Oemr.org and Drupal

jason0 wrote on Friday, July 29, 2011:

Hello,

My name is Jason Brooks.  Sometimes I do a tiny bit of development for openemr, but more often, I am beating it with a stick as an admin.

To me, the argument about advertising appears to have a middle ground.  Most of my proposed titles are meant as humor, but I don’t pretend to understand all of the issues.  I apologize if I step on any toes.

First, I think it should be made clear to the visitor what the site is.  This could just be the frontend for the 501©(3).  It could be the nexus for all things openemr, or even a list of all known open-source medical projects.

Second, I believe it is important to make it clear how decisions get made. For instance: “though we have sponsorship, said sponsors are well aware that we will choose what is best for the community, and if they don’t like it, they can go code their own emr product.”

Third, remember the range of people viewing the site: some will be technically oriented, but others may just be providers, or managers trying to keep their costs down.  So, perhaps a link to “How to use openemr” oriented to the layman, as well with technical references.  “You could build your own openemr server, or have someone do it for you”.  It’s what I tell people in person about openemr: “it’s so free you can install it on your own systems.”  Thus, I think it’s important to give people the sense of their freedom to do with it what they wish.

As money is important to keep the lights on and disks spinning, I believe fundraising has a fundamental part of the page’s function.  The donate button is good.  I think advertising can have a place here.  Some sites have links to a list of vendors.  Perhaps ours could have a link to “vendors that play nice with open-source software”.  We could even have a tab for “vendors that contribute money, and/or programming expertise”.

But the fundraising can go even further than just keeping the lights on.  This fundraising could be used to advertise openemr, and oemr on other sites.  There are parts of the code that need work but the code contributors haven’t gotten to, or lack the expertise.  I have lots of ideas on how to improve the database, but I don’t think like a DBA.  I think this is one of the reasons the board was put together: to keep openemr moving and growing, and to find resources for what needs to be done.

Most certainly we should have a credits page for any companies, groups, and individual contributors.

If we take the case that advertising may be allowed on the front page, perhaps an enclosing box with a title “paid advertisement”, or “we like these people enough that we allowed them to pay us to put their ad here”.  This might avoid the impression that oemr.org specifically endorses a particular company. 

If advertising on the front page is verboten, then perhaps a few additional links: One could be “how to become a sponsor, or patron”.  Another could be “Recommended Vendors”, “Known Vendors”, or even just “Vendors”.  Perhaps something to allow vendors to announce themselves. 

The x.org foundation is an example where they have a list of Acknowlegements to various vendors for what they do.  They also have a Sponsorship page. 

The pfsense.org people have a list of recommended vendors, and also make no pretenses about them offering commercial support.

I hope this helps…

-jason

drbowen wrote on Saturday, July 30, 2011:

Rod and Brady insist that Tony, the OEMR Board, and I have ignored the membership of the project.  One of the biggest problems that we have is that have a large number of “lurkers” and it is very difficult to know what they are thinking.  Since this is a really long thread, I am going to attempt to summarize the thread.  Forgive me if I mis-represent your views.  I tend to be colorful in my descriptions and use colorful vernacular.  (Thank goodness, that we didn’t publish the ad that Shameem really wanted).

Rod Roark – No bleep bleep advertising, He doesn’t believe OEMR has anything to do with this project and he is definitely not willing to admit they have any control.  Traditional donations and grant writing should be enough.  It is OK for OEMR to help with infrastructure.

Brady Miller -  Not intrinsically opposed to advertising but wants the PayPal Button to have primary visibility.  In newspaper terms he wants the PayPal button above the fold and any Ads below the fold.  He is worried about who will be allowed to advertise.  Does not want a new forum.  He doesn’t think the new site is really ready.  Upset about insensitivity to the community.

Shameem Hameed – Shameem is fine with advertising and agrees the Non-profit needs recurring revenue.

Tsvas – Donate button should be more well defined. He likes discrete $20 / $30 / $40 dollar suggestions.  We are getting ripped because we are not charging enough money for this privilege by a lot.  Would like to see a credits link.

Tony McCormick – of course oemr…org is the main landing zone.  It has been for 6 years.  We need recurring revenue.  The board voted and approved this.  Prefers to leave forums at SourceForge for now until a better tool is available.  No, we are not going back to the XOOPs page.

Art Eaton (aethelwulffe) – Confused over what OEMR is.  Recognizes that the project is starving for money.  Really would prefer a better forum than SourceForge.  Thinks we are dragging our feet on phpBB (Art I can only do so much in a day, it’s not malicious or intentional).  He is against such a direct ad.

