Agenda Minutes 1
Board of Directors Meeting (telephone conference)
AGENDA
Open Source Medical Software
Friday, February 15, 2008 at 1 PM (EST)
1. Call to order
2. Additions to agenda
a. One thing I would like to discuss is the internationalisation plans. So far we have not merged our Dutch changes with the CVS for fear of breaking the CVS (we do not have a lot of options/experience in testing a non-Dutch version); and I am afraid that the CVS and our version may be moving away from each other. Considering the changes we will be making to OpenEMR in our institute, and considering my lack of experience in software development, let alone open source development, I need some support in either choosing to fork or help in keeping our version merged with the CVS. That last choice really means I need some experienced OpenEMR users to test if our changes did not break their functionality (parts of OpenEMR that we do not use but might be affected by our code).
b. Another issue is the calendar. We now run 2 instances of OpenEMR. The largest instance runs with about 15 providers, which is problematic with the way the calendar is set up. Before the end of the year we will need to be able to run one OpenEMR instance with about 30-40 providers. Is our institute going beyond the capacities of OpenEMR? Would a major or minor calendar overhaul be possible? Any suggestions are welcome.
c. I pointed a colleague who is quite high in the Cleveland Clinic hierarchy to OpenEMR - do we know if any major playors are using and/or aware of OpenEMR?
d. Have we actively sought to promote OpenEMR with the NAFC (www.freeclinics.us) or other organisations that may have similar interests?
3. Go over financial and organizational status
- Form 1023 -
- Donations -
- Grants
- Financial Statement
- Taxes
4. Software Development
- International development
- Staying concurrent to avoid forks
- Road Map
- User forms
- Integration of Billing inside of OpenEMR
- FreeB 2 integration with OpenEMR (X12 progress)
- Practice Management module that is an integral part of OpenEMR.
5. Marketing
6. Comments period
7. Adjourn
2-15-08
Board of Directors Meeting Minutes
1. Call to order
Members present:
Michael Bosman; James Perry; Mark Leeds, DO; Sam Bowen, MD; ,Michiel Bosman, MD; Rod Roark; and Andres Paglayan
2. Additions to agenda
Michiel Bosman:
We have been working on the Dutch Billing system for the last six months. It is huge, probably 70,000 lines of code. We want to finish our revision of the billing system and then test it and try to integrate it into the rest of the EMR.
Rod Roark:
This could be a separate module?
Michiel Bosman:
Everything is tightly integrated. In the Netheralands, naming conventions are a lot different. We have to have intials. We have to have 4 name fields for the last name alone. We are doing the best we can. We need testers to help us test our new version to make sure it does not break any aspects of the existing EMR code.
Rod Roark: These are valid concerns.
Michiel Bosman: There are a large number of changes and a substantail investment of time. We cannot give up on these changes. Then we will try to merge our billing system back in over the next 3-4 weeks.
Michiel Bosman: Have to have UTF-8. the current OpenEMR currently uses ascii.
Sam Bowen: Need to standardize UTF-8.
Rod Roark: I dont think converting to UTF will be a problem.
Michiel Bosman: Each web page needs to have a tag identifying it as UTF8.
Sam: We need improved coordination. It is very important that each developer check in small changes frequently. They need to keep consistently downloading and working on a very fresh copy of the CVS. It is dramatically easier to make micromerges of the code instead of doing 6 months of coding and then trying to merge it in together as one big chunk.
Michiel Bosman: The calendar needs to be more sophisticated with improved multi-uses. We currently are having 15 users and all 15 users are squished onto one page. The text is so small that you can't read it. Our users have already been making errors. They have to scroll back and forth horizontally and the lose track of which line they are on. This causes them to sometimes schedule the patient with the wrong provider.
Rod Roark: There might be a way to get the calendar to collapse so that the clerk can look at a certain number of columns at the same time.
Sam: Trying to look at 5-6 providers is very inconvenient. Perhaps what we need is an organization system based on geographical location, such as one clerk taking care of 3-6 providers such as a hallway or a single clinic.
Rod Roark: With the calendar we should try to stick with 3-6 practitioners and try to show not more than 3-6 providers at a time.
Michiel Bosman: The calendar aught to be customizable so that the clerk could pick a group by specialty, groups, or location. I would also like to see it where they can change the order of providers on the calendar. Each organization has subgroups of 10-15 providers which includes pediatricians, psychiatrists, and psychologists. There should be an attribute in the table identifying a practitioner by their specialty, group, and location to help with the sorting process.
Michiel Bosman: The tables at the tops and sides of the columns ought to be sticky so that you can't scroll to where you can't see them. There should be stick labels for the records and sticky labels for the columns to allow the clerk to scroll up and down more easily without getting lost.
Rod: I think this can be done.
Michiel Bosman: Has anybody tried to contact any big medical institutions such as the Cleveland Clinic about opensource software and the use of OpenEMR.
Sam: The Cleveland Clinic is not likely to use OpenEMR. They need a large industrial database and so far OpenEMR is not scaling well for large clinics.
Michiel Bosman: I know a manager that will eventually be the chief operating officer of the Cleveland Clinic.
We definitely need more marketing to get the word out about OpenEMR.
Michiel Bosman: We are going to show our OpenEMR billing in Holland to other practices in Holland. Our billing runs at least as well as other commercial software and better than some available in Holland. We have spent a lot of time and money not to have it being used by more than one clinic.
