Non tech savvy - Non US use of Openemr is … - Question/Opinion

Management and Administration
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#1

I was hesitant to post my question/opinion about using Openemr as a medical professional with “basic” computer and networking skills. In my quest to find an open source clinic EHR system I found Openemr to provide a LOT but with some shortcomings.

-My main problem when I started to get involved in Openemr was the documentation. I found it outdated and not user friendly with little diagrams, screenshots and very old YouTube videos. As most physicians/clinicians (at least where I live) are kind of tech “deficient”. This is a big shortcoming.
-The second main problem was that Openemr is US centered. From using US units to using American Insurance and certification requirements. Which makes using Openemr for non-US users a bit overwhelming.
-In between these two problems there is a lot to think of.

Now am I looking in the wrong places? am I tech illiterate and cant handle open source culture? How one can help make the process of using Openemr easier for oneself and others who will reach out to use in the future. And when its a user friendly experience how to spread the word to help health care professionals and organizations to use EHR for their practices because not all countries have strong healthcare systems nor have the enough resources.

I understand its not simple to just have an executable with click to run option. But having a simple stripped down version of Openemr with easy deployment options would be a dream come true for a lot of non tech savvy users like myself.

I have to acknowledge that there are a lot of users who seems to help when they have the chance (thumbs up), and thanks to google and stack overflow I managed a LOT (at least for now).

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#2

You are right that a lot of the help documents are outdated. I am currently working on a knowedgebase site for developers but I think it would be nice to have videos for end users as well. The most recent versions of OpenEMR haven’t changed much in their basic structure but there have been many improvements to keep up-to-date with different sets of requirements needed in the US.

One of your options is to pay a developer / trainer to provide a series of training sessions to get you up to speed on the basic functioning. A developer can also modify OpenEMR to match your specific workflow, which is a major benefit to going with OpenEMR. The software itself is free, your only costs are for support, custom development, and hiring someone to teach the basics (if needed). At the end of the day, you will save a bunch of money compared to the costs of getting one of the non-opensource proprietary EHR’s available.

Although OpenEMR is USA-centric it has been used in Europe, South America, and Africa and can be customized to meet your needs. Feel free to contact me and I’d be happy to work with you.

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#3

@growlingflea i am willing to learn and trying to do my best and i understand that developers do a lot of work and to have training costs money. I need to tell you where i live closed source EMR/EHR can cost something between a 150 USD up to 5000+ USD with less than half what Openemr has to offer. I would eventually try when i have enough knowledge to may be pass the basics on for free so i can continue the legacy of this open source on to others.

#4

@growlingflea i sure will contact you over private messages to see how can i benefit from your skill.

#5

Hi Hi Mohamed,

If you look under administration -> globals -> locale

It gives you the option to change the units from US to metric, along with other customizations.

Screenshot_20210401-165213
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#6

@Rachel_Ellison already did it long time ago but some other stuff is not changed from administration>globals such as Firstname Lastname instead of the opposite which i changed as suggested to me before in the lists while didn’t get changed in the calendar. This is just an example.

#7

Hi Mohamed,

Consultant for a European user here. There are a number of issues with the installation as-is for non-US and non-English environments:

  • Translations are not complete or sometimes just plain wrong. We solved it by standardising on the English-language version because we have an international staff anyway, but if that’s not an option, you can always improve the translations yourself and share it with the community.
  • US-specific stuff can be edited away from the application by an IT-professional who takes training and/or dives deep into the application structure. There is a disadvantage to this as it will make it substantially harder to upgrade to later versions.

Our solution to dealing with the US-centric aspects was to ignore them and build around them: we deployed a Mirth Connect server on the side to deal with integrations with (other) internal and external systems, but also to provide business processes that aren’t covered by OpenEMR. Whenever a business process needs to be triggered by some data entry in OpenEMR, there is a technical process that monitors the underlying database, selects the required values and starts a Mirth channel.
It is not perfect to program in Javascript, but it gets the job done and it avoids changing too much of the existing codebase.
Sometimes however, you cannot but change the codebase itself. Document it well and make sure you can re-apply your changes after an upgrade. If you’re not computer-savvy yourself, get an IT professional. For sustainable changes, best make it a partner who sticks with you because when you start from scratch, the effort to dive into the depths of openEMR is substantial.

