Questions to users for a potential user

(Seth Goldstein) #1

Open emr has been recommended to a client of mine from a contractor. I have been tasked with evaluating it as a solution. From experience, I have found that asking actual offices that use software and their IT guys for feedback the most useful process.

How is Openemr with specialized practice like plastic surgery?

Day to day what is it like to live with and use?

Support wise if functions and features don’t work how long does it take for things to get fixed? Is there an actual paid support package?

Is it better to have a local installation of the server or go with AWS?

How well does e-prescribe integrate? How is the submission to insurance companies?

(Daniel) #2

Basically, this solution is Open Source. What you see is what you get, but… you can hire someone to provide support and custom development. The cool thing about FOSS (Free and Open Source Software) is it gives you a lot of flexibility. If you have the know-how, you can set up a server and run OpenEMR for free at no cost. If you are a good self learner, you can watch the on-line videos and learn how to use it. It can be free, but at the same time you can be much more productive if you hire a consultant to walk you through the installation, explain your hosting choices, provide your staff with a support contract and training, and provide custom software development if the out-of-the-box CE doesn’t meet your needs.

Let me directly answer some of your questions:

1: How is Openemr with specialized practice like plastic surgery?
OpenEMR comes with the community edition forms. If you need different types of forms, you can create your own forms using the Layout Based Forms creating tool or if you need something more advanced you should consider hiring a developer. Specialized practices use OpenEMR but sometimes they need to pay a developer to make the changes they need.

2: Day to Day… This depends on what your needs are. If you have a support contract with an OpenEMR expert, it can be very easy. This depends if your needs are already met.

3:Support wise if functions and features don’t work how long does it take for things to get fixed? Is there an actual paid support package?
This is an open-source community. If you experience a particular bug and need it fixed, you should hire a developer. You can report bugs in this forum, but there is no guarantee for a timeline fix. Sometimes its easy and it will be fixed right away or sometimes someone has a fix on a branch that has not been brought into the master branch. Other times you might want to hire a developer to assist.

4:Is it better to have a local installation of the server or go with AWS?
This depends on your needs. Personally, I think its much better to have a self-hosted server on-site and have a paid IT guy manage it. Some people are very much about the cloud, but if the Internet goes down, you lose access to your OpenEMR instance. In the case of a natural disaster (earthquake, hurricane, or other unpredictable natural / human caused disaster) keeping an instance in the cloud may prevent your access in the most dire situations. On the other hand, self contained servers brings other issues. I do recommend using AWS or GCP to back up your data.

5:How well does e-prescribe integrate? How is the submission to insurance companies?
There are services that are offered that offer e-prescribing. I am happy to discuss these with you. Out-of-the-box works well with Availity and Office Ally.

The thing to remember is that OpenEMR is an open-source project. I am happy to discuss more with you. Feel free to send me a PM and I can get you set up with a support contract and custom development, depending on your needs.

The most important thing to remember about open-source software is you are free to do with it as you wish. You can modify it, you can repackage it, you can use it for no cost, its yours. OpenEMR is powerful and its meaningful use certified (MU2). If you have a question you can ask it here in the forums and you will usually have a response within 24 - 48 hours, but if you want a guarantee of immediate help you will want to consider getting a support contract with someone.

The other thing to remember is that the folks that pay for fixes generally support contributing those fixes to the community. As OpenEMR evolves, so does your system. OpenEMR is a powerful solution and extremely cost-effective. We aren’t a billion dollar corporation, we are a community of developers consistently improving and modernizing a robust software solution.

( #3

Hi Seth @aaacomputer
Well, I am not a user either; I provide customer support for one of the OpenEMR vendors. However, I do see a few of your questions I believe I can constructively comment on.

  1. As Daniel said, specialized practices do much better with a FOSS EMR than with one of the proprietary EMRs because the proprietary ones are generally much more (or even ‘absolutely’) resistant to customizing their product to your needs. If you’re running a FOSS application you can change the codebase to do precisely what you want it to do. The issue is strictly whether the development costs are suitable for the benefit you derive from the modifications.
  1. Day to day use: I have limited experience with other EMRS, though have trained on Practice Fusion, Epic and Centricity. In my observation, they all have their idiosyncrasies, limitations and strengths; none are perfect for everybody and none are without drawbacks. But at least, OpenEMR is FOSS and you can modify those idiosyncrasies to something you like better.

  2. The time required for support depends strictly on who you choose to provide it. I do work for Medical Information Integration, LLC (MI-Squared), one of the vendors that support OpenEMR, but I’m not going to recommend us over the other vendors because one of them may suit your needs better than we do.
    The current list of ‘OpenEMR Certified Support Providers’ is listed on this page:

  3. I like Daniel’s answer on this one.

  4. Re: eRx, of the providers listed on that page above, as far as I know only MI-Squared and ZH Healthcare provide e-prescription subscriptions. If your customer signs with some other vendor for OpenEMR support they may still obtain their e-Rx acceess from us at MI-Squared. Our eRx subscriptions are served from NewCrop LLC, and are completely integrated into OpenEMR, presenting its own interface through which the provider accesses all the capabilities offered by NewCrop. We provide both regular, i.e., non- Controlled substance e-Rx, and also Electronic Prescription of Controlled Substances (EPCS).

