now.
I felt like i digged into my trap. So, right now that scares me some (because i have tons of other thinga to worry about to set up my practice)

I still like the idea of using open source, trying to convert MS windows to ubuntu in office before i convert to openemr. Bought first computer with i5 that costco was selling and it already caused problem. Ubuntu not getting installed. After many trial, got it work up wireless still dysfunctional and sometimes it doesnot shut down.

Anyway, too long intro.
Another question, if i implement openemr, would i be able to qualify meaningful use money?
There are many posts about it but so many technical terms that i so far figured it is ONC or some kind of certification. But it seems there is a few steps that are still needed. Am i right?

So far, i looked at demo and only thing i didn’t like was progress note. SOAP is not billable note but i don’t understand why people developed that way. As far as i understand, billable progress note has to have Chief complaint, HPI, (1-3 of Social history, family history, past medical history), ROS, PEx, and Assessment and plan.  These has to be in each note (as far as i understand) but these information is in EMRbut not on particular day’s note. I found there is template function. With that, can i make those standard H&P type note as progress note?

I know these questions may be answered if i dig around the forum and help site but finding that information has not been easy for me. Someone ket me know builing these templates are not that difficult or not? Then, i will dig around and will try to find the answer. I am asking because the openemr developer told me it will cost me $4000-$6000 to build that standard format H&P. Trust me i don’t make that much money to spend for standard H&p template.  All physician would require to write note on that standard format to get paid and i just can’t figure out why openemr has only soap note that no one in america use anymore. That was like 1980’s type of note.
Anyway, i feel like i am missing something. Please tell me i am wrong so i can use openemr!

Again, thank you so much for all the comment.
And sorry for all miss spelling. Most of my computers (4) are dysfunctional right now due to process of deleting window and installing ubuntu and i gt into problem making them work. Now, i only have ipad left.

9

yehster wrote on Wednesday, August 17, 2011:

Just curious about your medical specialty.  Is “chokidney” a reference to nephrology?  Also curious as to the identity of the developers who are asking for $4000-6000 for customization and how you found them?

As for some of your other questions.  Simply installing and using OpenEMR is not enough to qualify you for meaningful use incentives under the Medicare program.  However, if you qualify for the Medicaid program (30% “needy” patient population), that’s a different story.

The CMS webpage is the official source of information on how to get your incentive money.
https://www.cms.gov/EHRIncentivePrograms/01_Overview.asp#TopOfPage

I doubt there are many users out there who rely on the “base” forms from the out of box install.  There are three main ways to customize clinical forms in order of general “technical skill” required to create.

1. Layout Based Forms
2. XML Form Gen
3. Custom PHP.

There are a number of custom forms in the contrib directory which can be installed after the base setup.

10

anonymous wrote on Wednesday, August 17, 2011:

It seems that you have so much in your plate; the practice, the phone system, computer systems. Getting Linux configured properly is a journey by itself, and yet you want to dig in OpenEMR. Iam not shying you away from doing all these things as I myself have these multitude of projects. But you have to consider that some of these projects have a time constraint. I recommend to use the right tools for the tight job; use a consultant when you can save more money on the ROI (return on investment) than if you have to do it yourself.

JP

11

sunsetsystems wrote on Wednesday, August 17, 2011:

I think some involvement in the technology is desirable, and I push my clients to understand the basics of their installations.  It just goes hand-in-hand with choosing open source.  But as already noted, most physicians just don’t have the time to do it all and involving a vendor or consultant is usually very helpful.

Rod
www.sunsetsystems.com

12

drjohnloes wrote on Wednesday, August 17, 2011:

Do you recommend choosing a vendor who can do onsite service or can it be done remotely just as efficiently.  There does not seem to be any vendors in close proximity to me.

13

sunsetsystems wrote on Wednesday, August 17, 2011:

Recommend you have a local resource to do routine setup and maintenance of your local network, server and workstations, and also an offsite OpenEMR expert who can log in remotely to support OpenEMR.  In my experience a Linux-based server is easier to support remotely, so it’s nice if the local tech has some Linux experience.

Rod
www.sunsetsystems.com

14

chokidney wrote on Thursday, August 18, 2011:

Thanks again for all the good suggestion. I am definately plan to use IT consultant for installation and set up of EMR. The big question is which EMR. I think i want to give a try on OpenEMR (have IT consultant to install and set up) but feels Like i am flying uncharted area. So, still investigating.