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#8

@phenon
Thanks for the info. Definitely a great idea to take care when customizing to make sure it can work after upgrades. This why when I goof around making changes (simple) I try to hide or reuse what’s already on the table, instead of deleting or making radical changes.

As for the translations for Arabic (in my case) I find them good but not complete, there is a lot not translated.

Regarding the technical info you shared, I can’t say I follow any of it :sweat_smile:. But then this is what I was talking about. There are a lot of healthcare providers worldwide (not the US and europe) with no access to EHR or EMR. Either because they have no financial resources or they think its rocket science. I can’t deny Openemr in this moment is a great choice. It’s free, open source, updated pretty regularly, with lots of features. But since its US centered and needs a lot of customizations I guess a lot will jump the ship if they understood the concept of installing it in the first place. But again I think the effort that have been in Openemr is enormous and giving it for free is already fantastic.

A dream come true would be to make a lightweight click to run version that covers all specialities and need minimal infrastructure with easy for dummies instructions. May be I will help someday !

#9

I would recommend developers who want to make changes that will persist across upgrades should look at the work we are doing with our Event Dispatcher hooks. If you need to modify something in the system you should get committed into the OpenEMR project an event that fires off that you can tie in your custom modifications to. Any custom code can then be contained inside a module you maintain and it will persist across upgrades.

Our OpenEMR fax module is an example of this, the new SMART apps are show how this is done. Ken Chapple’s Patient Filtering module is another example.

It would be a big push but if the community was interested in helping, moving all of the US centric functionality into modules that can be turned on and off would facilitate @mohamed’s desire for a lightweight version.

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#10

Hi @mohamed
If I could share some thoughts and observations.

You have described some of the major differences between Free and Open Source Software (FOSS) and proprietary software. And one of the biggest is that ‘open source culture’ you mentioned. In FOSS, the development is mostly contributed by volunteers who work in their personal free time on what interests them, rather than what’s next on their corporate EMR employer’s agenda.

If you read through this forum it is clear how many of the users of OpenEMR want to simply download and install a system that meets their needs and how few of them make an effort to contribute back to it. Voluntary contributions are how a FOSS project grows and coding/ development are not the only useful contributions. If more non- English speaking users were to simply note the places in OpenEMR that were not translated or were incorrectly done, and then take the time to send their translations in to the project, OpenEMR would be the best multilingual EMR out there. It’s that easy to improve OpenEMR.

As far as the documentation being seriously out of date or badly written, that is mostly a true statement. A lot of the documentation in the OpenEMR wiki was written for ancient versions of the application and much of that was written by developers whose strengths are in coding, not Technical Writing. However, if one reviews the newer documents, perhaps half of them that were written for OpenEMR ver 4.2, and nearly 90% of the ones for 5.x, still apply to ver 6.x. A module or functionality’s interface may have been rearranged a little but ‘under the hood’ it still works the same and the documents for it are still good. And this is another opportunity for non- developers to contribute to the project. My coding expertise is basically Commodore Basic and VBA. But long ago I was a nurse, and that has helped me to contribute documentation to the project. If healthcare professionals find an EMR functionality they are familiar with, they could locate its documentation in the wiki, and write a version of it (or create a completely new document) in their native language. I have some experience in publishing non- English docs to a wiki repository. If anybody’s interested in doing that I would be happy to help.

When I started working with OpenEMR I was amazed at how widely varied healthcare practice is, even just within the US. Not only do different specialties conduct different activities, but within a specialty different practices want to perform the same operation differently. In my opinion, trying to create a single general purpose ‘stripped down’ EMR is not very practical because it is nearly impossible to find any functionality that is common to most practices. However, some developers in the OpenEMR project are working on a method of packaging the software so a user can select just the functionalities they want. Myself, I think that this approach shows major promise but again, that effort progresses only as fast as the developers can spare the time from their Real Jobs.