Sam Bowen -  Uuuhhhh… that’s me.   I am in favor of recurring revenue by whatever legal means necessary.  We have raised, between OSMS and OEMR, around $7,700 in the last 6 years.  Around $5,000 was specifically donated to Open Source Medical Software. The balance (%2,700) was directed to OEMR.  Refractoring the database is going to need about $200,000 to get started.  Probably $2 million to complete.  I am basing this on the recently completed Meaningful Use project.  The donations and grant writing is not even a blip of what is needed.  I am definitely fine with ads.  I am like Brady.  Not sure where best to place these ads.

Jack Cahn -  Wants everybody to take a deep breath and calm down.  Best accomplished by stepping away for a few days.

Pimm  -  He doesn’t like all the animosity and virtual shouting.

Jason Brooks – Make the purpose of the web page clear to the end user.  Ads are OK.

At the OEMR Board meeting (the one that Rod and Brady do not recognize)

Greg Neuman – OK to advertise in the manner suggested.

Ron Beardon - OK to advertise in the manner suggested.

Sena Palanasami - OK to advertise in the manner suggested.

Tony McCormick and Sam Bowen were at this meeting as well and their views are listed about.

I make that 10 “YESes” in favor of advertising, 2 very definite “Nos” and 2 abstentions.

Sam Bowen, MD
http://www.oemr.org/

sunsetsystems wrote on Saturday, July 30, 2011:

Sam, if the OEMR.org nonprofit’s Board votes to have advertising, I think that’s fine.  It should have it.  On its own web site.  Particularly as it also collects the revenues and decides how to distribute them.  It troubles me a bit that the organization is controlled by a tightly knit group of vendors who, in turn, get to decide which vendors are deemed qualified to receive these funds, but whatever, that is the organization’s internal business.

It doesn’t surprise me that the Board would vote to advertise its members on someone else’s billboard.  But don’t expect the rest of us to get all warm and fuzzy about that.

It also doesn’t surprise me that this group of vendors wants to control everything that is OpenEMR.  But what if you guys would instead direct your energy towards building a large membership base which has the power to elect the nonprofit’s Board, getting a large portion of the thousands of OpenEMR users signed up and perhaps even paying dues, getting grants and so on.  Isn’t that what a nonprofit is supposed to do?  If you accomplish that I will be pleased to lose this battle with a smile on my face and join your movement.

Until then, I will continue to do what I think is right to protect this community of users.

Now can we stop this public airing of dirty laundry?  Brady tried to initiate private discussion of this but that only got misquoted in the opening salvo of public debate.  Nobody’s mind ever got changed in a flame war.

Rod
www.sunsetsystems.com

jcahn2 wrote on Saturday, July 30, 2011:

Ahoy Rod,

Let’s explore expanding the general membership further.  You have posted on this at least since January.  Do you have any specific ideas how oemr.org and/or the OpenEMR project can include and organize a broader membership.  If we could have input from even 1% of the folks who have made downloads there would be a whole new level of credibility here.

This would mean 30 new members a month (yes I know these are not all unique users due to multiple downloads per user but the number would be significant even at only 1%.)  A membership fee would be a barrier to participation and I would discourage that.  Membership would be necessarily tiered. 

Level one (free) would have voting rights in all of these issues where we say we would value knowing how the many users of OpenEMR feel about things. 

The next level (Low entry fee, say $25/year) would enjoy other benefits - maybe a newsletter, access to help via forums and the like.

Basic, Enhanced and Corporate levels have been defined by Tony on the oemr.org site.  Maybe we could divide down the Basic Level.  I just feel there should be voting rights at lower levels without the financial barriers if we feel we need more input from the user base.

A voluntary registration window would be juxtaposed to the download button (can we do this on SourceForge or do we need our own mirrors?) explaining the available categories right there.  Make it very easy with minimal required information.  Mandriva used to do something similar a few years ago as I recall.

This would of course be oemr.org membership since the project is not a membership entity (previously noted).  This would require up front explanation/definition.

Jack

drbowen wrote on Saturday, July 30, 2011:

Rod, please read the list a little closer.  Of the twelve cast votes only 4 can really be considered vendors.  I am counting you as one of these vendors.  The others are regular users.  This project has a lot of readers, a lot of folks who avoid controversy, and a few who step up and speak there mind.

If we subtract all the vendors the vote is still 7 to one with 6 abstentions (4 vendors + 2 true abstensions).

Your argument and Brady’s argument that we are ignoring the community doesn’t wash.

