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OpenEMR - Patient and Doctor Record Sharing

missionarogya wrote on Saturday, February 18, 2012:

We are a non-profit Healthcare organization for public health domain in West Bengal, India and realized that we will require a healthinformatics platform for efficiency. We also realized that we will like to have a opensource platform for two reasons- a) Financial reason to keep the cost minimal and b) Customize it for Indian public health domain.

We have been introduced to openEMR through a volunteer. We have a very specific fundamental question about OpenEMR, regarding sharing data across multiple clinics (facilities)

We will be implementing OpenEMR in multiple clinics which are in different part of the state. All these clinics are seperate entities and though for medical reason they may refer a patient to another clinic but they are essentially seperate clinics. Due to resource constrains (manpower, server, security), we cannot  install multiple openemr for each of the clinic spererately. We have to install  openemr in one central server at one of the central clinic (located centrally in Kolkata and thus having IT resource availability). From the other facilities the users will connect to this central OpenEMR server using browser from their computer. We will be using the SWAN (state wide area network), which is put in place by the state govt. for e-governance for connection. This is still under discussion.

To do a trial, we installed openemr , then we had setup two such clinics as facilities .We had setup some patients also. Then we realized that , though we can have different types of users (Clinician, Nurse, Physician, receptionist, clerk) using the ACL feature, but the users in both these locations can see all the patient data.

In reality, these hospitals are totally different facilities and they should not see each other’s patient , doctors etc from an ethical, legality perspective. The admin user (which will be the IT admin in the central location) may be allowed to see all patient data, but the hospital users and the doctors should not see each others patient data and/or doctor’s data, schedule etc.

So here are some specific questions:
Can the admin assign doctor and patients to a specific Facility, so only doctors in that facility can see the data of the patients in that facility?

Can the admin assign a patient to a specific doctor/hospital so that only this doctor can view and edit this patients data?

Can the admin assign other users (such as receptionist, clerk) to a specific facility , so that they can see/create schedule appointment for doctor and patients associatied with that facility only?

tmccormi wrote on Saturday, February 18, 2012:

For facilities that are essentially different and separate I would create separate database ‘sites’.  Then only the people with access the site DB will be able to see anything about the other clinics.  You can create a many site databases has you need and they will all share the same program code but be treated separately.

-Tony

bradymiller wrote on Saturday, February 18, 2012:

Hi,

Here’s a wiki page discussing the multi-site module(which is what Tony is referring to above):
http://www.open-emr.org/wiki/index.php/OpenEMR_Multiple_Sites_Module

-brady

missionarogya wrote on Sunday, February 26, 2012:

Thank you very much. We are going to try this out. We have couple of questions:
1. Should we install the default site in a windows box or linux or ubuntu box? Primarily from a performance perspective what is best.
2. Once the install for multiple site id done (say one for clinic1 and one for clinic2), what will be the URL that we will provide to the clinic1 and clinic2?
3. If we build some specific form using “Layout Based Visit Forms” and will require this form across multiple site, then should we first build the form and then copy the database?
4. And last but not least, what will be the process for sharing patient medical from one clinic to another? As this is for public health domain, so critical patients,  who will be coming in the village/rural clinics (most of the time this clinics are not equipped with the best treatment facilities), often need to be referred to the nearest district hospital. When the patient will come to the district hospital, it will be required that the patient’s medical record is available to the doctor at the district hospital. The patient can carry the paper records, but that will defeat the very purpose of implementing an EMR.
We are expecting that,in openEMR there is some way such that, for those patients only which are referred by the village clinic (say clinic1) the data should electronically come from the clinic1 openemr site to the district clinic(clinic 2) s openemr site.

arnabnaha wrote on Sunday, February 26, 2012:

Hi…
I am an internee in CNMC (Calcutta National Medical College). I am a lover and bug catcher (small one) of this software. Its immensely helpful and an awesme piece of work by all the developers here…
1. I have installed it in windows…no problems so far as I am testing this software for years. The community recommends linux
2. The normal URL is: http://your domain.com/openemr/interface/login/login_frame.php?site=default. After setting up clinic 1 and clinic 2 the URLS will be:
http://your domain.com/openemr/interface/login/login_frame.php?site=clinic1
http://your domain.com/openemr/interface/login/login_frame.php?site=clinic2

3. yes, first build the form in an empty database and then while using the setup for multiple site, you need to copy the database. This is true for Layout based Form. But if you want to use XMLformgenerator then you can transfer the form as you like.

4. There is an option in the patient summary screen called transaction. This is a method of referral. But I am not sure whether that will transfer data electronically to the second site. Please someone can enlighten on this issue.