Best- Harley

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#11

@htuck Okay as a starters how can I help with the Arabic translation. I guess this can be fairly easy to do if I have a table or something to write the translations into.

Regarding documentation, yes a lot of the older guides are still valid and applicable but not eye friendly at all and is time consuming. I was thinking of making some kind of “Openemr for dummies” either as guide or YouTube video in which I take a non-tech person from the point of downloading XAMPP step by step into having a running version of Openemr. Because there are usually small hiccups that would put the user off such as a dump semicolon in the original XAMPP ini file (which drove me nuts) or how to install and configure XAMPP and make own small server on local network. I know google is available, but still we humans are a bit lazy and need a hand. But then I have never worked in a wiki project before.

The stripped down version need not to be very specific to a special need. Rather more like the Forms Administration page with the ability to install and activate a specific database instead of cluttering the system of irrelevant data.

Regardless of any limitation it is still a very alive community and a lot of users reach out to help us the noobs!

#12

@adunsulag
If the work need to be done is not very complicated and divided into small parts may be this will make an average Joe get interested.

#13

Hi @mohamed
To clarify, I have not actually been involved in translating the text in the OpenEMR interface; I have worked with translators publishing non-English written documentation of another project to its wiki repository. Doing a search on ‘translation’ in this forum yields several threads on the topic but they are all quite old. However, maybe @brady.miller could give pointers to updated instructions on how to submit translations to OpenEMR?

Disregard this next if you are already familiar with writing and posting mediawiki documentation.
On the bottom of every page of the OpenEMR wiki- this one, for exaple:
https://www.open-emr.org/wiki/index.php/OpenEMR_Wiki_Home_Page
is the section, ‘Wiki Instructions’. You can find there everything you need to know to begin publishing in the OpenEMR wiki.
Particularly the page, ‘Account Request and Wiki Authorship Primer’.
If you have questions about those processes I’m familiar with them and am happy to explain.

It must be mentioned that some OpenEMR contributors started up a drive a while ago to convert the documentation wiki from mediawiki to drupal.


Their observation is correct in that mediawiki is indeed ‘outdated and difficult to maintain’. The concept behind the planned migration seems well thought out and the migration strategy is impressively detailed. I wish the project well, but as is so often the case with FOSS projects, they depend on the contributors having the time to do the work, and this migration project has been in the works for several years. If the migration does get up and running new submissions will certainly need to be tailored to the drupal platform, but until that happens I will continue to publish in the existing wiki.

I think making a video such as you describe would be a wonderful contribution to the body of OpenEMR documentation. OpenEMR installation is documented in many different places and mostly written for the tech- proficient. Having one resource in an accessible place would be very convenient and helpful.

As far as the stripped down version you envision, that method sounds like a great approach. But as my motto says, ‘I am not a dev’ so I wouldn’t know what deeper complications might exist that have prevented the OpenEMR devs from already having done it that way.

Best- Harley

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How do i change theme styles or create a new one
#14

@mohamed There is a spreadsheet that keeps all the translations that are then generated automatically every time there is a new release / patch in the system. I believe if you search the forum you will find the link or you can message @brady.miller who can connect you with the process for doing translations.

As for the work involved in breaking the system up into smaller more modular pieces, this is a task for a developer, if you are motivated and want to get involved in the development the best place to start is tackling minor github issues. Its a steep learning curve so assisting with translations or even just improving the documentation for users to know how to better the system is probably an easier task at this point if you’ve never done any kind of development before. Its doable to be an OpenEMR code developer but will take time and effort. Several medical doctors have taught themselves a bit of coding to assist with OpenEMR.

#15

hi @mohamed ,

Regarding translations, check out this page for an overview: https://www.open-emr.org/wiki/index.php/OpenEMR_Internationalization_Translator_Guide

If you are interested in helping out with translations, then just send me an email with your google email address (my email is brady.g.miller@gmail.com ) and will then give you access to the translation spreadsheet.

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#16

@brady.miller
Sent you an email