Customisation request

OpenEMR Development
1

innocuous wrote on Thursday, September 22, 2005:

We are a group of 50 doctors who are planning to form a not for profit HMO (Health maintenance organisation) for which we want to implement Openemr. We are situated in India.
We do not have stable internet connectivity in many rural areas where a doctor might be working.
To overcome this, we have thought of implementing Openemr locally on the computer of the GP. These will be offline local versions. Each GP will enter and maintain their patients using their own laptop.
At the end of the day, they will be able to synchronize with a central server (database) as this is necessary for quality checks and abilitiy to access information through internet if needed.
We also require the patient data to be exported in a summarised format so that it can be saved on cd and handed to the patient.
We would like a quote on this customization, which includes:
1)Converting the online version to offline version ie standalone software
2)Including update button which synchronizes the local databases of each doctors with the central database, updating the central database.
3)Each patient information can be exported into a pdf/txt/doc file so that they can be saved to cd and given to the patient incase he goes to a non participating doctor. A good feature will be if the data can be exported which can be read by an alternate installation of openemr in another GP’s office through open command.
Please let us know if this will be possible.
Thanks

2

jimbo456 wrote on Thursday, September 22, 2005:

I am working on a module (started this week) that will I believe do the updating module you are looking for. See a previous post by Jimbo456 about remote Openemr.
Email me at Jim (at) responsabill (dot) com so we can discuss it further.

Jim Proctor

3

sunsetsystems wrote on Thursday, September 22, 2005:

I’ve recently created an import/export feature that uses a simple XML format for offline storage.  Code for this is in the “custom” directory on CVS.

Currently it’s just demographics and insurance, but could be naturally enhanced to include encounters and other medical data (which is why I chose XML).

Not sure how closely this impacts your updating module, but perhaps we should discuss.  I’m also available for this kind of customization work.

– Rod (http://www.sunsetsystems.com/)
rod at sunsetsystems dot com

4

wpennington wrote on Friday, September 23, 2005:

There are several challenges to your proposed situation, but several groups are currently implementing solutions, mostly using Smart Cards. 

MySQL as the database for OpenEMR has few features for synchronization.  Other databases such as PostgreSQL and Oracle do have these features, but there are many hurdles to successful implementation of your  proposed solution. 

For example, what happens, if in off-line mode, Dr.1 changes the "patient name" to "Patient Name" and similarly while in off-line mode, Dr.2 changes the same record from "patient name" to "patient Name."   Which record is correct?  Which takes precedence?  How is it decided?  How is the correct information verified?

What happens if Dr.1, who synchronizes daily, updates the address of a patient, and Dr.2 who synchronizes monthly, modifies the old address to add an apartment number.  Dr.2’s change will overwrite the correct address entered by Dr.1, even though Dr.1 entered the correct current address.

How will overwritten changes be kept for viewing by providers? 

Computer Personalization  In areas where computers are not prevalent, administrators personalize a computer and put it in a safe and secure location, or preempt its use administration over clinical uses.

Synchronizing multiple databases to have the same information will require manual efforts to create a report of duplications and changes to insure that records are not being lost or overwritten, and that the information currently displayed is correct.

Some suggestions are:
1.  Create paper forms, and have users enter the information manually on-line.  This will keep a paper record at the clinic in the event that there is ever a problem ;
2.  The World Health Organization is addressing this issue for AIDS in several countries that do not have Internet or reliable electricity.  The WHO is a good resource for information on clinics addressing this problem;
3.  Another suggestion is to have a health record exchange connected to multiple types of EMRs, including OpenEMR.  A health record exchange allows the sharing of information, without the system being dependent on the EMR.  A health record exchange solution requires being able to access the health record exchange, which leaves the problem of Internet connectivity. 
4.  Smart Cards carrying medical information - Provide patients with Smart Cards that carries essential information on the patient.  The information is private, confidential, and requires a smart card reader.  The physician, can upload the information to their OpenEMR Smart Card reader. provide medical services, and then update the Smart Card. 

5

innocuous wrote on Saturday, September 24, 2005:

Thanks for the feedback.
The first issue regarding overwriting of records can be easily solved, as we require the patients of one doctor to be seperate from the patients of the other doctor. The doctors can access and synchronize only their patients and not the patients of other doctors.
The smart card option sounds very good to us. Can openemr be setup to support this? If yes, are there any links that can be helpful? Even with smartcards we will still require a central database which can be accessed online through a functional OpenEMR on the server.
Regards
Suvienay

6

sunsetsystems wrote on Wednesday, September 28, 2005:

Who is implementing smart cards?  Will this code be contributed to the project?

In general, it would be extremely beneficial for everyone if users working on major (or even minor) improvements would share the good news and relevant details here!

– Rod (http://www.sunsetsystems.com/)

7

andres_paglayan wrote on Wednesday, September 28, 2005:

Walt made a comment about it,
but I rather provide a mean for the patient to log in and retrieve their information on-line,

8

sankar1234 wrote on Thursday, October 06, 2005:

Interesting Discussion.  This situation is not unique to India.  It is a great requirement that many EMR systems turn their face.

I made a Palm Pilot template based chart writing application (though it could be called as mini EMR) ideally suited for this purpose.  I haven’t customized it for OpenEMR product, but love to if there is a funding.  The chart generated in the palm is a simple text file that can be uploaded to any EMR while hot syncing (or wireless connection under development).  This application is developed ideally for conditions wherein physicians don’t have access to EMR systems.

You can download the free copy for all specialties from Palmgear or www.emrupdate.com.

9

sankar1234 wrote on Thursday, October 06, 2005:

The weblink to my website is : http://www.cvquest.com