New OpenEMR implementation

gsporter wrote on Sunday, December 18, 2011:

I am getting ready to move a physician to OpenEMR from a “commercial” billing solution after their other option fell through.   They are now in solo practice and working “part time” and nearing retirement age so it is hard to justify $20-$30K to upgrade to a new version of their current Lytec system.   It is hard to make the jump since they have been using this system since it was DOS based and used BTrieve!  However to be able to continuing supporting their patients they need to able to bill under the new X12 5010 standard.

I have done several prototype installs of OpenEMR 4.1 using Ubuntu 10.0.4 server and followed the forums on Source Forge, the OpenEMR and project site for several months.   I was wondering if anyone had any suggestions, or guidance for implementing an OpenEMR from scratch.

I am looking at a Dell PowerEdge T110 II with a Intel® Xeon E3-1220 Processor, RAID 1 250GB hard drives and 8GB memory.     As a base for the OS I am looking at TurnKey (linux) Core which is based on Ubuntu 10.04.1 with Long Term Support.

I have used this as a platform to implement a number of projects since it offer a number of built in features likeTKLBAM.  TKLBAM is a automated  cloud backup solution to theAmazon cloud has saved me a couple of times!  It also provides quick disaster recovery through an easy migration to a cloud based server if needed. 

Am I correct I can get started testing using OpenEMR 4.1 with 4-1-0-Patch-5.zip to start testing the new electronic billing format?   We are currently using Gateway EDI as our X12 partner.  Rather than trying to do a data migration I think we can add patient, insurance company etc data as patients come in by running our existing system in parallel.

I know I need to be looking at a number of other issues such as e-rx, and a patient portal but I am a little overwhelmed at this point since there are only 2 weeks to get this implemented and tested.   We are not really trying to meet EMR incentives or “meaningful use” at this point, although we may in the future.  Any insight or guidance any one can provide would be deeply appreciated!

juggernautsei wrote on Sunday, December 18, 2011:

Hello,

You are on the right track. You have covered all the basics in what you wrote. It is just time to dig in and start. I just did an install simular to what you are getting ready to do. It went smoothly. The hardware you have chosen is great. It would seem to me that you would use a RAID 5 on a minmum of three drives . But I am a big fan of RAID 5 configurations they has saved me a lot. Anyway, that is the only weakness I see what you are proposing.

It is best to do the side by side. I have done both data migrations and the side by side and the later works best because with the migration there is to much chance of data corruption. Like they say, garbage in garbage out.

OEMR works with any x12 provider.

Fair winds and following seas,

Sherwin
openmedpractice.com

bradymiller wrote on Sunday, December 18, 2011:

Hi,

For ubuntu, very easy to install OpenEMR via the ubuntu/debian package:
http://www.open-emr.org/wiki/index.php/OpenEMR_4.1_Ubuntu-Debian_Package_Installation

And then agree with the patch 4-1-0-Patch-5.zip if need 5010 which will bring in X12 5010 compliance (note the patch has only been released on the forums for testing, but I expect it too test well and be released on the wiki within the next day or so).

-brady

gsporter wrote on Sunday, December 18, 2011:

Thanks for the feedback.   I don’t know that I would take this on except it is a imediate family member.   In my full time day job I teach Cyber Security in a Career Tech center in Oklahoma which keeps me busy.

If things go well with Turnkey Linux I will publish a patch ( http://www.turnkeylinux.org/docs/tklpatch/publishing ) or a installation iso for OpenEMR.   This will allow others to do a full install either straight from the Turnkey Core or directly from an iso.

I don’t know that I can help with the programing side, I stopped programing before they added the ++'s to C but hopefully I can help on the application security side.   One of my concerns is the number of vulnerablities in phpmyadmin (@15 this year).   It might be worth while to look at some alternatives like Adminer (free) or Navicat (commercial)

Again thanks for the works of encourgement

Greg Porter

yehster wrote on Sunday, December 18, 2011:

I thought that CMS was delaying enforcement of the 5010 standard.
http://journal.ahima.org/2011/11/17/cms-delays-enforcement-of-verison-5010-hipaa-standards/
I know that some Medicaid in Florida is still requiring 5010 on January 1.  Is Oklahoma still enforcing that deadline too?

You can easily remove phpmyadmin if you are concerned, but if you are running the system locally behind a firewall, you needn’t worry too much about vulnerabilities, as the only people who would be able to do any damage with it should be people who have access to the machine.

-Kevin Yeh
kevin.y@integralemr.com

cverk wrote on Sunday, December 18, 2011:

We discussed the general idea of turnkey before on the attached forum, and I still think it seems like a good idea.  It was pretty easy to get up and running at least locally, but I did not feel confident enough with security to go further than that. Having the input of a security expert seems ideal , particularly before going live with portals and cloud installs.

http://sourceforge.net/projects/openemr/forums/forum/202504/topic/4810938

gsporter wrote on Sunday, December 18, 2011:

I wasn’t sugguesting using Turnkey Linux for the portal.   I am going to use it for my main (physical) server install.   The advantage is that way if my server goes down (fire, tornado etc) I can get up and running quickly.   I can backup the data, and OpenEMR install to Amazon (and locally) then all I have to do is reinstall Turnkey Linux core, restore my backup either to a new physical box or a EC2 instance and presto “back in business”.

The portal could be hosted in a cloud instance.   I haven’t looked at the connection between the portal and the OpenEMR server.   It should be doable to set up a ssh or ipsec tunnel between the two.

Greg Porter

cverk wrote on Monday, December 19, 2011:

We had a pretty good discussion on this issue as well, without any real conclusion on the best approach to the security issue. The rules of meaningful use do make pursuit of a portal neccessary at some point.

https://sourceforge.net/projects/openemr/forums/forum/202505/topic/4769926

I outlined what it takes for a small primary care office to use openemr for meaningful use at the end of this discussion.

https://sourceforge.net/projects/openemr/forums/forum/202504/topic/4880702

Just to get up and running though, it is pretty much ready to go once you add the procedure codes you need and fees, as well as the insurance info. Somewhere along the line I posted my fee sheet which might help.  You also need to customize your patient statement form if you plan to bill patients.