Arnab Naha
Calcutta National Medical College

bradymiller wrote on Sunday, February 26, 2012:

Hi,

Agree with arnabnaha above. Suggest using linux/ubuntu (note ubuntu is a form of linux) if know how to use linux. For number 4, a couple suggestions come to mind. Note there is no current mechanism that will make a patient’s information available from one site on another site and will require some coding to implement. That being said, many ways to do this; one could be taking advantage of the patient portal mechanisms: http://www.open-emr.org/wiki/index.php/Patient_Portal
(guessing some modifications will be required to show all patient data since the portals don’t currently show all the physician notes etc.; but this wouldn’t be too hard for a developer to add to the embedded patient portal, at least)

-brady

bradymiller wrote on Sunday, February 26, 2012:

Actually,
Also the third party patient portal I think already has a feature to list all the physician notes (Z&H can correct me if I am wrong), so may be able to use that to already get what you want. See the Patient Portal wiki link above for details and note both the portals can be demo’d on the demo page:
http://www.open-emr.org/wiki/index.php/OpenEMR_Demo
-brady

missionarogya wrote on Sunday, February 26, 2012:

OpenEMR gurus,
Thank you very much for such quick and prompt reply. 
First of all, this type of software efforts are amazing for developing countries. Being a non-profit with minimal funding we are taking help of volunteers all across the world -  (currently all our funding are from the founders, we are trying for govt grants, which is very difficult here )
We realized that, this (EMR) is one such area where we will need such help… We are working with a organization in US who have several developers in different open-source efforts and have agreed to provide some of them in a volunteer capacity- Can you please let me know what exact skill set we will ask for doing this development work, if any required ?  They, infact mentioned about OpenEMR to us first and also helped our IT admin remotely to setup the first instance of openEMR. So we are sure that they know about openEMR pretty well, but we want to make sure that the developers they assign to this project have the skill set required…Though the organization is really gracious in offering developers free , but we don’t want to waste our doctors valuable time working with developers if they are not aware of this technology. I hope you understand.

bradymiller wrote on Tuesday, February 28, 2012:

Hi,
Skills for developers include knowledge of php, mysql, javascript, and jquery. Having knowledge of OpenEMR development and/or just knowing what is already available would be a huge plus(for example, figuring out best way to share data between instances requires knowledge of what options there are, such as the two patient portals). And if don’t have great knowledge of the OpenEMR codebase/features then their willingness to ask on the forums and figure things out would be a huge plus. Let them know they are always welcome to ask questions here and get code reviewed here if they wish.
-brady

missionarogya wrote on Sunday, April 22, 2012:

Hello Brady,
Please let us know if the sourcecode for the mydocsportal.com is available under the open-source licensing and if yes, can any one please provide the sourceforge link. We have been able to turn on and use the basic patient portal that comes with Openemr. Now,we are trying to enhance it and it seems most of the features are available in the mydocsportal - as such, we were thinking, instead of reinventing the wheel if the sourcecode is available under opensource, we will customize it, to get that integrated with our openemr install.
If it is not available under open-source, then is it possible to integrate with the mydocs portal with our openemr implementation? Is there any cost involved?
If none of these works out, we are trying to use microsoft healthvault as another option for patient portal. But that is a longer term goal

zhhealthcare wrote on Sunday, April 22, 2012:

Hi
mydocsportal.com isa free service and does not involve any fees.  It connects with any OpenEMR installation so long as they have a static IP.  There are bunch oof video tutorials posted that you can peruse to see how it is configured and used.  http://www.open-emr.org/wiki/index.php/Patient_Portal#Video_Tutorials

Thanks
Shameem
ZH Healthcare

missionarogya wrote on Monday, April 23, 2012:

Shameem, 
Thanks a lot for such a quick reply.  We will initially use the portal directly for the OpenEMR install as suggested in the videos.
But as we are planning to integrate with few other EMR (such as OpenMRS and other homegrown EMRs in different hospitals in India), we will really like to build our own patient portal version. As such, we don’t want to reinvent the wheel and at-least want to start from somewhere. Do you guys have the source code of the mydocsportal.com under GNU GPL licensing (or other open-source licensing) so that we can fork it from that? If not, we obviously understand. In that case, we just started to explore Indivo PHR as the base platform for this.

kodusote wrote on Sunday, October 14, 2012:

I believe the answer to your questions is YES.  However, this becomes complex, cumbersome and a bottle-neck as the system expands and staff changes occur.

One option you can consider is to have each facility run its own openEMR  on a local server and be able to have a system whereby patients can carry an encrypted version of their records in a portable media. If the patient needs to be seen in another facility within the network, the patient presents the portable medium (flash drive or smart card) and this provides enough information for the continuation of care at the new facility.

Check ACL for Patients, Appointment Flowboard