Sam Bowen, MD

sunsetsystems wrote on Saturday, July 30, 2011:

Jack I think that’s a fine topic of discussion, however this is the Developers forum and we have already strayed way too far from that.  Why don’t you initiate something about that in the Users forum, and try to keep it on-topic for OpenEMR users (i.e. keep in mind that as things stand now, only the OEMR.org Board can decide what its policies are).  Or we might consider starting an OEMR.org forum if the organization wants that.

Rod
www.sunsetsystems.com

sunsetsystems wrote on Saturday, July 30, 2011:

Sam, your statistical analysis methods are deeply flawed but I didn’t want to talk about that here.

Rod
www.sunsetsystems.com

zhhealthcare wrote on Saturday, July 30, 2011:

Like you, Rod,  ZH is not just a Vendor: we are also developers and users of the software.  Also, through us at least 75 plus providers are using OpenEMR.   So I speak for 75 users.  Should that count as a disqualification to vote, or should our opinions be given more weightage? Would I get more value if I was simply a user?

The same goes for many of the individuals you downgraded as mere “Vendors.”

How is it that these vendors want to control everything?  What is there to control? The only controlling these people did was to generate resources to get OpenEMR certified.  “Vendors” in that group, as recently as this last test, spent time into the wee hours of the morning so that we could pass certification: this includes Selvi (Visolve), Tony (MI-2) and myself(ZH).  And I assure you, we were never paid.

it appears the vendors behind OEMR.org and the related add-on for-pay services are determined to cash in,

I am assuming that you are talking about the eRx solution.  To me this is being done because there is no other way to meet contractual requirement, and eRx vendors do charge.  Also, it is not one Vendor that is allowed: there are four different solutions on last count.  OpenEMR maybe the only EMR with four different options for eRx.  Why dont you bring in a solution that is open source for eRx: That act should deflate this entire argument.  I dont see any other add ons.

I dont understand why you are so trigger happy to mark a distinction between oemr and the project.  As a senior, shouldn’t it be an act of statesmanship from your end to find a way to keep things together?  Why should it be your way or the highway? It’d seem like a deliberate attempt to drive out all the good contributors so that control will never be lost to whoever thinks they have it now?

Shameem

sunsetsystems wrote on Saturday, July 30, 2011:

I don’t see how we’re in a position to be voting here on behalf of the community.  That raises a huge swarm of issues that can keep us busy for a long time, and to what end I have no idea.  And I think I’ve talked enough about distinctions between OEMR.org and the project, not much I can add.  In any case it’s not something I’m trying to create, but something you guys seem to be trying to remove.

So I’m getting confused as to what OEMR.org is asking for that it doesn’t already have, and don’t know why you are suddenly quoting old discussion and talking about how hard you have worked.  Didn’t think that was in question.  Is this still about advertising or are we still not done with being negative?

Rod
www.sunsetsystems.com

bradymiller wrote on Saturday, July 30, 2011:

Rod,

Regarding using open-emr.org vs openemr.sourcforge.net for the project web site, I’m gonna open a new forum thread for that subject.

-brady

bradymiller wrote on Saturday, July 30, 2011:

Art,

Regarding the subject of a new forum, I’m going to start a new thread on that subject.

-brady

bradymiller wrote on Saturday, July 30, 2011:

Sam,

Appear to be two issues that are raised in your post:

1. Why the main project site has been migrated to openemr.sourceforge.net

This is what happened (quoted from my post above):
“I think the misstep taken here was that OEMR designed a implementation plan (including the advertising) for the new site that seemed reasonable. However, when implementing the plan, some members of the community began voicing some real concerns. Rather than listen, those concerns appeared to be ignored by OEMR as the original plan was carried out. At this point it became apparent they were not addressing these issues, so I requested(via forum and several emails) that the site migration be delayed/reversed in order to simply address/resolve the issues. My request was a completely appropriate request which was ignored/minimized.”

This is how the project administrators then responded(quoted from my post above):
“I would never ever consider forking the project, and that is not what I am proposing. I’m just concerned that the above took place, and that the community should consider the possibility of a separate Project site and a separate OEMR site(note the Project site would still clearly list OEMR prominently in multiple places on the site as it’s entity/Supporter to not lose the certification/ICSA etc.). These things are never set in stone and I hope it will be only temporary after OEMR addresses/resolves the issues.”