Most of my patients are medicare pts, not much of medicaid.
Yes, i am a nephrologist.

So far, openEMR on cloud vs Amazing Chart vs Dr. Chorono seems to be earning my interest. They are very different to each other and with different type of benefits.
I even thought about using amazing chart to get going and get help to get meaningful use money and later consider changing but this probably too costly than benefit.

In regard to who gave me quote, it was very approximated guess from two vendors plus IT tech that i would have to hire to help out set up so remote tech can login. I believe all their quotes were with good intention to help me decide so if it is grossly wrong i probably have to take responsibility that either i mislead them on what i need or i misunderstood what they meant i need.

Another reason why i keep thinking openEMR is that inlater future it may give me ability to tweak around EMR with my IVR that patients may call dedicated hot line to report their weight and blood pressure daily and it gets incorporated to EMR. Again, this is only my dream that one day i have enough money to set such thing to help my patients to be monitored more closely. Unfortunately, medicare do not believe such things need to be paid work, so all these things and my effort and my nursing staff efforts to monitor patients are to be free of charge (and all costs to be paid by me) (or be included in $60 that they pay me once three month visit). With automation, may be this can be possible.
Anyway, that’s my dream.
At this time in America, because no physician get paid to help these heart failure patients appropriately as preventive measure, these patients end up goimg to ER with shortness of breath and end up in ICU. These definately much much more expensive for medicare but medicare only think about $60 they don’t want to pay.
Only alternative i see is automation.

15

jojohit wrote on Thursday, August 18, 2011:

If you just want to get an impression from OpenEMR then try the demo:

http://www.openmedsoftware.org/wiki/OpenEMR_Version_4.0.0_Demo

or the development demo which will probably have more features but under development:

http://www.openmedsoftware.org/wiki/Development_Demo

Uploading your patient’s health vitals is something that is under development now. There are personal medical devices like weighing scale which can upload the data automatically to the patient’s online private electronic health record (EHR). Then OpenEMR can pull it from there and record it on the patient’s EMR.

The government is pouring money to revamp healthcare. The ACO project (accountable care organization) is a new health law that gives incentives to healthcare providers for the quality of healthcare service that they give to their patients.

http://www.kaiserhealthnews.org/Stories/2011/January/13/ACO-accountable-care-organization-FAQ.aspx

There are a lot of things going on in the healthcare industry since last year. And it will stay that way for the next decade or so, IMHO. Check out the uemployment rate and the job growth in the healthcare industry.

http://www.bls.gov/news.release/empsit.nr0.htm

Your situation is a good fit for a hosted OpenEMR. This way you don’t have to deal with the hassle of figuring out how it works Just login and use it since it will be a web-based application (internet). Let me know and I can hook you up.

JP
chokidney@lagunarty.com

16

chokidney wrote on Thursday, August 18, 2011:

Thank you JP. I am leaning toward hosted EMR just like you suggested. It seems it will delete some headache of setting up and maintenance.
I will have to spend couple of days to think and investigate about it (own server vs hosted has been a hot debate in IT community as you know)

Interesting that you mentioned ACO. Unlike all the non-health related people who believe ACO will improve quality of care, most of practicing physicians do not believe that (except physicians who are in politics or administrations for insurance company or medicare). It is another gimick medicare use to cut the cost and a lot of patients who are sick will be abandoned. But that is another whole topic i should not get into. Yes, i agree that it created a lot of business opportunities for nonphysician personnels.

17

yehster wrote on Thursday, August 18, 2011:

Dr. Cho,
Do you see patients in both your office and in a dialysis center?  If so, I’m curious if you plan to incorporate OpenEMR (or whatever EMR you ultimately choose) into the workflow for documenting hemodialysis treatment.

Also, you are going to want to integrate all of the blood work for your CKD patients into your EMR workflow as well. You could scan the paper reports in at first, but to truly be useful you are going to want a proper interface with labs so you can get structured data.  Monitoring eGFR, ACR, HbA1c, Lipid profiles and alerts for significant changes from previous values must be something you’d want.  Simply highlighting abnormal values like the lab reports provide would almost certainly result in alert fatigue since the reason you are seeing all these patients in the first place is low eGFR. The ability to see trends is what matters isn’t it? This is another big piece of functionality you are going to want that is going to require significant resources.

