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Project - Integrate Telehealth

Telehealth is increasingly being used in healthcare and while OpenEMR does support a patient portal and communication with physicians via secure messaging or chat, OpenEMR does not yet support Telehealth. The goal is to support telehealth in OpenEMR.

Mentors:
@sjpadgett
@ken
@Nilesh_Hake
@arnabnaha
@gutiersa

2 Likes

Hi, I am Shreya Goyal, currently pursuing master’s in Health Informatics from IUPUI. I have a strong background in biomedical data analysis, Machine Learning, Clinical decision support systems, clinical information system and database management systems. I think telehealth is an important aspect of today’s modernization and incorporating Telehealth with EHR will largely benefit the users. The project looks interesting to me and I believe that I have the required skills to contribute to the project and to the organization.

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Hi Shreya,
I agree. How can I help you get started? I could outline what I think is a good starting point and show where in codebase one could start the engineering process.

I’m really happy you’ve shown an interest here and look forward working with you. If you so choose to accept the mission.:slight_smile:

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Could you please elaborate on what all functionalities do we intend to achieve as a part of this project.

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Hi, I am Vasu Jain. he project looks interesting to me and I want to contribute to this idea. I believe this idea will require Machine learning and Natural language processing tools along with web sockets for communication between physicians and patients. I would like to know about the codebase of this project so that I can start contributing. Thanks.

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Hi,
Thank you for the reply. Yes, sure. I am interested in the project and looking forward to work on this project. That would be great if you can provide an brief overview and outline of he project and I can start working on it.

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Hi all,
I suppose we need a starting point. For OpenEMR’s purpose, i’d like to focus on the clinical(telemedicine) namely, communications.

Currently the only feature that addresses this is in our portals Secure Chat. This feature was written with allowing patient and care teams or providers to securely message. It includes ability to send images whether video or image formats. However, with the recent proliferation of video(including chat feature) tools, portal chat is somewhat passe.

So, i’d say video conference would be our best bet to get a telemedicine feature started. To this end we’d need to find the best video tools to fit with a hipaa compliant implementation of video along with building infrastructure into OpenEMR to support. These two requirements can happen in tandem.

For infrastructure the main areas needing addressed are:

  • Integrate video sessions with Appointments for scheduling and billing.
  • Integrate with encounters because, well how else do we document.
  • Integrate with portal however, should still have ability to conference from other means. Mobile etc.

For video streaming tools, currently we have Nodejs, PHP and Javascript that can support.

My current thinking is to have our own streaming server while trying to keep as much as we can within OpenEMRs domain. I’ve setup a node server in the past using https://webrtc.org/ but, by all means research as I haven’t looked in awhile.

Important is to keep Hipaa forefront.

Suggestions?

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Hi All,

We can integrate the Zoom api for the video conference just we need to check zoom api is freely available or not.

If any one already investigated on that then please comment

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Here is a version of OpenEMR patient portal with Zoom
First, the patient needs to create a video appointment from here
https://patient-portal.visolve.com/signin
Request an appointment by clicking “Videoconsult”

Now, the physician can login to OpenEMR and start the video conference using zoom just by clicking the patientportal—>scheduled appointments from the OpenEMR home screen.
-visolve-899

hi @Nilesh_Hake, what about jitsi?

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@stephenwaite,

I will check that and comment here later

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are their any plans for integration with solutions such as Vsee?

Just posted a TeleHealth Visit form that links to Jisti-meet on github. Maybe others will tweak it to work with your provider of choice (Zoom, Vsee, 8x8 etc.). Should be simple to do. It is currently being reviewed to see if it is codebase worthy. The form does also link to MedEx’s Telemedicine Service but if you do not have to be a MedEx SMS/Voice subscriber - it will work just fine without that. It is not a “module” - it is just a form - and installation is not complex.

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Alternatively, we could try google duo. I would prefer to use a solution that is US based, just because we want openemr to continue to comply with certifications and meaningful use. More specifically, with US CMS.

Check out this article:

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Ideally, if the video conferencing (telemedicine) solution could be set up as a connection to openemr, then users could have multiple options:
It could be connected to a paid service, or
it could be connected as a free opensource solution

Is this possible?

Hopefully the GSOC folks will add all the right options. I’m a clinician not a programmer but when I see a need not being addressed I feel obliged to write something. I wrote the form so people would have something today. I linked it to Jitsi which is opensource and MedEx, which is part of this community already. Jitsi is an opensource product, and the company Jitsi is owned by 8x8, a US company (San Jose, CA). Most interfaces you will see for teleconferencing/medicine are built from Jitsi. They are just like the vendors repackaging OpenEMR. Some share back, some don’t. We could of had telemedicine years ago in the codebase…

I believe any corporation that is offered a hook in the OpenEMR codebase should become a sponsor of the foundation. You think Twilio, EFax or RC would contribute to OpenEMR development? I hope the people promoting those interfaces ask those corporations (Twilio’s market cap is > 10Billion) for financial support too - it could be enough to fund MU3? Heck they could sneeze in OpenEMR’s direction, a million dollars could drop and many, many things could be accomplished… You just don’t know until you ask.

Yes, I do agree with you about considering US companies because of HIPAA. I’d vote against including Zoom, not because of Zoom bombing, but because their key servers are reportedly not in the US (Beijing, China). If true, they are not HIPAA-compliant even if they offer a BAA. Time will tell there… I’d vote against a local node.js webRTC implementation too. One less thing for the user to have to secure and patch themselves. Jitsi itself does not offer a BAA for HIPAA compliance so when the pandemic is over it is not an option for me. Will 8x8/VSee/Doxy.me offer a BAA and sponsorship? Asking should be part of the GSOC experience.

Best of luck to the GSOC candidates and mentors! It should be a great learning experience.

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I am a clinician as well.
“I’d vote against a local node.js webRTC implementation too”
May I ask why?

“ One less thing for the user to have to secure and patch themselves”

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Hi @sjpadgett - I have experience working with WebRTC, and would like participate in this project if I could. Here are few cents from my side.

If we are looking for One-to-One call on web, all we need is a singling server and preferably turn servers for better quality of calls.

If we are looking for multi-party calls, we have to introduce media servers e.g; jitsi, janus or kurento.

If we are looking for hosted solution, then quickblox and twillio have products which can help.

Looking forward to working with you.

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Hello, I am interested also in this topic, let me ask you, by multi party calls do you mean more than two people?