I do not blame anybody from OEMR; I truly respect everybody within OEMR and deeply value their contributions. Again, a plan was formulated that was thought to be reasonable by OEMR. My issue is that OEMR did not respond to the communities concerns(notably, despite the concerns and ongoing debate at this time, the advertisement still sits on www.oemr.org). It’s not a question of whether the community agrees to advertising in the future, it’s the issue that OEMR did not and still continues to not respond to the communities concerns. Also, this discussion is ongoing, which leads me to issue number 2.

2. Encouraging open discussions on the forums
Members from the community took their time to express their thoughts on this issue. The categorization of members and the shortening of their lengthy, well thought out posts into one or two sentences comes off as disrespectful and does not foster an open discussion.

-brady

ericsbrown wrote on Monday, August 01, 2011:

     I am brand new to using OpenEMR, just this year, I had never heard of it before.  I was looking for an EMR and did searches for open source and found plenty.  What made me lean towards OpenEMR was the fact that it wasn’t plastered with ads.  The more that I looked into the other “open-source” EMR’s the more frustrated I became.  Oh sure the software was free to download but the instructions on how to set it up or use it were of course provided at a charge by the many advertisers on the pages.  After checking out several EMR’s I chose OpenEMR because it seemed that there wasn’t anyone that was holding back information or wanted to get your money.  I was glad to see the separate page of not only contributors to the project but the offerings from the various companies on the services that they can provide.  Having separate pages for these things doesn’t come across like a smack in the face that no one is going to help you if you have a question because all they care about is the money that they can make.  Putting the ads on a separate page will also not stir up things because bob didn’t get on the home page and sally did.  The truth of the matter for me is that I have asked questions in the forums before and haven’t gotten responses.  Tony happened to answer one my questions, he didn’t act like I was a total idiot because I asked the question to begin with, and as a result I am doing business with him (Labcorp is paying for a bi-directional interface and we are going to do eprescribing also).  There was no ad smacking me in the face, he didn’t try to give me a sales pitch, it was simply that he answered a question when others wouldn’t.  Please do not turn this great EMR into one of the ones that I turned away from because of the pay me and I will tell you attitudes.  Oh by the way no I haven’t donated any money, if I could I would in a heart beat, and when I get to a point where I can I will.  All of the businesses that I am a part of are new start ups so there isn’t a lot of money flying around, if there was I wouldn’t have found OpenEMR in the 1st place so in that respect I’m glad.

If you read this then that’s great, if you ignore what a user thinks then whatever.

Eric
Marion Occupational Medicine
GB Enterprises
Marion Primary Care
RCS Collections
Marion Urgent Care
American Imaging & MRI
Open & Wide MRI

aethelwulffe wrote on Monday, August 01, 2011:

It is great.
Agreed on all points.
Yes, it is good to have links to professionals who will support users by contract.
Those links should be earned by contributing to the community at large in a regular, non-self promoting manner that says: “Yes, I do this for a living, but I am also here as a philanthropist”.

-Art
Beach bum/bubblegum scraper/Adventurer

drbowen wrote on Tuesday, August 02, 2011:

Dear Eric,

The issue being discussed does not involve adding ads to the OpenEMR program.  I don’t think I wishes or wanted to imply this.  The issue was to whether to allow advertising on the non-profit web page (http://oemr.org/).   The administrators here felt very differently about this issue than the OEMR board and uhh… became upset when the OEMR board did not act as swiftly as they wished.

I would like to remind everybody that the OEMR board currently has ten members and it takes a while to get a consensus.  I am a representative of the board and will do what they ask me to.  Most of the offending changes have already been reverted.  I removed the links to the forum as requested. The advertisement hasn’t been moved yet primarily because the board is still deliberating the issue.  I think we will likely change the location based on the feedback that we have received. It is still a bit up in the air.

If you would like to express your opinion now would be the time to do it.  I was taking a rather un-scientific poll above.  The first poll was the two site admins and one user.  The second pole counted 14 known opinions.  Neither is very scientific but we don’t actually have a very good policy about who gets to vote, how to conduct a vote, or to just conduct a public opinion poll.

The current site admins seem to think that they will be able to get consensus without any dissenting opinions from this loosely associated project.

The OEMR non-profit has well defined bylaws that define a quorum, how votes occur, how they are counted.

Rod is quite correct that my poll above is "un-scientific.  I for one don’t really relish the idea of letting anonymous users to be polled on anything more than feature requests.  I would be willing to bet that the admins of the sight would not allow this type of polling of anonymous users to decide on software policy and planning.

It would be reasonable to discuss the following:

Who is a member?

Who gets to vote and on which topics?

Rod and Brady?

The four integrators?

The OEMR Board?

Registered donating members?

Any anonymous passerby?

How do we vote and tally the results?

