What I thought OpenEMR would be - confusion

Management and Administration
#1

Hi,

When i first heard and walked into realm of OpenEMR, it was with the thinking that the abbreviation EMR meant Electronic Medical Records. With this understanding i figured the scope of this software would be related to the Creation, Management and Administration of patient medical records (with the same applied to EHR).

After i went through the documentation and the installed software, i realized i was partially correct as it appeared that, from the functionality, OpenEMR seems to manifest a hospital/clinic system. Would this be correct?

I hope to get some help in understanding if my thoughts were consistent.

#2

Hello @murugappan -
Yes, OpenEMR is an Electronic Medical Record and it does maintain patient medical records in the way you described.

However, OpenEMR is not intended for inpatient settings such as hospitals where patients are admitted and remain for care over multiple days. It is oriented to outpatient clinics and physicians’ practices where patients make appointments to come in to see the provider then leave the clinic.

Some of OpenEMR’s capabilities can be configured to work in an inpatient environment but many of the activities that are commonly performed in a hospital are not supported by OpenEMR.

If you have any other questions about OpenEMR this forum is a great place to ask people who use it or support it every day.
Best- Harley

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#3

@murugappan Since the team just went through significant effort for ONC 2015 certification, it is fair to say this is a EHR system by industry (at least USA) standards.

Best.

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#4

@htuck , good to hear from you.

Thank you so much for the update. I understand what OpenEMR is today. Based on what it has become today, shouldnt it be named as Open Medical Management System or some sort? I am sure you agree that functions such appointment, encounters etc are daily workflow of a clinic. Initially i thought it was more of a system similar to document management systems (DMS) for medical info.

We have/developed an extensive hospital /clinic management system with telemedicine and pharma facilities. The problem we have is maintaining the details of each patient in a central generic repository which can be tapped into by any medical, reporting and/or analytical systems. We had trouble with that due to the complexity of information and medical terms. I guess i misunderstood OpenEMR though we could use design ideas to create one such repository.

If you remember, i suggested we should re-document the system some time ago. Well, as i dug deeper into the system i realized OpenEMR is not what i expected to be therefore i decided to put on hold as this would duplicate the efforts of our own system

In my opinion, after significant BPM studies on many clinics and hospital here, I would say OpenEMR may be on overkill for clinics in countries in South and South East Asia due to the population size. For a hospital, OpenEMR records component may be suitable but patient management part may not be. We tried the system with medium size ambulatory center and results were not satisfactory.

@mdsupport , thank your for the feedback. I agree the effort is really great and fantastic but i just feel that some part may be a re-invention of the wheel (based on my feedback to @htuck above). The patient documentation part is great but the clinic management part, i am not convinced (need more time). With regards to the certification, i understand but i am not sure OpenEMR jives well with BPMN standards and outcome. Just my 2 cents worth.

#5

I have a few questions for you and maybe we on the forum can clarify confusion and also offer advice on how to accomplish what you see is lacking.

Questions:

  1. What are the tasks that you expected to be able to preform but you have not been able to do?

  2. Are missing capabilities something specific to your geographical area?

  3. What requirements do you need? If OpenEMR does not provide them, are you willing to consider doing a cost analysis of the cost of hiring a developer(s) versus paying for an alternative solution?

#6

I, like @growlingflea, would appreciate a more detailed explanation of where you see improvements are needed especially how we can become a better fit for international and underserved communities.

This I don’t understand. How so?

#7

@growlingflea thank you for the offer. But no thanks we have our own developers but in case of any consulting opportunity i will definite keep your offer in mind. To answer your questions and hopefully that of @sjpadgett too, let me explain what i meant by “I would say OpenEMR may be on overkill for clinics in countries in South and South East Asia due to the population size.”

The word “overkill” does not mean “lack of” instead it means “too much” functionalities. The doctors and nurses here are competent in their jobs but cannot say the same about their technology knowledge. They are raw nurses but dumb when comes to terminologies which they dont use often. Example in EMR we say “encounter”. If we use the same word with a nurse, she immediately relates this to a police encounter wherein a criminal is tracked down and shot. The term used here is “visit”. This is just a simple example. Another example, people here are not yet adaptive to idea of making appointment with outpatient doctors. They would walk-in most of the time. Anyway, clinic doctors do not keep with appointment times too. Its difficult when they have 30 patients waiting with “short fuses” outside their door. A friend of mine did a simulation of the OpenEMR processes using Bizagi BPMN modeler and the results were depressing with too many hiccups.