It is just as important to worry about your vendors, if not more so than the EMR itself. You are going to want someone with a strong understanding of both the system and someone to whom you can easily communicate your requirements.

-Kevin Yeh

18

chokidney wrote on Friday, August 26, 2011:

Thank you, Kevin. You are absolutely right about all the yhings you pointed out.
The potential problems i see is that with openemr, it seems like i have to spend a lot of resource to customize and each customization is quite expensive, can easily cost way more than even midium size EMR. Allscript which is higher end of EMR may cost much more but all functionalities are there. You just have to learn how to use it.
Openemr (so far with my impression without experience using it except the demo) seems not so expensive to install and set up, but in order to be able to be very usuful, it seems i will probably spend thousands of dollars per months for several months to get all set up, which can run as high as allscript which make me very cautious to choose openemr.
I downloaded the openemr and will try it for next couple of weeks to see if this can be safe bet for me or not. If it seems so, then, i guess i will hire a vendor to install the program right and get kquote for those lab functionalities.

Oh,BTW, in order to incorporate Labcorp and Quest lab data to my EMR, is that plug and play or is that another several weeks of programmer need to set that up? 

19

yehster wrote on Saturday, August 27, 2011:

Dr. Cho,
If you would like to explore working with me to get OpenEMR up and running for you let me know.  I believe that I can deliver for far less than thousands of dollars you seem to think you need to spend upfront.

While Allscripts’ solution might be cheaper for you initially, I suspect that ultimately you would be disappointed with that route for a number of reasons. 

Firstly, the CQM features that Allscripts support do not significantly overlap with the KDOQI guidelines you would be interested in such as diabetes control.

http://onc-chpl.force.com/ehrcert/EHRProductDetail?id=a0X30000003jwhYEAQ&retURL=%2Fehrcert%2FEHRProductSearch&setting=Ambulatory

Also, to get OpenEMR support for CQMs that you might be interested in that it doesn’t support will be much easier than trying to convince Allscripts to implement something for you.

Also I think it is interesting that in this list of top rated systems, Allscript isn’t listed for Solo practices, but is for larger practices.

http://www.emrandehr.com/2011/08/19/top-emr-vendors-solo-physician-practice-black-book-rankings/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+EmrAndEhr+%28EMR+and+EHR%29&utm_content=Google+Feedfetcher

Why struggle with Ubuntu setup when you can defer to an expert? 

20

chokidney wrote on Tuesday, August 30, 2011:

I have downloaded and installed 4.0 Oemr on my ubuntu server. So far a few days of testing, I like what I see.  Very fast (having server on my site definately help).  Just several very very important things missing on oemr 4.0 (like prescription function, ICD9, lab).  I haven’t fiugure out how to print my note or fax it to PCP.
I did all install and etc myself but this was just for testing purpose only, and thinking about expert to do installation and set up for my production server (desktop in my data room).

In regard to the quote I wrote previously: I did receive several quotes before I posted message here. 
The price they gave me, yes, they are significantly less than what I wrote, but I added other cost to it that will ultimately cost me, (eg, my price was including such things like hiring local IT guys which is additional cost to me to set up and work with oemr vendor… it seems Las Vegas IT guys are much more expensive than other parts of country).
Also, it seems there has to be a lot of customization of oemr that can be quote costly (“unknown” amount seems to be more scary than certain dollar value) :(  At the time, I felt as if I am buying a brand new car for $500 but only to find out it only comes as frame and I have to buy engine, 4 seats, transmission, axil, tires, wheel etc.  haha  (sorry, all these frustration probably came because I didn’t and don’t know much about it).  I think this is how most of physician may feel about it when they first start to explore oemr as well.

Bottom line: So far demo version, I like what I have seen BUT definately, I need some serious customization to be able to use it for me.   And thank you Kevin for your insight for what I may need.

One question: nowadays, all American consultants doctors need to write note like H&P but oemr only has SOAP note.  I’m pretty sure all american doctors request H&P type of note and likely it is somewhere available.  Is that available?  It seems so much waste of time and money for every american doctor to adjust that note function to make it acceptable to medicare (likeh H&P that includes chief complaint, history of present illness, past medical/surgical history, social history, family history, allergy, medication, review of system, physical exam, assessment and plan.  All info can be available somewhere in oemr but doesn’t seems to be incorporated to physician’s note which I think cannot be reimbrusible by medicare if not included in my note.)