I do not know how ZH handles their eRx subscriptions or what services they offer.

Re: insurance access, Daniel’s right about the Availity and Office Ally compatabilities. Other clearinghouses (e.g., Trizetto) have much more idiosyncratic claim submission file requirements but OpenEMR, being FOSS, can be modified to provide whatever they need.

Hope this information is helpful.
Best- Harley

(Daniel) #4

I’d also like to add a bit about the clearing houses. I am currently completing a script that complies to the TR3 X12 format. Some insurance companies require this. I am hoping that with the code I have we can skip clearing houses all-together.

(Ralf Lukner MD PhD) #5
  1. You could use the OpenEMR software “as is.” It’s a giant database of information about clinical encounters, diagnosis codes, billing information, etc. that is ready to use. It is fairly straightforward to create your own “layouts” (forms) if you do not like the ones it comes with. You would need to hire some kind of system administrator/developer to maintain the system, create users, setup and test backup, investigate problems. I’m a doctor who does all this mostly himself. I wish I could afford to hire someone to administer the system and customize it, and I have done that on one occasion (on a small project basis). Mostly, I have simply customized it myself with the help of the OpenEMR community.
  2. The system (when running on AWS) is rock solid and a very high performance system. I have used about 7 EMRs, and I would compare it most closely to CPRS (the VA EMR) in that this system can handle enormous volumes of data robustly. It has extensive “automation” (such as clinical decision rules) that work well but are not nearly as “pretty” as what you would find on an EPIC or NEXTGEN system. Literally, the sky is the limit and you do not have to pay another $1000, $10000, $100,000, $1 mill or whatever once the feature is built or customized. You accumulate a computational and information “infrastructure” or “workflow” that grows as you build it and forms a foundation for future enhancements. If you can think of it, OpenEMR can do it. However, expectations probably need to be considered with respect to cost of custom-building or integrating some specialized feature. This is a very mature EMR that has been around for years and is rugged for real life. AWS is certainly one of the leading cloud infrastructures with as much power and redundancy as you will ever need at a cost that is surprisingly affordable with respect to running OpenEMR. There is simply nothing it cannot do. However, there are some things such as billing (where we use Kareo), lab orders (where we use Quest Quantum electronic lab orders) and eRx (where we use MDTOOLBOX) that we use other commercial/vendor web sites/packages because we need extensive, robust, and extremely efficient/fast features in areas where OpenEMR has the “hooks” but setup is currently very cumbersome, time consuming, and inefficient in actual “production” use compared to reasonably priced commercial alternatives (at least for me with my budget). For example, for controlled substances prescribing, it’s nice to use the PMP integration with MDTOOLBOX. It saves me 30 seconds every time I write a controlled substance prescription and that adds up quickly … plus it’s free (in Texas anyway). Could a custom interface for PMP be written? Sure. I’m sure that commercial firms that integrate OpenEMR, such as ViSolve and Z&H have these customized solutions or can make them … but for a “one provider” clinic like mine, it’s currently not cost-effective to make OpenEMR do everything that needs to be done. We use OpenEMR for the vast majority of the EMR recording, storage, and reporting. However, we currently have not customized it to do everything over the 2 years that we have worked with it.
  3. Repairs are probably 10X to 100X faster and more robust than with commercial vendors such as EPIC and NextGen. Plus, you don’t need to talk to an eager but inexperienced/relatively uneducated “rep” describing a problem. You can make fixes at lightning speed. Repairs are prioritized. Realistically, a difficult problem might take 2-3 months to get repaired, but you would have a workaround ready that week until the official repair is available.
  4. AWS.
  5. Poorly. We literally write “see MDTools” in our notes for the prescriptions. If there are specific medication changes, we mention them in the note. We can always copy and paste the medication list or part of it into the note or incorporate the PDF. With MDTOOLBOX, you have online prescribing information, electronic canceling of prescriptions, professional support that can trace prescription transmittal problems, interaction checking, electronic retrieval of prior prescriptions … none of this is available “out of the box” with OpenEMR. There are developers working hard on improving “gaps” such as electronic prescribing with OpenEMR (and keeping it open-source) but it’s not quite “ready” for general consumption when you compare it to the commercial alternatives that I mentioned. If you have 100 plastic surgeons and a 100 million budget for your EMR, you would be talking to Epic and friends and you wouldn’t be here. A plastic surgeon or two or 8 … you could probably afford to develop or purchase a custom eprescribing solution that does what you want.
    We print a billing report and then the billing person enters this information into Kareo. You do not want billing information from doctors going straight to billing companies unless you really don’t care about getting paid. Getting paid is a battle. For example, if you see a patient for a follow-up, an insurance company might deny the claim because the diagnosis claims are the same as they were at the last follow-up (the patient is healing, etc.). Only a person specializing in billing is going to know that those diagnosis codes need to be moved around for certain insurance companies from one follow-up to the next in order to get paid. There are ways of accomplishing this in OpenEMR, but it takes too much provider and biller time to work through the user interfaces and to generate the intermediate and working reports for that.
  6. Be sure to get an appointment reminder system. I like the MedEx system, which integrates tightly with OpenEMR.
    Best regards,