“Too much” functionality means extra steps or functions in EMR to be executed from registering a patience to leaving the clinic after treatment. Here, the clinics just register/select the patient profile details as walk-ins mostly. Very seldom through appointments unless the doctor is a specialist. On the average, a medium size clinic get at least 100 patients a day. Well the BP (business process) is different when compared to the west. Each clinic here have their own mini pharma too.

I hope i have provided some clarify. One thing though the level of medical records kept are very much disgraceful here. That is what i meant by managing a central repo for EMR (records system). This is what i meant to address. We are TPA company that process medical payment claims and want to provide a rep for all our clinic and hospital members which number 4,500 of them.

#8

Ah @murugappan is your use case to provide EHR functionality for your clinic customers that do not have their own EHR so they enter all data remotely for you to manage claims part of their business?

If you go through processes in detail you would find most of the overkill functionalities can be disabled easily in current product or with little help from your php developers.

However, based on my limited understanding, challenge for your central repo requirement using standard interface would be that this product assumes patient info belongs to entire installation. Luckily you are the type of entity that ONC Certification had in mind. So I would encourage you to create your own process models based purely on FHIR calls while your repo gathers data in single instance. Just start playing with latest version and make FHIR implementors for this project your best friends.

Who knows, hopefully you can add some additional capabilities to this project that others will see as overkill.

Best.

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#9

Hi @mdsupport , thank you for the advise and feedback. Great stuff.

My post here was not to question what OpenEMR is today. I raised this as a discussion point on the scope of OpenEMR as to what it should be and what it is now based on the term “Electronic Medical Records”. The term EMR indicates that it should be medical data repo but what it is to day is a medical management system.

As per your suggestion, we could disable the clinical processes and still develop external depository interfaces to create a repo. We were looking at it in that direction but the worrying point on subsequent upgrades and functionalities may create dependencies on these processes. Additionally, we have a principle of not meddling with the original code and to use the system “as is”. Meddling and refactoring code defeats the purpose of using the software as our modified version will no longer be OpenEMR. We might as well develop our own. This is my viewpoint based on Information Strategy Planning (ISP) standards.

#10

If all you care about is strictly the Electronic Medical Records storage database, look at building something off of Hapi or Linux-FHIR (formerly IBM-FHIR). If you’d like more out of the box solutions, Azure, Google, and AWS all offer SAAS services for FHIR.

In terms of making sure modifications don’t impact hacking the core software product, We’ve been encouraging people to consider how to use event listeners and custom/laminas modules to maintain a sane upgrade path for their customization. We are very happy to take pull requests for event listeners that you can connect to and make plugin customization to the core code.

You’ll have to look at the cost benefit analysis to building your own versus modifying existing software, there is always trade offs.

#11

@adunsulag So sad you did not read my previous post-reply to @mdsupport or perhaps my English is bad for which i apologize. This is what i said:

My post here was not to question what OpenEMR is today. I raised this as a discussion point on the scope of OpenEMR as to what it should be and what it is now based on the term “Electronic Medical Records”. The term EMR indicates that it should be medical data repo but what it is to day is a medical management system.

Which has nothing to do with what i care about. My post is a discussion about the scope of OpenEMR and what it represents.

#12

@murugappan I read all of your posts and I gave you suggestions based on what you wrote in your previous post. It sounds like there is a language barrier problem as I was responding directly to what you stated.

Since you are looking for a central repository that segments your patient data based on your clients and you wish to do analytics and reporting across all those segments, OpenEMR is not a good fit for that use case right now. You can run things in multisite mode to segment your data but you’ll have to inhouse develop methods for analytics across all of that data. With a bit of work this could be developed in OpenEMR, but you’ll need to have a deep understanding of the internals to make this happen. If you are looking for a multi-tenant centralized data repository, you are going to experience friction, which it sounds like is what has happened for you. That is specifically why I suggested you look at data repository solutions such as Azure, Hapi, etc to accomplish what you are wanting since the architecture and design solutions for OpenEMR are not to your satisfaction.

Also, I don’t think there is very much interest in rebranding OpenEMR to fit with the terminology that has evolved today. People now commonly use the term EMR to signify a repository of data, but that is not how the term was used in the past. OpenEMR has been around for over 20 years and predates the segmented product brands that are now being tossed around between EHR / EMR. As the industry has evolved, those two terms have evolved to mean different things than what was commonly used before. I can understand how that can be confusing to people today.

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#13

Never mind. It was just a discussion. Lets close the subject and move on.