The International organization that we are working with will be very important to have on board. Who is using OpenEMR is also very important. We need this information to market OpenEMR. During installation, we need to have an option to register OpenEMR. Registration allows us to contact you by email when there are major upgrades in the system.
Knowing how many clinics are using this and how large they are is very important.
Andres: It is very easy to add some code in the source that causes OpenEMR to send out a ping that says “I am alive at IP”. There are other companies that send a ping to count when the installation occurs.
Michiel: Be careful that this is not viewed as invasion of privacy.
Andres: It is still very easy code to do this.
Michiel: This needs to be a private and electable option such as an option to "send an email to get on our email list to update or to get on our list of registered OpenEMR users.
Rod Roark: Security updates in particular are very important. We need to know who uses the ping.
Michiel Bosman: We can tell administrators that it is time to update. It is important to make OpenEMR easier to install. We need to create certain install packages such as Yum install OpenEMR, Debian, Windows .msi packages, possibly a Cygwin package that includes both OpenEMR and SQL ledger.
Michiel Bosman: Need a packager. How much time does it take to make a YUM package or a Debian package?
Andres: Well, it's really not that difficult. I've done Debian packages myself.
3. Go over financial and organizational status
- Form 1023 -
Sam Bowen: Form1023 I have enlisted my local Congressman Patrick McHenry to try to help me get the 501(c)(3) letter.
Rod Roark: I believe freemed.org has gotten the 501(c)(3) classification. It is not for profit. This could be used as a legal precedence.
Mark Leeds: I am setting up a Pod Cast about Opensource and not for profit. Sam I need source.
- Donations, Grants, Financial Statement, Taxes -
Sam: Taxes We had $4,000 worth of contributions in 2007. I have been seeking local accountant David Herman. He is going to help file the taxes for the corporation.
4. Software Development
- International development-
Sam: Internationalization. We need more translations and we need to try to make sure the code is consistent with being used internationally. We may need a separate billing module for each country to include a separate localized demographic page.
- Staying concurrent to avoid forks -
Rod: We need close communication. We need code changes to be committed in small, tiny chunks with frequent checks for compatability.
- Road Map and User forms -
Sam: I need help with working on the roadmap and the oemr.org forums. There are a lot of questions concerning the VMware appliance.
Rod Roark: Why don't you just switch the oemr.org forums over to SourceForge?
Sam Bowen: I have done this before and gotten resistant from some of the users. Overall I think the end users get faster and better quality support if they use the SourceForge forums. So in general I agree with this.
Bosman: I have been helping work on the road map, in particular where writing a prescription causes it to be included in the permanent medication list.
James: Well, I already fixed this. There is a check box on the prescription writing form that causes it to be added to the permanent list.
- Integration of Billing inside of OpenEMR
- FreeB 2 integration with OpenEMR (X12 progress)
- Practice Management module that is an integral part of OpenEMR.
Rod: We now have support for an in house pharmacy. Keeping track of non-prescription products with offers to sell and tracking inventory as part of the large international organization. Code changes need integration. Some of the code needs integration with the rest of OpenEMR.
Rod Roark: Issues and problems. FreeB is no longer needed to use electronic claims. The logic of using paper claims still needs to be converted inside of OpenEMR. Once the paper claims logic is fixed, FreeB will no longer be needed. I am however trying to maintain backwards compatibility for the users who are using SQL-Ledger for their practice management.
James Perry: We need to be able to fax paper claims. This includes printing on a blank HCFA1500 form.
Sam Bowen: I would like to see integration of practice management inside of OpenEMR. It would be nice for a practice to be able to choose either OpenEMR for their practice management or SQL Ledger for their needs.
Mark Leeds: CAMOS can help generate some billing info for each encounter. It handles co-pays.
Rod Roark: SQL ledger drivers the collection reports, EOB posting, cash receipts.
James Perry: The SQL ledger is integrated very well
Rod Roark: I agree with Sam. All we would need to do is build an SQL ledger filter that exports the data into OpenEMR. This piece could probably be done for about $1,000.
Sam Bowen: Physicians, especially inside the United States, are strobgly encouraged to select integrated billing packages. SQL-Ledger will never be a fully integrated package. Peter Simader, the developer of SQL-Ledger is very independent and has no interest in incorporating or accommodating OpenEMR.
To make significant impact in the United States there needs to be a ful integration of OpenEMR with practice management so that it is one seamless package.
General accounting can be done by SQL-Ledger, Quickbooks, Peachtree, or the program of choice by the individual practice accountant.
Sam: If we get rid of the SQL-Ledger, then we won't need to install FreeB. We won't need to install PostgreSQL. Using MySQL only makes this a dramatically easier installation
Rod: phpGACL is currently separate, but if we can integrate phpGACL with OpenEMR the installation will be a lot easier as well. The group maintaining phpGACL has not released a new version in over a year. The code appears to be pretty static. Integrating phpGACL should be relatively easy.
Sam: Installation needs to be easy.
Michiel: We'll be doing a lot of coding.
Rod: It can only be coordinated by loading small chunks of code at a time.
5. Marketing
Michiel: I'll be going to Florida next week and will stop in to see Sam Bowen in Hickory where will talk about marketing at greater length.
6. Comments period
No further agenda items were proposed.
7. Adjourn
A motion to close the meeting was entertained and seconded. The meeting was adjourned.