Who gets to vote?

Brady has insisted that the software integrators remain a relatively small tight group.  Currently there are four GitHub integrators and setting up coding guidelines should really be handled by these guys.  This I think has caused the current code base to be released with relatively high quality

Rod and Brady have control of the SourceForge site and don’t tolerate dissent. (But maybe we should put that up for a vote as well :wink: ?

I think the OEMR Board should set policy for the non-profit.   There is provision to elect board members in the by-laws but we are still trying to get the non-profit organized.  The OEMR organization will need to decide who can vote on the board of directors and get a membership going before we have anybody who can vote.

There is still a host of issues that need to be worked out.

Most non-profits especially, if they have large corporate contributors, to have one company representative on the board.  This is a self-preservation instinct on the part of the non-profit because that is where most of the donations come from.  Having these members on the board are a right wing plot.  This is standard operating procedure for successful non-profits.

Rod’s original suggestion was to ask for donations to become members of OEMR.  I think this a valid model and we have set some recommended donation levels.  I like Jack Cahn’s idea of still having free membership and a $25 level.  We already have a $100 level and a $500 level for companies.

We need to have some public form for the board members of OEMR to have more public discussions.  Currently all the discussions have been happening by private email.  I think this has been feeding into the confusion.  We really have been discussing these issues a lot but unfortunately at this time is has been hidden from public view.  I had set up a forum at http://oemr.org/ for this purpose but it has been disabled at the request of Rod and Brady.

Sam Bowen, MD
http://oemr.org/

drbowen wrote on Tuesday, August 02, 2011:

oops…important typo correction “NOT a right wing plot” sorry.

sunsetsystems wrote on Tuesday, August 02, 2011:

Sam, better to discuss OEMR issues in the Users forum.  Jack started a thread there entitled “Membership” that may apply for some of this.  The Developers forum is for software development stuff.  I do have comments but don’t want to extend that discussion here.

Rod
www.sunsetsystems.com

aethelwulffe wrote on Tuesday, August 02, 2011:

Hmmmm…. at a casual glance I see a large number of forum topics that are not about software development (with no protestations) that have been in this loosely defined section that have nothing to do with software development.  An end user might protest the use of their forum to discuss things that have not bearing on the use of the program…unless that is just really a dumping forum that no-one cares for?

  Hard to poll opinion about getting a forum with polling on a forum with no polling….

Sam.  It is a right-wing plot.  This is permitted.  We left-wingers fight for the right of the fundies to plot in that manner.

sunsetsystems wrote on Tuesday, August 02, 2011:

Do you guys want an OEMR.org forum on SF?  I’m willing to create one if Brady doesn’t have a reason to the contrary.

Rod
www.sunsetsystems.com

ericsbrown wrote on Tuesday, August 02, 2011:

Dr. Bowen
           I did realize that the discussion was talking about the website ads and not ads being placed in the EMR itself I should have been more specific in my wording.  I was just throwing my two cents in by explaining how most of the sites that had ads on their main website pages offered a “free and open-source” EMR but the reality was that they were more interested in trying to sell the support and setups that they didn’t help anyone.  I came across one, that was the worst, they didn’t even offer setup instructions.  But they would be more then happy to sell them to you.  The first thing I noticed about OpenEMR was there were no ads out on the home page (or any for that matter).

      If it comes down to it and the decision is made to have ads let them be random or rotate them every week that way it doesn’t come across as anyone trying to promote a certain company above others.  Everyone here I am sure does good work but you may have a smaller company that wouldn’t be able to pay to have their ad on say the homepage.  They may be just as good as the bigger company that has more money to advertise.  Along with rotating the ads, a disclaimer could be put on the site that says something to the effect that the ads on the site are paid for by contributing companies and the site is not implying that they should go to anyone specifically and oh here by the way is a link to the page that lists all of the companies that offer services in conjunction with OpenEMR. 

OpenEMR is a great product and I would hate to see it go down hill because to side can’t work together.  I worked as a consultant for Si*m*ns RIS system for 2 1/2 years after I worked on it for 5 years at a hospital.  They had there EHR side and the RIS side and the two couldn’t get on the same page to save their lives.  I saw several places dump them in the middle of an install because of bickering between project managers.

I think you all are better then that - setup a dual board do 5 from each side and then pick someone as an 11th so there isn’t a tie vote.  I would quite frankly like to take as much business away from that certain company as I can and I think OpenEMR has the potential to to do that in not only clinical areas but as a potential RIS.

Ok so I’m done. Its almost 1am and I have to get a soap note made.

Thanks

Eric